56
NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING MEDICAL REGIONALISM Marta E. Hanson Abstract Physicians during the Ming dynasty (1368–1644) understood that the Chinese empire was geographically diverse. They observed that their patients were corporeally and physiologically heterogeneous. They interpreted this eco- logical and human diversity within the reunited Ming Empire according to both an ancient northwest-southeast axis and a new emphasis on north versus south. The geographic distinctions—northern and southern (nanbei ) as well as northwestern (xibei ) and southeastern (dongnan )—similarly helped explain doctrinal and therapeutic divergences within the literate sector of Chinese medicine. They thought about ecological, climatic, and human variation within the framework of a uniquely Chinese northwest- southeast polarity with roots in Chinese mythology and the Inner Canon of the Yellow Emperor. They also thought in terms of a north-ern and southern split in medicine, which the Yuan scholar Dai Liang (1317–1383) explic- itly mentioned in his writings. The Ming physicians who discussed medical regionalism mostly asserted, however, the opposite; namely their own impar- tiality as medical authorities for all of China. Nevertheless, their essays on regionalism reveal considerable tensions, ssures, and conicts in the literate sector of Ming medicine. Introduction With the unprecedented expansion of medical publishing during the Ming dynasty (1368–1644), currents of medical thought primarily developed in northern China circulated extensively for the rst time throughout the increasingly wealthy and urbanised Jiangnan region of central China. 1 These Ming medical texts made possible the wide- spread distribution of a common frame of reference regarding regional styles of practice based in both the medical canons from Han antiq- uity and post-northern-Song (960–1126) revisionist writings from the © Brill, Leiden, 2006 ASME 2,2 1 On the publishing boom in the Ming, see Brokaw and Chow 2005. For a study of one late-Ming publisher who also published medical texts, see Widmer 1996, pp. 77–122.

NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

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Page 1: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

NORTHERN PURGATIVES SOUTHERN RESTORATIVESMING MEDICAL REGIONALISM

Marta E Hanson

Abstract

Physicians during the Ming dynasty (1368ndash1644) understood that the Chineseempire was geographically diverse They observed that their patients werecorporeally and physiologically heterogeneous They interpreted this eco-logical and human diversity within the reunited Ming Empire according toboth an ancient northwest-southeast axis and a new emphasis on north versussouth The geographic distinctionsmdashnorthern and southern (nanbei ) aswell as northwestern (xibei ) and southeastern (dongnan )mdashsimilarlyhelped explain doctrinal and therapeutic divergences within the literatesector of Chinese medicine They thought about ecological climatic andhuman variation within the framework of a uniquely Chinese northwest-southeast polarity with roots in Chinese mythology and the Inner Canon ofthe Yellow Emperor They also thought in terms of a north-ern and southernsplit in medicine which the Yuan scholar Dai Liang (1317ndash1383) explic-itly mentioned in his writings The Ming physicians who discussed medicalregionalism mostly asserted however the opposite namely their own impar-tiality as medical authorities for all of China Nevertheless their essays onregionalism reveal considerable tensions fissures and conflicts in the literatesector of Ming medicine

Introduction

With the unprecedented expansion of medical publishing during theMing dynasty (1368ndash1644) currents of medical thought primarilydeveloped in northern China circulated extensively for the first timethroughout the increasingly wealthy and urbanised Jiangnan regionof central China1 These Ming medical texts made possible the wide-spread distribution of a common frame of reference regarding regionalstyles of practice based in both the medical canons from Han antiq-uity and post-northern-Song (960ndash1126) revisionist writings from the

copy Brill Leiden 2006 ASME 22

1 On the publishing boom in the Ming see Brokaw and Chow 2005 For a studyof one late-Ming publisher who also published medical texts see Widmer 1996 pp 77ndash122

ASME 22_f3_115-170IIII 41207 511 PM Page 115

116 marta e hanson

2 Leung 2003a pp 374ndash98 For Song medicine Hinrichs 20043 On northern-Song medical activism in terms of expansion of medical educa-

tion medical institutions medical publishing and drug therapy as well as the stan-dardization of acu-moxa therapy and texts see Goldschmidt 2005 On the particularrole of Emperor Huizong (1082ndash1135 r 1101ndash1126) see Goldschmidt 2006

4 Hanson 1997 19985 For convincing arguments that support revising Kleinmanrsquos model of the three sec-

tors of health care from the lsquoprofessional sectorrsquo to the lsquoliterate sectorrsquo for early-modernChina see Cullen 1993 Original Three Sectors model explained in Kleinman 1980

Jin (1115ndash1234) and Yuan dynasties (1280ndash1368)2 In the process ofcoming to terms with the medical innovations of the Jin-Yuan periodby transmitting them from the north to the south the mid- to late-MingphysiciansmdashWang Lun (fl 1484ndash1521) Xue Ji (1487ndash1559)Xu Chunfu (1520ndash1596) and Li Zhongzi (1588ndash1655)mdashdiscussed regional differences in climates constitutions dis-eases and treatments They reassessed inherited medical knowledgethrough their regional lens Instead of a unified medical orthodoxypassed on from northern-Song medical activism3 they encountereddoctrinal conflict and therapeutic diversity

Two main concepts borrowed from the sociology of knowledgeand from anthropology guide this interpretation First medical dis-course is often as much about social ills as it is about physical ill-ness Diagnosing disease may also serve as a means for making asocial diagnosis Second polarities are not symmetrical but asym-metric hierarchical and unequal One pole is always given highervalue Polarities directly reflect value judgments about the ideal socialorder In the Chinese yin-yang polarity related to medical regionalismnorth is respected over south strong is admired over weak frugal-ity is favoured over indulgence Disease as social diagnosis and thevalue-laded asymmetry of yin-yang polarities weave together a cul-turally and historically situated analysis of Ming medical regionalism

My interest in Ming medical regionalism stems from previousresearch on the role medical regionalism and Jiangnan regional iden-tity played (or did not) in the formation of two new currents oflearning that emerged during the Qing dynasty focused on epidemics(wenyi xuepai ) and on warm or febrile disorders (wenbing xuepai )4 In this article I analyse the Ming debates on regionalvariation in the literate sector of classical Chinese medicine to estab-lish the range of issues concepts and practices related to medicalregionalism that later Qing physicians then drew upon for their ownpurposes5 Other scholars have written extensively about Chinese

ASME 22_f3_115-170IIII 41207 511 PM Page 116

northern purgatives southern restoratives 117

6 Xiao Fan 1993 pp 67ndash171 Fan Ka Wai 1995 pp 155ndash77 Fan Ka Wai2004 pp 127ndash54 Sun Tiansheng 1998 pp 68ndash74 and Leung 2002 pp 165ndash212

7 Rosenberg 1992 p xxii Two essays in this volume directly deal with the useof lsquodisease as social diagnosisrsquo in the history of what is called lsquosocial medicinersquo inWestern medical history Eyler 1992 pp 275ndash96 Fee 1992 pp 297ndash317 He sim-ilarly used the nineteenth-century cholera epidemics as a sampling device to examineissues beyond medical practice such as lsquodemographic and economic circumstancesideas and institutional relationshipsrsquo Rosenberg 1992a pp 109ndash21 Rosenberg 1962

8 Grant 2003 pp 18ndash199 Furth 1999 pp 266ndash300

10 Cullen 1993 pp 99ndash150 Similar to Furth and Cullen Pelling 1996 analysesthe criticism of male practitioners towards female healers and their medical prac-tices in early modern England as indications of the gender anxiety these men feltas physicians in a cultural sphere in which healing was gendered female

11 For a range of interpretations of the history of medical geography and medical

conceptions of the relationship between local environment and ill-ness before the Qing dynasty6

In contrast to these diachronic studies I take a more synchronicapproach This essay illuminates changes over time just during thesecond half of the Ming dynasty and focuses on how Ming physiciansused this relationship at particular historical junctures over that periodto discuss other matters that concerned them both within the medicalsphere and more broadly within society

Physicians wrote about diseases not simply to explain or to treatthem but also as an index of problems in society and a critical com-mentary on them7 The case records of the Ming physician WangJi (1463ndash1539) are best read with an eye to broader social andeconomic transformations in early sixteenth-century Anhui when andwhere he lived His diagnosis of depletion disorders among many ofhis male patients due to overindulgence in sex drinking wine andeating rich foods for example mirrored his own anxiety about thenewly emergent merchant class and the declining morals in con-temporary Huizhou8 Late-Ming male physiciansrsquo criticism of lsquomed-ical granniesrsquo ( yipo and yifu ) do not reflect the lower statusand poorer quality of illiterate female healers but rather expresstheir anxiety about female healers as competitors especially for thecare of women and children9 Similar tensions between male andfemale healers come to play in the narrative of the sixteenth-century novel The Plum in the Golden Vase ( Jinpingmei )10 Mingmedical regionalism reveals comparable anxieties over competitionand a range of tensions fissures and conflicts in the social and cul-tural geography of literate Chinese medicine11

ASME 22_f3_115-170IIII 41207 511 PM Page 117

118 marta e hanson

discourses on the geography of health in European and colonial contexts see thearticles compiled in Rupke (ed) 2000

12 For comparable binaries in ancient Indian medicine see Zimmerman 1987pp 30ndash1 In ancient Indian medicine for example the central polarity in medicaltexts between the jagravengala or jungle lsquodrylandsrsquo to the west and the agravenugravepa lsquomarsh-landsrsquo to the east expressed a preference for the jungle (and all things foods andpeople associated with it) over the marshlands (and all things associated with them)Because Hindu kings preferred to establish their kingdoms in the jagravengala region tothe west it held greater geo-political value as well as economic value as the centreof Indian agriculture The jagravengala-drylands-west and agravenugravepa-marshlands-east polarityin ancient Indian medicine also divided health and disease agriculture and wilder-ness Aryan versus non-Aryan peoples This dividing line was not merely symbolicbut social it was a value judgment on the social division between the alleged supe-riority of people from the jagravengala-drylands-west compared to those from the agravenugravepa-marshlands-east region

I The asymmetry of polarities and value judgments

The terms Ming physicians used to talk about the environment werenot the modern ones such as lsquoenvironmentrsquo (huanjing ) lsquodistrictrsquo(diyu ) or lsquoregionrsquo (quyu ) but rather were phrases that evokedthe specific quality of localities such as lsquolocalrsquo ( fangtu ) lsquolocal cli-matersquo or lsquolocal customsrsquo ( fengtu ) and lsquolandrsquo lsquosoilrsquo or lsquothe localgod of the landrsquo (tudi ) Sometimes physicians referred to broadregional categories such as lsquosouth of the mountainsrsquo (Lingnan )and lsquosouth of the riverrsquo ( Jiangnan ) provinces such as Shaanxi Jiangsu or Zhejiang or states in antiquity including Yan

Wu or Yue They also used three geographic models todivide the Chinese world into regions the lsquofive regionsrsquo (wufang )namely the center and the four cardinal directions lsquonorthwest-southeastrsquo(dongnan-xibei ) and lsquonorthern region-southern regionrsquo (beifang-nanfang ) The specific terms they used illuminate how theyimagined Chinarsquos physical as well as political and social geographyThe binaries they employed expressed value judgments on whatphysicians considered better and worse not just for treating thepatient but also for ameliorating society12

By the mid-Ming dynasty two comparable geographic binariesbecame the most important regional divisions in literate medical textsnorthwest-southeast and north-south Physicians used these binariesto systematise the correspondences they thought connected differentclimates diseases and bodily constitutions and required differenttherapeutic strategies in medical practice Physicians also used thesegeo-cultural binaries to express problems they perceived both in the

ASME 22_f3_115-170IIII 41207 511 PM Page 118

northern purgatives southern restoratives 119

13 I follow the argument in Allan 1991 p 6814 Hawkes 1993 pp 48ndash5515 See translations by Hawkes 1985 p 128 lines 33ndash5 Field 1986 35 and

Major 1993 p 6416 Although the Liezi is attributed to an early Taoist Lie Yukou (c 400

BCE) it was not written down until around 300 CE probably by one anonymousauthor See Graham 1990 p 12 and Barrett 1993 pp 298ndash308

medical field and in society Instead of the west being valued overthe east as in ancient Indian medicine however the north was supe-rior to the south northwest valued over southeast The binary inclassical Chinese medicine current during the Ming dynasty lookedlike this northwest-north-dry-cold-highlands-frugality-robust bodiesand southeast-south-damp-hot-lowlands-indulgence-weak bodies Mingphysicians admired the simple life of northerners over the life ofleisure of southerners and favoured restraint over pleasure thoughnone suggested either that they or their patients should move north

II Origins and representations of the northwest-southeastpolarity

(1) Mythological origins Gong Gong butts into Mount Buzhou

The earliest textual origins of the uniquely Chinese northwest-south-east polarity relates to a story about the destroyer god Gong Gongrecorded in the lsquoHeavenly Questionsrsquo (Tian wen ) chapter of thePlaints of Chu or Songs of the South (Chu ci )13 Although this bookcontains a small number of works by followers and imitators most ofthe poetical works in this collection are attributed to Qu Yuan(c 343ndashc 277) a nobleman who was a contemporary of King Huai

(reigned during last quarter of the fourth century BCE)14 Thepassage from the lsquoHeavenly Questionsrsquo succinctly reads lsquo[When] KangHui [= Gong Gong] was enraged why did the land lean southeastrsquo(Kang Hui feng nu di he gu yi dongnan qing )15

The Book of Master Lie (Liezi c 300 CE) preserved one of theearliest responses to this question16 The Liezi version attributed thenorthwest-southeast imbalance of yin-yang in the world to a fightbetween Gong Gong and the second of the first five rulers Zhuan Xu

It follows that heaven and earth are lsquothingsrsquo like the things within themand things have imperfections That is why in ancient times Nuwa

ASME 22_f3_115-170IIII 41207 511 PM Page 119

120 marta e hanson

17 Gujin luli kao juan 9 I use a Ming source for this story to emphasise that itwas a story in circulation at that time I adapted the English translation of this pas-sage in Graham 1990 p 96 by using pinyin

18 Major 1993 p 3ndash5 See Huainanzi 31andashb Translations in Major 1993 p 62 lines 23ndash9 Hawkes 1985 p 136 Allan 1991 p 68 Birrell 1993 69

19 Namely the first section titled lsquoThe origin of the cosmosrsquo in Huainanzi ch 3lsquoThe treatise on the patterns of heavenrsquo (tianwenxun )

20 Major 1993 p 6421 See the section on lsquoKung Kung Butts into the Mountainrsquo of chapter four

lsquoDestroyersrsquo in Birrell 1993 pp 97ndash8

smelted stones of all the five colours to patch up the flaws and cutoff the feet of the turtle to support the four corners Afterwards whenGong Gong was fighting Zhuan Xu for the Empire he knocked againstMount Buzhou in his rage breaking one of the pillars of heaven snap-ping one of the threads which support the earth For this reasonheaven leans North West and the sun moon and stars move in thatdirection the earth does not fill the South East so the rivers and therain floods find their home there17

A similar early version of this story is preserved in the Huainanzi (c secondcentury BCE) for which the king of Huainan Liu An (179ndash122BCE) served as general editor18 John Major succinctly explainedthe astronomical significance of this account by concluding that lsquothelast part of this section19 recounts the famous story of the fightbetween Gong Gong and Zhuan Xu that led to the tilting of heavenand earthmdashin cosmological terms to the astronomical fact that theecliptic (the sunrsquos apparent path around the earth as seen againstthe fixed stars) does not coincide with the celestial equator (the earthrsquosequator as projected onto the fixed stars)rsquo20

Although the Book of Master Guan (Guanzi fifthndashfirst centuryBCE compiled c 26 BCE by Liu Xiang ) and Discourses of theStates (Guoyu contents date from 431ndash314 BCE) contained otherstories about Gong Gong only the accounts in the Liezi and theHuainanzi recounted his destruction of Mount Buzhou and the sub-sequent toppling of one of the eight earthly pillars believed to holdup the canopy of the sky21 [See Figure 1]

The eight pillars featured in this cosmological myth were designedto explain two problems 1) why the Celestial Pole around whichthe sky appears to revolve was not directly overhead in the skywhich should be the case in an ideal universe but rather was northof it and 2) why the earth (namely China proper) inclined down-wards towards the southeast causing the major rivers to flow in an

ASME 22_f3_115-170IIII 41207 511 PM Page 120

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 2: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

116 marta e hanson

2 Leung 2003a pp 374ndash98 For Song medicine Hinrichs 20043 On northern-Song medical activism in terms of expansion of medical educa-

tion medical institutions medical publishing and drug therapy as well as the stan-dardization of acu-moxa therapy and texts see Goldschmidt 2005 On the particularrole of Emperor Huizong (1082ndash1135 r 1101ndash1126) see Goldschmidt 2006

4 Hanson 1997 19985 For convincing arguments that support revising Kleinmanrsquos model of the three sec-

tors of health care from the lsquoprofessional sectorrsquo to the lsquoliterate sectorrsquo for early-modernChina see Cullen 1993 Original Three Sectors model explained in Kleinman 1980

Jin (1115ndash1234) and Yuan dynasties (1280ndash1368)2 In the process ofcoming to terms with the medical innovations of the Jin-Yuan periodby transmitting them from the north to the south the mid- to late-MingphysiciansmdashWang Lun (fl 1484ndash1521) Xue Ji (1487ndash1559)Xu Chunfu (1520ndash1596) and Li Zhongzi (1588ndash1655)mdashdiscussed regional differences in climates constitutions dis-eases and treatments They reassessed inherited medical knowledgethrough their regional lens Instead of a unified medical orthodoxypassed on from northern-Song medical activism3 they encountereddoctrinal conflict and therapeutic diversity

Two main concepts borrowed from the sociology of knowledgeand from anthropology guide this interpretation First medical dis-course is often as much about social ills as it is about physical ill-ness Diagnosing disease may also serve as a means for making asocial diagnosis Second polarities are not symmetrical but asym-metric hierarchical and unequal One pole is always given highervalue Polarities directly reflect value judgments about the ideal socialorder In the Chinese yin-yang polarity related to medical regionalismnorth is respected over south strong is admired over weak frugal-ity is favoured over indulgence Disease as social diagnosis and thevalue-laded asymmetry of yin-yang polarities weave together a cul-turally and historically situated analysis of Ming medical regionalism

My interest in Ming medical regionalism stems from previousresearch on the role medical regionalism and Jiangnan regional iden-tity played (or did not) in the formation of two new currents oflearning that emerged during the Qing dynasty focused on epidemics(wenyi xuepai ) and on warm or febrile disorders (wenbing xuepai )4 In this article I analyse the Ming debates on regionalvariation in the literate sector of classical Chinese medicine to estab-lish the range of issues concepts and practices related to medicalregionalism that later Qing physicians then drew upon for their ownpurposes5 Other scholars have written extensively about Chinese

ASME 22_f3_115-170IIII 41207 511 PM Page 116

northern purgatives southern restoratives 117

6 Xiao Fan 1993 pp 67ndash171 Fan Ka Wai 1995 pp 155ndash77 Fan Ka Wai2004 pp 127ndash54 Sun Tiansheng 1998 pp 68ndash74 and Leung 2002 pp 165ndash212

7 Rosenberg 1992 p xxii Two essays in this volume directly deal with the useof lsquodisease as social diagnosisrsquo in the history of what is called lsquosocial medicinersquo inWestern medical history Eyler 1992 pp 275ndash96 Fee 1992 pp 297ndash317 He sim-ilarly used the nineteenth-century cholera epidemics as a sampling device to examineissues beyond medical practice such as lsquodemographic and economic circumstancesideas and institutional relationshipsrsquo Rosenberg 1992a pp 109ndash21 Rosenberg 1962

8 Grant 2003 pp 18ndash199 Furth 1999 pp 266ndash300

10 Cullen 1993 pp 99ndash150 Similar to Furth and Cullen Pelling 1996 analysesthe criticism of male practitioners towards female healers and their medical prac-tices in early modern England as indications of the gender anxiety these men feltas physicians in a cultural sphere in which healing was gendered female

11 For a range of interpretations of the history of medical geography and medical

conceptions of the relationship between local environment and ill-ness before the Qing dynasty6

In contrast to these diachronic studies I take a more synchronicapproach This essay illuminates changes over time just during thesecond half of the Ming dynasty and focuses on how Ming physiciansused this relationship at particular historical junctures over that periodto discuss other matters that concerned them both within the medicalsphere and more broadly within society

Physicians wrote about diseases not simply to explain or to treatthem but also as an index of problems in society and a critical com-mentary on them7 The case records of the Ming physician WangJi (1463ndash1539) are best read with an eye to broader social andeconomic transformations in early sixteenth-century Anhui when andwhere he lived His diagnosis of depletion disorders among many ofhis male patients due to overindulgence in sex drinking wine andeating rich foods for example mirrored his own anxiety about thenewly emergent merchant class and the declining morals in con-temporary Huizhou8 Late-Ming male physiciansrsquo criticism of lsquomed-ical granniesrsquo ( yipo and yifu ) do not reflect the lower statusand poorer quality of illiterate female healers but rather expresstheir anxiety about female healers as competitors especially for thecare of women and children9 Similar tensions between male andfemale healers come to play in the narrative of the sixteenth-century novel The Plum in the Golden Vase ( Jinpingmei )10 Mingmedical regionalism reveals comparable anxieties over competitionand a range of tensions fissures and conflicts in the social and cul-tural geography of literate Chinese medicine11

ASME 22_f3_115-170IIII 41207 511 PM Page 117

118 marta e hanson

discourses on the geography of health in European and colonial contexts see thearticles compiled in Rupke (ed) 2000

12 For comparable binaries in ancient Indian medicine see Zimmerman 1987pp 30ndash1 In ancient Indian medicine for example the central polarity in medicaltexts between the jagravengala or jungle lsquodrylandsrsquo to the west and the agravenugravepa lsquomarsh-landsrsquo to the east expressed a preference for the jungle (and all things foods andpeople associated with it) over the marshlands (and all things associated with them)Because Hindu kings preferred to establish their kingdoms in the jagravengala region tothe west it held greater geo-political value as well as economic value as the centreof Indian agriculture The jagravengala-drylands-west and agravenugravepa-marshlands-east polarityin ancient Indian medicine also divided health and disease agriculture and wilder-ness Aryan versus non-Aryan peoples This dividing line was not merely symbolicbut social it was a value judgment on the social division between the alleged supe-riority of people from the jagravengala-drylands-west compared to those from the agravenugravepa-marshlands-east region

I The asymmetry of polarities and value judgments

The terms Ming physicians used to talk about the environment werenot the modern ones such as lsquoenvironmentrsquo (huanjing ) lsquodistrictrsquo(diyu ) or lsquoregionrsquo (quyu ) but rather were phrases that evokedthe specific quality of localities such as lsquolocalrsquo ( fangtu ) lsquolocal cli-matersquo or lsquolocal customsrsquo ( fengtu ) and lsquolandrsquo lsquosoilrsquo or lsquothe localgod of the landrsquo (tudi ) Sometimes physicians referred to broadregional categories such as lsquosouth of the mountainsrsquo (Lingnan )and lsquosouth of the riverrsquo ( Jiangnan ) provinces such as Shaanxi Jiangsu or Zhejiang or states in antiquity including Yan

Wu or Yue They also used three geographic models todivide the Chinese world into regions the lsquofive regionsrsquo (wufang )namely the center and the four cardinal directions lsquonorthwest-southeastrsquo(dongnan-xibei ) and lsquonorthern region-southern regionrsquo (beifang-nanfang ) The specific terms they used illuminate how theyimagined Chinarsquos physical as well as political and social geographyThe binaries they employed expressed value judgments on whatphysicians considered better and worse not just for treating thepatient but also for ameliorating society12

By the mid-Ming dynasty two comparable geographic binariesbecame the most important regional divisions in literate medical textsnorthwest-southeast and north-south Physicians used these binariesto systematise the correspondences they thought connected differentclimates diseases and bodily constitutions and required differenttherapeutic strategies in medical practice Physicians also used thesegeo-cultural binaries to express problems they perceived both in the

ASME 22_f3_115-170IIII 41207 511 PM Page 118

northern purgatives southern restoratives 119

13 I follow the argument in Allan 1991 p 6814 Hawkes 1993 pp 48ndash5515 See translations by Hawkes 1985 p 128 lines 33ndash5 Field 1986 35 and

Major 1993 p 6416 Although the Liezi is attributed to an early Taoist Lie Yukou (c 400

BCE) it was not written down until around 300 CE probably by one anonymousauthor See Graham 1990 p 12 and Barrett 1993 pp 298ndash308

medical field and in society Instead of the west being valued overthe east as in ancient Indian medicine however the north was supe-rior to the south northwest valued over southeast The binary inclassical Chinese medicine current during the Ming dynasty lookedlike this northwest-north-dry-cold-highlands-frugality-robust bodiesand southeast-south-damp-hot-lowlands-indulgence-weak bodies Mingphysicians admired the simple life of northerners over the life ofleisure of southerners and favoured restraint over pleasure thoughnone suggested either that they or their patients should move north

II Origins and representations of the northwest-southeastpolarity

(1) Mythological origins Gong Gong butts into Mount Buzhou

The earliest textual origins of the uniquely Chinese northwest-south-east polarity relates to a story about the destroyer god Gong Gongrecorded in the lsquoHeavenly Questionsrsquo (Tian wen ) chapter of thePlaints of Chu or Songs of the South (Chu ci )13 Although this bookcontains a small number of works by followers and imitators most ofthe poetical works in this collection are attributed to Qu Yuan(c 343ndashc 277) a nobleman who was a contemporary of King Huai

(reigned during last quarter of the fourth century BCE)14 Thepassage from the lsquoHeavenly Questionsrsquo succinctly reads lsquo[When] KangHui [= Gong Gong] was enraged why did the land lean southeastrsquo(Kang Hui feng nu di he gu yi dongnan qing )15

The Book of Master Lie (Liezi c 300 CE) preserved one of theearliest responses to this question16 The Liezi version attributed thenorthwest-southeast imbalance of yin-yang in the world to a fightbetween Gong Gong and the second of the first five rulers Zhuan Xu

It follows that heaven and earth are lsquothingsrsquo like the things within themand things have imperfections That is why in ancient times Nuwa

ASME 22_f3_115-170IIII 41207 511 PM Page 119

120 marta e hanson

17 Gujin luli kao juan 9 I use a Ming source for this story to emphasise that itwas a story in circulation at that time I adapted the English translation of this pas-sage in Graham 1990 p 96 by using pinyin

18 Major 1993 p 3ndash5 See Huainanzi 31andashb Translations in Major 1993 p 62 lines 23ndash9 Hawkes 1985 p 136 Allan 1991 p 68 Birrell 1993 69

19 Namely the first section titled lsquoThe origin of the cosmosrsquo in Huainanzi ch 3lsquoThe treatise on the patterns of heavenrsquo (tianwenxun )

20 Major 1993 p 6421 See the section on lsquoKung Kung Butts into the Mountainrsquo of chapter four

lsquoDestroyersrsquo in Birrell 1993 pp 97ndash8

smelted stones of all the five colours to patch up the flaws and cutoff the feet of the turtle to support the four corners Afterwards whenGong Gong was fighting Zhuan Xu for the Empire he knocked againstMount Buzhou in his rage breaking one of the pillars of heaven snap-ping one of the threads which support the earth For this reasonheaven leans North West and the sun moon and stars move in thatdirection the earth does not fill the South East so the rivers and therain floods find their home there17

A similar early version of this story is preserved in the Huainanzi (c secondcentury BCE) for which the king of Huainan Liu An (179ndash122BCE) served as general editor18 John Major succinctly explainedthe astronomical significance of this account by concluding that lsquothelast part of this section19 recounts the famous story of the fightbetween Gong Gong and Zhuan Xu that led to the tilting of heavenand earthmdashin cosmological terms to the astronomical fact that theecliptic (the sunrsquos apparent path around the earth as seen againstthe fixed stars) does not coincide with the celestial equator (the earthrsquosequator as projected onto the fixed stars)rsquo20

Although the Book of Master Guan (Guanzi fifthndashfirst centuryBCE compiled c 26 BCE by Liu Xiang ) and Discourses of theStates (Guoyu contents date from 431ndash314 BCE) contained otherstories about Gong Gong only the accounts in the Liezi and theHuainanzi recounted his destruction of Mount Buzhou and the sub-sequent toppling of one of the eight earthly pillars believed to holdup the canopy of the sky21 [See Figure 1]

The eight pillars featured in this cosmological myth were designedto explain two problems 1) why the Celestial Pole around whichthe sky appears to revolve was not directly overhead in the skywhich should be the case in an ideal universe but rather was northof it and 2) why the earth (namely China proper) inclined down-wards towards the southeast causing the major rivers to flow in an

ASME 22_f3_115-170IIII 41207 511 PM Page 120

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 3: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 117

6 Xiao Fan 1993 pp 67ndash171 Fan Ka Wai 1995 pp 155ndash77 Fan Ka Wai2004 pp 127ndash54 Sun Tiansheng 1998 pp 68ndash74 and Leung 2002 pp 165ndash212

7 Rosenberg 1992 p xxii Two essays in this volume directly deal with the useof lsquodisease as social diagnosisrsquo in the history of what is called lsquosocial medicinersquo inWestern medical history Eyler 1992 pp 275ndash96 Fee 1992 pp 297ndash317 He sim-ilarly used the nineteenth-century cholera epidemics as a sampling device to examineissues beyond medical practice such as lsquodemographic and economic circumstancesideas and institutional relationshipsrsquo Rosenberg 1992a pp 109ndash21 Rosenberg 1962

8 Grant 2003 pp 18ndash199 Furth 1999 pp 266ndash300

10 Cullen 1993 pp 99ndash150 Similar to Furth and Cullen Pelling 1996 analysesthe criticism of male practitioners towards female healers and their medical prac-tices in early modern England as indications of the gender anxiety these men feltas physicians in a cultural sphere in which healing was gendered female

11 For a range of interpretations of the history of medical geography and medical

conceptions of the relationship between local environment and ill-ness before the Qing dynasty6

In contrast to these diachronic studies I take a more synchronicapproach This essay illuminates changes over time just during thesecond half of the Ming dynasty and focuses on how Ming physiciansused this relationship at particular historical junctures over that periodto discuss other matters that concerned them both within the medicalsphere and more broadly within society

Physicians wrote about diseases not simply to explain or to treatthem but also as an index of problems in society and a critical com-mentary on them7 The case records of the Ming physician WangJi (1463ndash1539) are best read with an eye to broader social andeconomic transformations in early sixteenth-century Anhui when andwhere he lived His diagnosis of depletion disorders among many ofhis male patients due to overindulgence in sex drinking wine andeating rich foods for example mirrored his own anxiety about thenewly emergent merchant class and the declining morals in con-temporary Huizhou8 Late-Ming male physiciansrsquo criticism of lsquomed-ical granniesrsquo ( yipo and yifu ) do not reflect the lower statusand poorer quality of illiterate female healers but rather expresstheir anxiety about female healers as competitors especially for thecare of women and children9 Similar tensions between male andfemale healers come to play in the narrative of the sixteenth-century novel The Plum in the Golden Vase ( Jinpingmei )10 Mingmedical regionalism reveals comparable anxieties over competitionand a range of tensions fissures and conflicts in the social and cul-tural geography of literate Chinese medicine11

ASME 22_f3_115-170IIII 41207 511 PM Page 117

118 marta e hanson

discourses on the geography of health in European and colonial contexts see thearticles compiled in Rupke (ed) 2000

12 For comparable binaries in ancient Indian medicine see Zimmerman 1987pp 30ndash1 In ancient Indian medicine for example the central polarity in medicaltexts between the jagravengala or jungle lsquodrylandsrsquo to the west and the agravenugravepa lsquomarsh-landsrsquo to the east expressed a preference for the jungle (and all things foods andpeople associated with it) over the marshlands (and all things associated with them)Because Hindu kings preferred to establish their kingdoms in the jagravengala region tothe west it held greater geo-political value as well as economic value as the centreof Indian agriculture The jagravengala-drylands-west and agravenugravepa-marshlands-east polarityin ancient Indian medicine also divided health and disease agriculture and wilder-ness Aryan versus non-Aryan peoples This dividing line was not merely symbolicbut social it was a value judgment on the social division between the alleged supe-riority of people from the jagravengala-drylands-west compared to those from the agravenugravepa-marshlands-east region

I The asymmetry of polarities and value judgments

The terms Ming physicians used to talk about the environment werenot the modern ones such as lsquoenvironmentrsquo (huanjing ) lsquodistrictrsquo(diyu ) or lsquoregionrsquo (quyu ) but rather were phrases that evokedthe specific quality of localities such as lsquolocalrsquo ( fangtu ) lsquolocal cli-matersquo or lsquolocal customsrsquo ( fengtu ) and lsquolandrsquo lsquosoilrsquo or lsquothe localgod of the landrsquo (tudi ) Sometimes physicians referred to broadregional categories such as lsquosouth of the mountainsrsquo (Lingnan )and lsquosouth of the riverrsquo ( Jiangnan ) provinces such as Shaanxi Jiangsu or Zhejiang or states in antiquity including Yan

Wu or Yue They also used three geographic models todivide the Chinese world into regions the lsquofive regionsrsquo (wufang )namely the center and the four cardinal directions lsquonorthwest-southeastrsquo(dongnan-xibei ) and lsquonorthern region-southern regionrsquo (beifang-nanfang ) The specific terms they used illuminate how theyimagined Chinarsquos physical as well as political and social geographyThe binaries they employed expressed value judgments on whatphysicians considered better and worse not just for treating thepatient but also for ameliorating society12

By the mid-Ming dynasty two comparable geographic binariesbecame the most important regional divisions in literate medical textsnorthwest-southeast and north-south Physicians used these binariesto systematise the correspondences they thought connected differentclimates diseases and bodily constitutions and required differenttherapeutic strategies in medical practice Physicians also used thesegeo-cultural binaries to express problems they perceived both in the

ASME 22_f3_115-170IIII 41207 511 PM Page 118

northern purgatives southern restoratives 119

13 I follow the argument in Allan 1991 p 6814 Hawkes 1993 pp 48ndash5515 See translations by Hawkes 1985 p 128 lines 33ndash5 Field 1986 35 and

Major 1993 p 6416 Although the Liezi is attributed to an early Taoist Lie Yukou (c 400

BCE) it was not written down until around 300 CE probably by one anonymousauthor See Graham 1990 p 12 and Barrett 1993 pp 298ndash308

medical field and in society Instead of the west being valued overthe east as in ancient Indian medicine however the north was supe-rior to the south northwest valued over southeast The binary inclassical Chinese medicine current during the Ming dynasty lookedlike this northwest-north-dry-cold-highlands-frugality-robust bodiesand southeast-south-damp-hot-lowlands-indulgence-weak bodies Mingphysicians admired the simple life of northerners over the life ofleisure of southerners and favoured restraint over pleasure thoughnone suggested either that they or their patients should move north

II Origins and representations of the northwest-southeastpolarity

(1) Mythological origins Gong Gong butts into Mount Buzhou

The earliest textual origins of the uniquely Chinese northwest-south-east polarity relates to a story about the destroyer god Gong Gongrecorded in the lsquoHeavenly Questionsrsquo (Tian wen ) chapter of thePlaints of Chu or Songs of the South (Chu ci )13 Although this bookcontains a small number of works by followers and imitators most ofthe poetical works in this collection are attributed to Qu Yuan(c 343ndashc 277) a nobleman who was a contemporary of King Huai

(reigned during last quarter of the fourth century BCE)14 Thepassage from the lsquoHeavenly Questionsrsquo succinctly reads lsquo[When] KangHui [= Gong Gong] was enraged why did the land lean southeastrsquo(Kang Hui feng nu di he gu yi dongnan qing )15

The Book of Master Lie (Liezi c 300 CE) preserved one of theearliest responses to this question16 The Liezi version attributed thenorthwest-southeast imbalance of yin-yang in the world to a fightbetween Gong Gong and the second of the first five rulers Zhuan Xu

It follows that heaven and earth are lsquothingsrsquo like the things within themand things have imperfections That is why in ancient times Nuwa

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120 marta e hanson

17 Gujin luli kao juan 9 I use a Ming source for this story to emphasise that itwas a story in circulation at that time I adapted the English translation of this pas-sage in Graham 1990 p 96 by using pinyin

18 Major 1993 p 3ndash5 See Huainanzi 31andashb Translations in Major 1993 p 62 lines 23ndash9 Hawkes 1985 p 136 Allan 1991 p 68 Birrell 1993 69

19 Namely the first section titled lsquoThe origin of the cosmosrsquo in Huainanzi ch 3lsquoThe treatise on the patterns of heavenrsquo (tianwenxun )

20 Major 1993 p 6421 See the section on lsquoKung Kung Butts into the Mountainrsquo of chapter four

lsquoDestroyersrsquo in Birrell 1993 pp 97ndash8

smelted stones of all the five colours to patch up the flaws and cutoff the feet of the turtle to support the four corners Afterwards whenGong Gong was fighting Zhuan Xu for the Empire he knocked againstMount Buzhou in his rage breaking one of the pillars of heaven snap-ping one of the threads which support the earth For this reasonheaven leans North West and the sun moon and stars move in thatdirection the earth does not fill the South East so the rivers and therain floods find their home there17

A similar early version of this story is preserved in the Huainanzi (c secondcentury BCE) for which the king of Huainan Liu An (179ndash122BCE) served as general editor18 John Major succinctly explainedthe astronomical significance of this account by concluding that lsquothelast part of this section19 recounts the famous story of the fightbetween Gong Gong and Zhuan Xu that led to the tilting of heavenand earthmdashin cosmological terms to the astronomical fact that theecliptic (the sunrsquos apparent path around the earth as seen againstthe fixed stars) does not coincide with the celestial equator (the earthrsquosequator as projected onto the fixed stars)rsquo20

Although the Book of Master Guan (Guanzi fifthndashfirst centuryBCE compiled c 26 BCE by Liu Xiang ) and Discourses of theStates (Guoyu contents date from 431ndash314 BCE) contained otherstories about Gong Gong only the accounts in the Liezi and theHuainanzi recounted his destruction of Mount Buzhou and the sub-sequent toppling of one of the eight earthly pillars believed to holdup the canopy of the sky21 [See Figure 1]

The eight pillars featured in this cosmological myth were designedto explain two problems 1) why the Celestial Pole around whichthe sky appears to revolve was not directly overhead in the skywhich should be the case in an ideal universe but rather was northof it and 2) why the earth (namely China proper) inclined down-wards towards the southeast causing the major rivers to flow in an

ASME 22_f3_115-170IIII 41207 511 PM Page 120

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 4: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

118 marta e hanson

discourses on the geography of health in European and colonial contexts see thearticles compiled in Rupke (ed) 2000

12 For comparable binaries in ancient Indian medicine see Zimmerman 1987pp 30ndash1 In ancient Indian medicine for example the central polarity in medicaltexts between the jagravengala or jungle lsquodrylandsrsquo to the west and the agravenugravepa lsquomarsh-landsrsquo to the east expressed a preference for the jungle (and all things foods andpeople associated with it) over the marshlands (and all things associated with them)Because Hindu kings preferred to establish their kingdoms in the jagravengala region tothe west it held greater geo-political value as well as economic value as the centreof Indian agriculture The jagravengala-drylands-west and agravenugravepa-marshlands-east polarityin ancient Indian medicine also divided health and disease agriculture and wilder-ness Aryan versus non-Aryan peoples This dividing line was not merely symbolicbut social it was a value judgment on the social division between the alleged supe-riority of people from the jagravengala-drylands-west compared to those from the agravenugravepa-marshlands-east region

I The asymmetry of polarities and value judgments

The terms Ming physicians used to talk about the environment werenot the modern ones such as lsquoenvironmentrsquo (huanjing ) lsquodistrictrsquo(diyu ) or lsquoregionrsquo (quyu ) but rather were phrases that evokedthe specific quality of localities such as lsquolocalrsquo ( fangtu ) lsquolocal cli-matersquo or lsquolocal customsrsquo ( fengtu ) and lsquolandrsquo lsquosoilrsquo or lsquothe localgod of the landrsquo (tudi ) Sometimes physicians referred to broadregional categories such as lsquosouth of the mountainsrsquo (Lingnan )and lsquosouth of the riverrsquo ( Jiangnan ) provinces such as Shaanxi Jiangsu or Zhejiang or states in antiquity including Yan

Wu or Yue They also used three geographic models todivide the Chinese world into regions the lsquofive regionsrsquo (wufang )namely the center and the four cardinal directions lsquonorthwest-southeastrsquo(dongnan-xibei ) and lsquonorthern region-southern regionrsquo (beifang-nanfang ) The specific terms they used illuminate how theyimagined Chinarsquos physical as well as political and social geographyThe binaries they employed expressed value judgments on whatphysicians considered better and worse not just for treating thepatient but also for ameliorating society12

By the mid-Ming dynasty two comparable geographic binariesbecame the most important regional divisions in literate medical textsnorthwest-southeast and north-south Physicians used these binariesto systematise the correspondences they thought connected differentclimates diseases and bodily constitutions and required differenttherapeutic strategies in medical practice Physicians also used thesegeo-cultural binaries to express problems they perceived both in the

ASME 22_f3_115-170IIII 41207 511 PM Page 118

northern purgatives southern restoratives 119

13 I follow the argument in Allan 1991 p 6814 Hawkes 1993 pp 48ndash5515 See translations by Hawkes 1985 p 128 lines 33ndash5 Field 1986 35 and

Major 1993 p 6416 Although the Liezi is attributed to an early Taoist Lie Yukou (c 400

BCE) it was not written down until around 300 CE probably by one anonymousauthor See Graham 1990 p 12 and Barrett 1993 pp 298ndash308

medical field and in society Instead of the west being valued overthe east as in ancient Indian medicine however the north was supe-rior to the south northwest valued over southeast The binary inclassical Chinese medicine current during the Ming dynasty lookedlike this northwest-north-dry-cold-highlands-frugality-robust bodiesand southeast-south-damp-hot-lowlands-indulgence-weak bodies Mingphysicians admired the simple life of northerners over the life ofleisure of southerners and favoured restraint over pleasure thoughnone suggested either that they or their patients should move north

II Origins and representations of the northwest-southeastpolarity

(1) Mythological origins Gong Gong butts into Mount Buzhou

The earliest textual origins of the uniquely Chinese northwest-south-east polarity relates to a story about the destroyer god Gong Gongrecorded in the lsquoHeavenly Questionsrsquo (Tian wen ) chapter of thePlaints of Chu or Songs of the South (Chu ci )13 Although this bookcontains a small number of works by followers and imitators most ofthe poetical works in this collection are attributed to Qu Yuan(c 343ndashc 277) a nobleman who was a contemporary of King Huai

(reigned during last quarter of the fourth century BCE)14 Thepassage from the lsquoHeavenly Questionsrsquo succinctly reads lsquo[When] KangHui [= Gong Gong] was enraged why did the land lean southeastrsquo(Kang Hui feng nu di he gu yi dongnan qing )15

The Book of Master Lie (Liezi c 300 CE) preserved one of theearliest responses to this question16 The Liezi version attributed thenorthwest-southeast imbalance of yin-yang in the world to a fightbetween Gong Gong and the second of the first five rulers Zhuan Xu

It follows that heaven and earth are lsquothingsrsquo like the things within themand things have imperfections That is why in ancient times Nuwa

ASME 22_f3_115-170IIII 41207 511 PM Page 119

120 marta e hanson

17 Gujin luli kao juan 9 I use a Ming source for this story to emphasise that itwas a story in circulation at that time I adapted the English translation of this pas-sage in Graham 1990 p 96 by using pinyin

18 Major 1993 p 3ndash5 See Huainanzi 31andashb Translations in Major 1993 p 62 lines 23ndash9 Hawkes 1985 p 136 Allan 1991 p 68 Birrell 1993 69

19 Namely the first section titled lsquoThe origin of the cosmosrsquo in Huainanzi ch 3lsquoThe treatise on the patterns of heavenrsquo (tianwenxun )

20 Major 1993 p 6421 See the section on lsquoKung Kung Butts into the Mountainrsquo of chapter four

lsquoDestroyersrsquo in Birrell 1993 pp 97ndash8

smelted stones of all the five colours to patch up the flaws and cutoff the feet of the turtle to support the four corners Afterwards whenGong Gong was fighting Zhuan Xu for the Empire he knocked againstMount Buzhou in his rage breaking one of the pillars of heaven snap-ping one of the threads which support the earth For this reasonheaven leans North West and the sun moon and stars move in thatdirection the earth does not fill the South East so the rivers and therain floods find their home there17

A similar early version of this story is preserved in the Huainanzi (c secondcentury BCE) for which the king of Huainan Liu An (179ndash122BCE) served as general editor18 John Major succinctly explainedthe astronomical significance of this account by concluding that lsquothelast part of this section19 recounts the famous story of the fightbetween Gong Gong and Zhuan Xu that led to the tilting of heavenand earthmdashin cosmological terms to the astronomical fact that theecliptic (the sunrsquos apparent path around the earth as seen againstthe fixed stars) does not coincide with the celestial equator (the earthrsquosequator as projected onto the fixed stars)rsquo20

Although the Book of Master Guan (Guanzi fifthndashfirst centuryBCE compiled c 26 BCE by Liu Xiang ) and Discourses of theStates (Guoyu contents date from 431ndash314 BCE) contained otherstories about Gong Gong only the accounts in the Liezi and theHuainanzi recounted his destruction of Mount Buzhou and the sub-sequent toppling of one of the eight earthly pillars believed to holdup the canopy of the sky21 [See Figure 1]

The eight pillars featured in this cosmological myth were designedto explain two problems 1) why the Celestial Pole around whichthe sky appears to revolve was not directly overhead in the skywhich should be the case in an ideal universe but rather was northof it and 2) why the earth (namely China proper) inclined down-wards towards the southeast causing the major rivers to flow in an

ASME 22_f3_115-170IIII 41207 511 PM Page 120

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

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northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 5: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 119

13 I follow the argument in Allan 1991 p 6814 Hawkes 1993 pp 48ndash5515 See translations by Hawkes 1985 p 128 lines 33ndash5 Field 1986 35 and

Major 1993 p 6416 Although the Liezi is attributed to an early Taoist Lie Yukou (c 400

BCE) it was not written down until around 300 CE probably by one anonymousauthor See Graham 1990 p 12 and Barrett 1993 pp 298ndash308

medical field and in society Instead of the west being valued overthe east as in ancient Indian medicine however the north was supe-rior to the south northwest valued over southeast The binary inclassical Chinese medicine current during the Ming dynasty lookedlike this northwest-north-dry-cold-highlands-frugality-robust bodiesand southeast-south-damp-hot-lowlands-indulgence-weak bodies Mingphysicians admired the simple life of northerners over the life ofleisure of southerners and favoured restraint over pleasure thoughnone suggested either that they or their patients should move north

II Origins and representations of the northwest-southeastpolarity

(1) Mythological origins Gong Gong butts into Mount Buzhou

The earliest textual origins of the uniquely Chinese northwest-south-east polarity relates to a story about the destroyer god Gong Gongrecorded in the lsquoHeavenly Questionsrsquo (Tian wen ) chapter of thePlaints of Chu or Songs of the South (Chu ci )13 Although this bookcontains a small number of works by followers and imitators most ofthe poetical works in this collection are attributed to Qu Yuan(c 343ndashc 277) a nobleman who was a contemporary of King Huai

(reigned during last quarter of the fourth century BCE)14 Thepassage from the lsquoHeavenly Questionsrsquo succinctly reads lsquo[When] KangHui [= Gong Gong] was enraged why did the land lean southeastrsquo(Kang Hui feng nu di he gu yi dongnan qing )15

The Book of Master Lie (Liezi c 300 CE) preserved one of theearliest responses to this question16 The Liezi version attributed thenorthwest-southeast imbalance of yin-yang in the world to a fightbetween Gong Gong and the second of the first five rulers Zhuan Xu

It follows that heaven and earth are lsquothingsrsquo like the things within themand things have imperfections That is why in ancient times Nuwa

ASME 22_f3_115-170IIII 41207 511 PM Page 119

120 marta e hanson

17 Gujin luli kao juan 9 I use a Ming source for this story to emphasise that itwas a story in circulation at that time I adapted the English translation of this pas-sage in Graham 1990 p 96 by using pinyin

18 Major 1993 p 3ndash5 See Huainanzi 31andashb Translations in Major 1993 p 62 lines 23ndash9 Hawkes 1985 p 136 Allan 1991 p 68 Birrell 1993 69

19 Namely the first section titled lsquoThe origin of the cosmosrsquo in Huainanzi ch 3lsquoThe treatise on the patterns of heavenrsquo (tianwenxun )

20 Major 1993 p 6421 See the section on lsquoKung Kung Butts into the Mountainrsquo of chapter four

lsquoDestroyersrsquo in Birrell 1993 pp 97ndash8

smelted stones of all the five colours to patch up the flaws and cutoff the feet of the turtle to support the four corners Afterwards whenGong Gong was fighting Zhuan Xu for the Empire he knocked againstMount Buzhou in his rage breaking one of the pillars of heaven snap-ping one of the threads which support the earth For this reasonheaven leans North West and the sun moon and stars move in thatdirection the earth does not fill the South East so the rivers and therain floods find their home there17

A similar early version of this story is preserved in the Huainanzi (c secondcentury BCE) for which the king of Huainan Liu An (179ndash122BCE) served as general editor18 John Major succinctly explainedthe astronomical significance of this account by concluding that lsquothelast part of this section19 recounts the famous story of the fightbetween Gong Gong and Zhuan Xu that led to the tilting of heavenand earthmdashin cosmological terms to the astronomical fact that theecliptic (the sunrsquos apparent path around the earth as seen againstthe fixed stars) does not coincide with the celestial equator (the earthrsquosequator as projected onto the fixed stars)rsquo20

Although the Book of Master Guan (Guanzi fifthndashfirst centuryBCE compiled c 26 BCE by Liu Xiang ) and Discourses of theStates (Guoyu contents date from 431ndash314 BCE) contained otherstories about Gong Gong only the accounts in the Liezi and theHuainanzi recounted his destruction of Mount Buzhou and the sub-sequent toppling of one of the eight earthly pillars believed to holdup the canopy of the sky21 [See Figure 1]

The eight pillars featured in this cosmological myth were designedto explain two problems 1) why the Celestial Pole around whichthe sky appears to revolve was not directly overhead in the skywhich should be the case in an ideal universe but rather was northof it and 2) why the earth (namely China proper) inclined down-wards towards the southeast causing the major rivers to flow in an

ASME 22_f3_115-170IIII 41207 511 PM Page 120

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 6: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

120 marta e hanson

17 Gujin luli kao juan 9 I use a Ming source for this story to emphasise that itwas a story in circulation at that time I adapted the English translation of this pas-sage in Graham 1990 p 96 by using pinyin

18 Major 1993 p 3ndash5 See Huainanzi 31andashb Translations in Major 1993 p 62 lines 23ndash9 Hawkes 1985 p 136 Allan 1991 p 68 Birrell 1993 69

19 Namely the first section titled lsquoThe origin of the cosmosrsquo in Huainanzi ch 3lsquoThe treatise on the patterns of heavenrsquo (tianwenxun )

20 Major 1993 p 6421 See the section on lsquoKung Kung Butts into the Mountainrsquo of chapter four

lsquoDestroyersrsquo in Birrell 1993 pp 97ndash8

smelted stones of all the five colours to patch up the flaws and cutoff the feet of the turtle to support the four corners Afterwards whenGong Gong was fighting Zhuan Xu for the Empire he knocked againstMount Buzhou in his rage breaking one of the pillars of heaven snap-ping one of the threads which support the earth For this reasonheaven leans North West and the sun moon and stars move in thatdirection the earth does not fill the South East so the rivers and therain floods find their home there17

A similar early version of this story is preserved in the Huainanzi (c secondcentury BCE) for which the king of Huainan Liu An (179ndash122BCE) served as general editor18 John Major succinctly explainedthe astronomical significance of this account by concluding that lsquothelast part of this section19 recounts the famous story of the fightbetween Gong Gong and Zhuan Xu that led to the tilting of heavenand earthmdashin cosmological terms to the astronomical fact that theecliptic (the sunrsquos apparent path around the earth as seen againstthe fixed stars) does not coincide with the celestial equator (the earthrsquosequator as projected onto the fixed stars)rsquo20

Although the Book of Master Guan (Guanzi fifthndashfirst centuryBCE compiled c 26 BCE by Liu Xiang ) and Discourses of theStates (Guoyu contents date from 431ndash314 BCE) contained otherstories about Gong Gong only the accounts in the Liezi and theHuainanzi recounted his destruction of Mount Buzhou and the sub-sequent toppling of one of the eight earthly pillars believed to holdup the canopy of the sky21 [See Figure 1]

The eight pillars featured in this cosmological myth were designedto explain two problems 1) why the Celestial Pole around whichthe sky appears to revolve was not directly overhead in the skywhich should be the case in an ideal universe but rather was northof it and 2) why the earth (namely China proper) inclined down-wards towards the southeast causing the major rivers to flow in an

ASME 22_f3_115-170IIII 41207 511 PM Page 120

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 7: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 121

Northwest Pillar = North Pillar Northeast PillarMount Buzhou

West Pillar East Pillar

Southwest Pillar South Pillar Southeast Pillar

Fig 1 The eight earthly pillars that hold up heaven

22 Summary of argument and chart in Hawkes 1985 pp 135ndash623 The second image is of the 64 hexagrams of the Book of Changes (Yijing )

arranged according to the four cardinal directions It comes from the The ImperialLongevity Permanent Calendar (Shengshou wannian li ) which the Ming princeZhu Zaiyu (1536ndash1611) published in 1595 The third image is of the palm-side of the left hand which the late-Ming physician Zhang Jiebin (1563ndash1640)published in the Leijing tuyi (Illustrated Commentary of the Classified Canon 1624)See the longer Chinese version of this article for a discussion of all these images

easterly direction The myth explained why the cosmos is askewrather than perfect and symmetrical as one would expect based ona balance of yin and yang22 One oft-repeated phrase in a wide rangeof sources from commentary on the Book of Changes (Yijing ) tocalendars thereafter summarised the geographic consequences of thisancient cosmic battle in Chinese mythology lsquoHeaven tilts in thenorthwestrsquo (Tian qing xibei ) or sometimes lsquoHeaven is insuffi-cient in the northwestrsquo (Tian buzu xibei ) and lsquoEarth isincomplete in the southeastrsquo (Di buman dongnan ) Illustra-tions of this geographic concept do not appear to circulate howeveruntil the late-Yuan and Ming dynasties

(2) Visual Representations of the northwest-southeast polarity

At least three types of images of this geographic concept lsquoHeaven isinsufficient in the northwest earth is incomplete in the southeastrsquocirculated during the Ming geographic relating to the imagined formof heaven and earth numerological relating to the hexagrams of theBook of Changes and medical related to the macrocosm-microcosmmodel These images illustrate the multiple levels of meaning thisancient concept carried not only within the medical sphere but alsoin Chinese culture generally23 In the interest of space I focus onthe geographic image printed in the earliest extant Yuan edition

ASME 22_f3_115-170IIII 41207 511 PM Page 121

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 8: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

(r 1330ndash1333) of the encyclopaedia titled the Broad-ranging Record on Many Matters (Shilin guangji ) which the Southern-Songscholar Chen Yuanjing (c 13th century) compiled The imagetitled the lsquoDiagram of the two appearances and two luminariesrsquo (Liangyiliangyao zhi tu ) appeared on the first page of the Yuan-dynasty edition directly following Zhou Dunyirsquos (1017ndash1073) famous diagram of cosmological process titled the lsquoDiagramof the great unityrsquo (Taiji tu )24 [See Figure 2] The top of theimage is north and the bottom is south The three-legged black birdof mythology resides in the sun on the upper right side correspondingto the northeast The elixir-producing rabbit of mythology lives onthe moon in the upper left side corresponding to the northwestMountains associated with earth fill the upper left side where lsquoHeaventilts in the northwestrsquo (Tian qing xibei ) Ocean waters fill thelower right side where lsquoEarth is incomplete in the southeastrsquo (Dibuman dongnan ) The result is a skewed lsquoplate tectonicsrsquoin which earth slants up toward the northwest taking space whereheaven should be and then slides down toward the southeast wherewater takes the place where earth should be

Two essays accompanied this image explaining the cosmologicalprocesses represented therein The lsquoExplanation of the diagram ofthe two appearancesrsquo (liangyi tu shuo ) discussed the interde-pendent yin-yang relationship between heaven and earth by quotingfrom several classical texts including the statement from the Inner Canonof the Yellow Emperor Basic Questions (Huangdi neijing suwen

c first century BCE) that lsquoHeaven is insufficient in the north-west therefore the northwest region is yinrsquo (Tian buzu xibei gu xibeifangyin ye )25

The ldquoExplanation of the diagram of the two luminariesrsquo (liangyaotu shuo ) on the other hand elaborated on the yin-yangrelationship between the sun and the moon describing the legendsthat go back to late-Zhou mythology of the three-legged bird in the sunand the rabbit in the moon (formerly the goddess Chang E who

122 marta e hanson

24 [Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun reign edition juan 1p 2

25 For history and dating of the Inner Canon of the Yellow Emperor Basic Questionssee Sivin 1993 Quotation in lsquoMajor essay on the resonance and appearance of yinand yangrsquo (Yin yang yingxiang dalun ) Ren 1986 5 pian 4 zhang 3 jiep 22 (See ninth line in passage in figure 2)

ASME 22_f3_115-170IIII 41207 511 PM Page 122

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 9: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 123

Fig 2 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin qunshu lei yao] Shilin guangji Yuan Zhishun ed (r 1330ndash1333)

ASME 22_f3_115-170IIII 41207 511 PM Page 123

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 10: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

124 marta e hanson

26 Allan 1991 pp 27ndash3827 According to Despeux 2005 pp 39ndash41 Taoist adepts of the inner alchemy

tradition read a comparable image from bottom to top as an aid for meditationpractices and associated the five phases with the five main ingredients of internalalchemy (cinnabar silver mercury lead and earth) instead of the five Neo-Confucianvirtues as in this example

28 [Zuantu zengxin leiju] Shilin guangji Ming Hongzhi reign edition juan 1 pp 2bndash3aTaipei facsimile

stole the elixir of immortality from Archer Yi and escaped to themoon) Or by other accounts a toad resides on the moon26 Theplacement of this fairly abstract image directly after Zhou DunyirsquoslsquoDiagram of great unityrsquo gave it comparable status as a visual rep-resentation of yin-yang forces in the world Read from top to bottomthe lsquoDiagram of great unityrsquo illustrated the process of transformationfrom undifferentiated unity to the division of yin-yang (correlated inthe text to the human heart) which then differentiated into the fivephases (analogous in the text to the five Neo-Confucian virtueshumaneness righteousness ritual decorum wisdom and trustwor-thiness) and finally transformed into the myriad things of the worldor possibilities of human affairs27 The complementary second imageof the lsquoTwo appearances and two luminariesrsquo that concerns this arti-cle on the other hand depicted the external manifestations of yin-yang in the sun and the moon in heaven and earth and in thepolarity of northwest-southeast Instead of universal processes in thecosmos and within the human microcosm it represented the mainyin-yang contours of the world

The Ming edition of the Broad-ranging Record on Many Matters thatcirculated during the Hongwu era (r 1488ndash1505) contained a clearerand larger illustration of this same northwest-southeast polarity28 [SeeFigure 3] Covering the length of two facing leafs the image has lit-tle seal-like circles that indicate the compass pointsmdashnorth eastsouth and westmdasharound a depiction of lsquoheaven and earthrsquo enclosedin a circle Four decorative clouds fill the space outside the circleindicating the flow of qi through the cosmos The phrases lsquoHeaventilts in the northwestrsquo to the right and lsquoEarth is insufficient in thesoutheastrsquorsquo to the left flank the circle like a pair of couplets for theNew Year on two sides of a lsquomoonrsquo gate

The yin-yang principle functioned in this northwest-southeast polar-ity to systematise and in the process simplify actual geographic andhuman variation in China proper This myth and the imagined

ASME 22_f3_115-170IIII 41207 511 PM Page 124

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 11: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 125

Fig 3 lsquoDiagram of the two appearances and the two luminariesrsquo[Zuantu zengxin leiju] Shilin guangji Ming Hongzhi ed (r 1488ndash1505)

skewed geography of China it reinforced similarly helped physiciansexplain an imperfect and asymmetrical human society This geo-graphic conception was broadly influential in several other domainsfrom ancient mythology to calendrical sciences the Book of Changesnumerology to popular encyclopaedias in Ming culture For Chineseculture at the time this geographic concept was what the early soci-ologist of knowledge Emile Durkheim would have called a total socialfact Just as Zimmerman defined the specific Hindu reality of thejagravengala or jungle as a total social fact in the Durkheimian sense thespecific Chinese reality of lsquoHeaven tilts in the northwest earth is

ASME 22_f3_115-170IIII 41207 511 PM Page 125

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 12: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

126 marta e hanson

29 Zimmerman 1987 p 21930 For this source and argument see Leung 2002 p 170

insufficient in the southeastrsquo should also be considered a total socialfact in late imperial China29

Why the northwest-southeast polarity resonated in Chinese cultureinstead of for instance the northeast-southwest or even just the west-ern-eastern binaries may well relate to Chinarsquos political history whereinthe northwest since the Shang dynasty (c 1600ndash1045) was the for-mer lsquocradle of Chinese civilisationrsquo and the southeast from at leastthe Tang dynasty (618ndash907) became arguably Chinarsquos lsquorice bowlrsquoThe northern-southern binary was also historically situated in Chinesepolitical history and only emerged later as an important medical dis-tinction from the Yuan dynasty on

III Dai Liang and northern and southern medicine

Northern and southern medicine climates and bodies became animportant geographic binary in Ming medical literature in large partbecause it resonated with perceived social cultural and economicdivisions between the north and south after the Jurchen armies in1127 forced the Song court to move south where it established anew capital in Hangzhou Zhejiang province The dominant divi-sion of north and southmdashagricultural economic political social andculturalmdashsince the southern Song dynasty (1127ndash1278) contributedto physicians thereafter systematising northern and southern differencesas they appeared to them in medicine Although actual regionaldifferences in medical practices existed throughout Chinese historysince antiquity the earliest mention of differences between specificallylsquonorthern medicinersquo or lsquonorthern physiciansrsquo (beiyi ) and lsquosouth-ern medicinersquo or lsquosouthern physiciansrsquo (nanyi ) did not enter thehistorical record until the end of the Yuan dynasty Two biographiesof physicians in the collected writings Jiuling shanfang ji(Compilation of the Mountain Villa of Nine Divinities) of the late-Yuanand early-Ming literatus Dai Liang (1317ndash1383) offer the rich-est evidence of a broader conception of northern and southerndifferences in medical practice30

ASME 22_f3_115-170IIII 41207 511 PM Page 126

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 13: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 127

31 Li Yun 1988 pp 644ndash45 He Shixi 1991 pp 773ndash7432 These three doctors were Liu Wansu Zhang Congzheng and Li Gao33 Jiuling shanfang ji juan 19 For use of this source see Leung 2002 p 17034 It is noteworthy that based on the origins of the southern physicians Dai Liang

wrote about the lsquosouthrsquo refers to the Jiangnan region in Central China and notthe lsquofar southrsquo which would have included Guangdong and Guangxi provinces

35 Li Yun 1988 p 177 He Shixi 1991 p 246

(1) Conflict between northern and southern physicians

Dai Liang used the terms lsquobeiyirsquo and lsquonanyirsquo in a biography titled lsquoBaoYiweng zhuanrsquo of a famous southern physician named XiangXin (c 14th century)31 Near the end of this biography Dai Liangmentioned a conflict between northern and southern physicians

Nowadays those who venerate the three masters frequently slander eachother32 Moreover there is the difference between southern physiciansand northern physicians [such] that [they] certainly would not consentto use cold amp cooling [formulas] in the south or acrid amp hot [formu-las] in the north Why are they [so] attached to this Regarding thisthe Canon said quote lsquo[For a] disease [one] must inquire where itstarted and firmly express the differences of the regionsrsquo However[when] treating cold with hot hot with cold and going contrary tothe flow of the slight [cases] or going with the flow of the extreme[cases] one should treat according to the changing fluctuations of theclinical situation How could [one] limit [onersquos inquiry] to the vastdifference between cold and hot due to the norhern-southern division33

This passage illustrates how the discourse on regional differences inmedical practices also reveals significant social divisions in the med-ical sphere Some physicians were of the opinion that what waseffective in the north should not be taken in the south Dai Liangrsquosunderlying warning however was to be less rigid in practice andadapt to the clinical situation of the individual patient Yet he stillreaffirmed the great geo-climatic divide between a colder north anda warmer south34

(2) Northern purgatives versus southern restoratives

In another essay Dai Liang recounted a conversation he had withthe Suzhou doctor Zhu Bishan (c 14th century)35 He askedDoctor Zhu why physicians in the southeast do not use the sameapproach as do northern doctors who used purgatives to expel the

ASME 22_f3_115-170IIII 41207 511 PM Page 127

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 14: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

128 marta e hanson

36 Jiuling shanfang ji juan 1337 Leung 2002 p 170 quoted this passage as representative of the medical con-

ceptions of northern and southern differences from then on after the Yuan dynasty38 For a comparable analysis of anxiety about the immoderate appetites for food

and sex among male patients in sixteenth-century Huizhou see Grant 2003

illness-causing agent In response Zhu Bishan described northern andsouthern differences not only in terms of appropriate therapies butalso with respect to climate body types eating habits and pleasures

One day I was talking with the Wu physician Zhu Bishan about thisand Bishan changed expression and said lsquoYou sir are truly a north-ern scholar you understand northern medicine and that is all Medicineoriginally did not have a difference between north and south but thosewho are familiar with its teachings are suitably informed about it Thenorthern wind and qi are turbid and thick constitutions are powerfuland robust and combined with their simple and generous and frugaland simple diet and desires no one suffers from violence or loss ofvitality through dissipation As soon as [someone] falls sick [they] thenuse a bitter cold clearing beneficial formula to throw [it out] andthereby quickly [bring the patient back] to good health and spirits

As for southern people [their] constitutions are soft and fragile thepores of their flesh are loose and shallow [they] indulge in food anddrink have excessive desires [all of] which is completely different fromnortherners But if you wish to use the previous method [ie the bit-ter cold clearing formula] to treat them it would be no different fromusing a knife to murder someone Thus to treat illnesses in the northit is best to take as the first [option] using attack [formulas] to strikedown the external pathogenic (xie ) [qi ] to treat illnesses in the southit is best to take as the root [therapy] using protecting [formulas] tonourish the inner qi That is the meaning of this36

This passage represents what became a typical conception of north-ern and southern medical differences37 At that time it also expressedan underlying anxiety about the ill affects of a decadent southernlifestyle of over-indulgence in foods and pleasures38 Dai Liang usedregionalism here to criticise an intemperate southern culture in favourof the simpler more frugal northern culture from which he cameand of which he implicitly embodied

(3) The northern patient takes southern restoratives

Dai Liang contrasted the stronger northern patient with whom hepersonally identified with the stereotype of a more delicate southern

ASME 22_f3_115-170IIII 41207 511 PM Page 128

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 15: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 129

39 Jiuling shanfang ji juan 13

patient After spending some time in the south as an official andbecoming sick however he also found that the northern purgativetherapies of his home were not always the most appropriate inter-ventions while living in Jiangnan

When I was an official in Jiangsu and Zhejiang Bishan was the impe-rial physician for the province During my wanderings I became sickso that it was necessary to seek out Bishan However each time Bishanused lsquoprotecting and nourishing formulasrsquo (baoyang zhi ji ) inorder to get it It was effective because although I am a northernproduct I had lived in the south for a long time and so it was alsono longer appropriate to devote myself exclusively to purgatives (gongfa

) and probably [should now be] cautious about themMy mother is very elderly so when she encounters an illness it is

quite serious All of the Wu physicians said that only Bishanrsquos medi-cinal strategy [ie protecting and nourishing formulas] would be suit-able And I had a case of lsquocollapsed Bloodrsquo (wangxue bing ) forwhich I had taken drugs for many years Bishan examined me andsaid lsquoThis is a yin depletion syndrome Slowly take restoratives for itand [you will be] curedrsquo Impatient [I] stopped and then had a majorset back From then on [I] used his method [ie restorative formu-las] and in less than two months was cured39

This appears to be the first case where a northerner explicitly expressedthat living in the south had changed his strong constitution so muchso that he had contracted an illness of lsquoyin depletionrsquo ( yinxu )Dairsquos underlying message about northern-southern medical regional-ism in his preface for the southern doctor Zhu Bishan remains thesame as in his biography of Xiang Xin While physicians (and north-ern patients like himself ) should be aware of northern and southerndifferences in climates and constitutions they should not adhererigidly to either northern or southern therapeutic styles He foundthat living in the south could change a northernerrsquos robust consti-tution into a southern case of yin depletion Although Dai clearlypreferred the eliminating rationale of lsquonorthern purgativesrsquo throughthis account of his own healing experience he also valorised thereplenishing rationale of lsquosouthern restorativesrsquo as a regionally appro-priate therapy

If Dai Liangrsquos observations of northern purgatives and southernrestoratives could be read as also expressing the broader body relations

ASME 22_f3_115-170IIII 41207 511 PM Page 129

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 16: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

130 marta e hanson

40 For articles on how the human body organs and bodily substances have alsobeen used as models for the ideal functioning of human society and to naturalisepolitical institutions in other cultural and historical contexts see Feher et al (eds)1989

41 For theory of body-society semiotics see Douglas 1982 and reassessment inSchatzki T R and W Natter 1996

42 The spleen being associated with the earth phase and the central region ofChina in the five phases system of correlations symbolically corresponded also toChinese ethnic and political identity here

43 Unschuld 1990 pp 239ndash41

of power in society during the Yuan dynasty then the medical atten-tion to eliminating external pathogens appears particularly well suitedfor a body politic concerned about external invasion along its north-ern borders conversely the emphasis on restoring internal depletionappears socially resonate for a subservient southern body politic anx-ious about depleting its resources and strengthening its internal core40

A comparable body-society semiotics41 can be found in the writingsof a Qing physician reflecting back on the fall of the Song and theChinese loss of the north to Jurchen control in 1127 The mid-Qingphysician scholar Xu Dachun (1693ndash1771) delineated the rela-tionship between the somatic and political body in an essay titledlsquoIllnesses follow the fate of statesrsquo (Bing sui guo yun lun )published in a 1757 collection of his essays He directly related thefall of the Song dynasty subsequent loss of Chinarsquos central plainweakening of the head of state and slackening of his ministers (zhurou chen chi ) to the therapeutic innovations of the Chinesephysicians Zhang Yuansu (c 12th century) and Li Gao (1180ndash1251) Both physicians lived in the north under the Jurchenestablished Jin dynasty In response to the weakened Chinese bodypolitic Xu argued these physicians emphasised formulas that restoredthe lsquocentral palacersquo (bu zhonggong ) lsquostrengthened the spleen andstomachrsquo ( jian piwei )42 and contained drugs with hardy anddry qualities to bolster yang qi43

Whether or not contemporary Yuan physicians were conscious ofthis kind of body-society semiotics Dai Liangrsquos writings neverthelessbrought to the fore a new tension between northern and southernphysicians and their respective therapeutic preferences characteristicof the age This tension however does not appear to have beenexplicitly discussed in a medical text until over 100 years later butthis time in the writings of a southern scholar-official that date tothe first decade of the sixteenth century

ASME 22_f3_115-170IIII 41207 511 PM Page 130

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 17: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 131

44 Huguang encompasses the two provinces Hubei and Hunan45 He Shixi 1991 pp 44ndash5 Li Yun 1988 p 49 Although three other books

are attributed to him the one that made him known and is still being reprinted isthe Mingyi zazhu [Miscellaneous Writings by Enlightened Physicians]

46 Mingyi zazhu juan 1 p 3 juan 3 pp 106ndash7 A third essay titled lsquoIntention totreat Lingnanrsquos various disordersrsquo (Ni zhi Lingnan zhubing ) juan 2 pp 82ndash6 could have also been included under lsquoMing medical regionalismrsquo but sinceother scholars have already analysed the history of medical views of the Lingnanregion and diseases of the far south since the Tang dynasty in the interest of spaceI chose not to include this essay in my analysis See Xiao Fan 1993 and Leung 2002

IV Wang Lun and Enlightened Physicians

The wide range of essays in one of the earliest Ming medical primersthe Miscellaneous Writings by Enlightened Physicians (Mingyi zazhu 1502) offers a useful entry point into the Ming debates on medicalregionalism The author Wang Lun (fl 1484ndash1521) was fromCixi county in Zhejiang province Wang was foremost a scholar-official who in 1484 received the jinshi degree which granted him aplace in the Chinese imperial bureaucracy as a secretary in theMinistry of Works He rose in government positions until he servedas the Right Vice-Censor-in-Chief and Grand Coordinator of Huguangfrom 1506 to 152144 As an official of the central imperial govern-ment he was sent to coordinate and supervise provincial-level agen-cies in these provinces In such a high position he was a memberof the highest elite but instead of writing poetry prose or historymdashas many men of his status didmdashhe became most famous for one ofhis published writings on medicine45

(1) Wang Lunrsquos medical regionalism

Of over 75 essays in Enlightened Physicians two provide direct evidenceon how Wang Lun thought about northern and southern differencesand where he learned his views on medical regionalism 1) lsquoOndifferent methods being regionally suitedrsquo (Yifa fangyi lun )and 2) lsquoIf one asked about the treatment methods of Dongyuan [LiGao (1180ndash1251)] and Danxi [Zhu Zhenheng (1282ndash1358)]rsquo (Huowen Dongyuan Danxi zhibing zhi fa )46

Wang Lun used a range of geographic and climatic vocabulary toexpress his take on medical diversity and human variation within China

In the first essay Wang relied on the northwest-southeast axiswhich was depicted in the Yuan encyclopaedia Broad-ranging Record

ASME 22_f3_115-170IIII 41207 511 PM Page 131

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 18: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

132 marta e hanson

47 This phrase is often translated literally as the lsquorivers and lakesrsquo or lsquoto travelrsquoand metaphorically refers to lsquoitinerant entertainers and charlatansrsquo or those who plytheir trade on the waterways and byways In the context of Wang Lunrsquos essayhowever the two terms more likely refer to the first characters of the names oftwo provinces next to each other as are Jiangxi and Hunan

on Many Matters Here he employed the terms lsquosoutheastrsquo and lsquonorth-westrsquo to refer to regional characteristics different qualities of climaticqi levels of land relative dryness or dampness regional use of pep-per and ginger and whether cold or hot types of drugs are recom-mended In the second essay he developed further Dai Liangrsquosnorthern-southern dichotomy in medicine by differentiating not onlythe particular climatic qi of the lsquosouthern regionrsquo (nanfang ) andthe lsquonorthern regionrsquo (beifang ) but also by discussing separatelylsquosouthern illnessesrsquo (nanbing ) and a lsquosouthern physicianrsquo (nanyi

) from lsquonorthern illnessesrsquo (beibing ) and a lsquonorthern physicianrsquo(beiyi ) He also specified four other regions Shaanxi in thenorthwest Jiang Zhe ( Jiangsu and Zhejiang provinces) JiangHu ( Jiangxi and Hunan)47 of central China along the middlereaches of the Yangzi river and Lingnan (Guangdong andGuangxi provinces) in the far south Wang Lunrsquos essays offer a rep-resentative range of the regional terminology that informed the prac-tice of literate Ming physicians at the very beginning of the sixteenthcentury

On eating acrid and hot foods

The problem of regional variation in medical practice appears inthe third essay of Enlightened Physicians lsquoOn different methods beingregionally appropriatersquo (Yifa fangyi lun ) Wang Lun dis-cussed regionally different eating habits of acrid and hot spices thatappeared to be contrary to accepted uses of these substances as drugsin the classical medical tradition

Someone asked People say that the qi of the southeast is hot [so itis] appropriate to prescribe cold medicines the qi of the northwest iscold [so it is] appropriate to prescribe warm medicines However whyis it that these days southeastern people often consume black pepperginger and cassia bark [yet we] do not see them get sick yet north-western people avoid consuming acrid and hot substances such as blackpepper and ginger

ASME 22_f3_115-170IIII 41207 511 PM Page 132

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 19: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 133

48 Mingyi zazhu juan 1 p 3

On the surface his answer to this conundrum was simple

This is because although it is hot in the southeast the land is lowlying and damper acrid and hot foods and drugs [such as black pep-per ginger and cassia bark] can also expel the dampness Althoughit is cold in the northwest the land is mountainous and dryer acridand hot foods and drugs can conversely exacerbate the dryness Thosewho use drugs to treat illnesses must understand the meaning of this48

Wang Lun focused on the regionally different culinary practices ofconsuming acrid hot spices in a hot climate and avoiding the samein a cold climate precisely because these practices challenged themaxim in classical Chinese medicine lsquoto treat hot with cold and coldwith hotrsquo (rezhe han zhi hanzhe re zhi ) He solvedthe apparent contradiction by arguing that the relative dryness ofthe climate in the northwest and dampness of the climate in thesoutheast complicated the cold-hot distinction Because acrid sub-stances disperse and move qi the black pepper ginger and cassiabark in south-eastern cooking assists in drying out the dampness peo-ple living there contracted from their climate The same spices maybe good for countering the cold of the north-western climate buttheir acrid quality also exacerbated the dryness of those who livedthere by further dispersing their qi

Wang Lun solved the contradiction by employing geo-climatic dis-tinctions of a dryer (as well as colder) northwest and a damper (aswell as hotter) southeast He strategically used this regional variationin preferences for and taboos against acrid hot substances to com-plicate the simplistic notion with which he opened the essay Writinga medical primer he assumed that some of his potential readersmight believe that physicians prescribed hot drugs to those living inthe northwest to counter the effects of a cold climate and cold drugsto those in the southeast to counter the effects of a hot climate Herehe attempted to teach the novice reader to reason with greater sub-tlety and consider multiple climatic factors beyond just hot and cold

On Xue Jirsquos regional constitutions and Su Shirsquos formula Shengsanzi

Although Wang Lun did not impart a value judgment on the binaryexpressed in this essaymdashnamely the northwest-cold-dry taboo on

ASME 22_f3_115-170IIII 41207 511 PM Page 133

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 20: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

134 marta e hanson

49 He Shixi 1991 pp 277ndash80 Li Yun 1988 p 95250 The 1985 version of the book edited by Wang Xinhua was based on the 1551

Song Yangshan blockprint the earliest known edition of the Mingyi zazhu TheMingyi zazhu may well have been preserved and was more widely distributed thanWang Lunrsquos other medical texts because the more prolific and influential Mingphysician Xue Ji wrote a commentary to it and published it in two collections ofhis own and othersrsquo works he edited arranged or wrote commentary on the MrXuersquos Medical Case Histories 24 Kinds (Xueshi yirsquoan ershisi zhong) and Mr Xuersquos MedicalCase Histories 16 Kinds (Xueshi yirsquoan shiliu zhong) See also Xu Senyu (ed) 1986 p 820 (left)

51 Xue Ji revised and self-published his fatherrsquos book on paediatrics titled theAbstracts on protecting infants (Baoying cuoyao 1556)

52 Also see Cheng Weizhong (ed) 1999 pp 1091ndash3

acrid hot spices and the southeast-hot-damp preference for acrid hotspicesmdashhis later commentator clearly did Thirty years after Wang Lunrsquosdeath Xue Ji (1487ndash1559) wrote a preface to commented onand had republished Enlightened Physicians in 155149 Xue Jirsquos com-mentated edition is the only version of Enlightened Physicians thatremains today Its preservation is due in large part to having beenincluded in two collections of Xue Jirsquos commentary and editorialwork on the medical texts of other physicians50 Xue Ji was born intoa family of hereditary physicians in Wu prefecture of Jiangsu provincenow modern-day Suzhou city His father Xue Kai (c latendash15th century) was a physician in the imperial medical bureau dur-ing the Hongzhi reign (r 1488ndash1505) and a contemporary of WangLun who was a secretary in the Ministry of Works during the samereign Xue Kai was promoted to Commissioner of the medical bureauand was known for his work in paediatrics51 Upon the death of XueKai in 1508 Xue Ji took his fatherrsquos place as a physician in theImperial Medical Bureau where it is possible that he had contacteither with Wang Lun himself (concurrently the Right Vice-Censor-in-Chief and Grand Coordinator of Huguang from 1506 to1521) orat least the original editions of his books He worked there until1512 when an injury from a vehicle accident compelled him to returnto his native Suzhou to recover In 1519 however he moved up tothe sixth rank in the imperial medical bureau of Nanjing In 1530he left the imperial medical service as a fifth ranked physician inorder to devote his energy to medical practice and publishing52

The official Shi Qianwei (c 1549ndash51) endorsed Xue Jirsquosedition of Enlightened Physicians by writing a preface to it and thuslending his prestige as an official to ensure its success Furthermorehe expressed an awareness of medical currents ( yipai ) of regional

ASME 22_f3_115-170IIII 41207 511 PM Page 134

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 21: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 135

53 Shi Qianwei preface to Mingyi zazhu p 3 For the history of transmission ofthis current of learning see Wu Yiyi 1993ndash4 pp 36ndash65 Wu argues that the edi-torrsquos introductory statement on medicine in the Wenyuange Siku quanshu of 1782 lsquowasthe first to affirm the existence of such lineages among medical practitionersrsquo WuYiyi 1993ndash4 p 37 But Shi Qianweirsquos preface places this kind of affirmation inthe mid 1550s

54 Xue Jirsquos commentary follows the original passage in Mingyi zazhu juan 1 p 3

learning by praising the role of Suzhou (Gusu ) physicians intransmitting in the south the medical learning of the northern physi-cians Liu Wansu (1120ndash1200) and Zhang Congzheng(1156ndash1228) Already in 1549 when Shi Qianwei wrote this pref-ace he had a clear sense of a Suzhou lsquocurrent of learningrsquo in med-icine and that he considered both Wang Lun and Xue Ji to be partof it53 In his preface to Enlightened Physicians on the other hand XueJi emphasised Wang Lunrsquos concern for the peoplersquos welfare duringepidemics and the efficacy of his fever treatments His commentaryto Wang Lunrsquos essays expressed his own thoughts on Wangrsquos con-clusions and recommended additional courses of therapy

Xue argued for example that the regional differences in the con-sumption (or not) of acrid hot spices which Wang Lun used as anillustration of simplistic reasoning were in fact due to regionaldifferences in bodily constitutions It was not the climatic differencesin hot or cold damp or dry that explained the regional preferencefor or against acrid and hot substances but rather the relative full-ness or depletion of the yang qi within the people themselves of eachregion

The southeastern regions are low lying damp and hot the pores ofthe people there are loosely opened (couli shutong ) so theirsweat and ye fluids drain out and their yang qi is depleted withinThus it is appropriate for them to eat black pepper ginger and suchacrid and hot things in order to boost their yang qi [However] thenorthwestern regions are high mountainous windy and cold the poresof the people there are tightly closed (couli zhimi ) so that theirsweat and ye fluids are secure within and their yang qi is completeand full It is not appropriate for them to eat black pepper gingerand such acrid and hot things which would contrarily boost their yangqi54

Xue Ji gave an historical example from the Northern Song dynasty(960ndash1127) to further support his position The famous Song officialSu Shi (1036ndash1101) was serving in Huangzhou a prefectural

ASME 22_f3_115-170IIII 41207 511 PM Page 135

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 22: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

136 marta e hanson

55 Needham 2000 p 5456 This formula is cited in The Superlative Formulas of Su Shi and Shen Kua (Su Shen

liangfang) juan 2 and 3 Neither juan of the Su Shen liangfang however refer to the1089 epidemic in Huangzhou It is discussed however in the Formulas for GeneralBenefit (Puji fang ) juan 151

57 Mingyi zazhu juan 1 p 3

city located just east of Wuhan on the Yellow River in Hubei provinceDuring an epidemic sweeping through the region in 1089 he foundedand endowed a government hospital to treat the sick and take careof the dead55 At that time Su Shi prescribed the formula Shengsanzi

to treat patients suffering from the disease which from thenbecame a popular formula for treating epidemics56 Xue Ji wrotethat this prescription was highly effective in the south precisely becausethe acrid and warm qualities of the drugs in the Shengsanzi formulaaddressed the depletion of yang qi and countered the resulting coldin the southeastern patients Xue asserted however that when peo-ple used this same prescription to treat epidemics in the northwestit only led to countless deaths This was because the acrid hot qual-ities of the same formula only exacerbated the constitutional drynessand brought to excess the already full yang qi of northern patients57

Although Shengsanzi effectively treated fevers in the southeast becauseof corporeal differences in constitution Xue argued in the north-west it would only cause greater suffering from the same kind ofepidemic fevers Although Xue Ji considered full yang qi better thandepleted yang qi thus valorising the northwest over the southeastexcessive yang qi nevertheless could also kill patients

On multiple rhetorical ends of Ming medical regionalism

This textual exchange between Wang Lun and Xue Ji reveals howa single example of geo-culinary practicesmdashin this case the north-western avoidance of acrid hot substances and the southeastern pref-erence for themmdashcould be used for multiple rhetorical ends WangLun used the example to give novice readers an exception to therule that they should treat lsquohot with cold and cold with hotrsquo Healerted them to consider as well dampness and dryness as patho-genic factors

Xue Ji on the other hand further developed the same examplein a way that affirmed both constitutional differences between north-

ASME 22_f3_115-170IIII 41207 511 PM Page 136

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 23: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 137

58 For dating see Sivin 1993 pp 196ndash21559 Ren 1986 di 12 pp 39ndash40

western and southeastern people and regionally appropriate thera-peutic interventions Neither one of these two points was implicit inWang Lunrsquos original example Xue Jirsquos use of medical regionalismhere by contrast expressed an anxiety that even the most effectiveformula for treating fevers Su Shirsquos famous Shengsanzi was not uni-versally effective throughout the empire The literate medical dis-course on regional variations reveals what physicians perceived atthe time were limitations biases and shortcomings in medical prac-tice as well as the transmission of medical knowledge

(2) Medical regionalism in the Yellow Emperor of the Inner Canon

From what sources did Wang Lun and Xue Ji acquire these conceptsof medical regionalism The title of Wangrsquos essay lsquoOn different meth-ods being regionally appropriatersquo (Yifa fangyi lun ) offersthe most obvious starting point The essayrsquos title suggests that thelsquolocus classicusrsquo of this medical regionalism is the section of the sametitle in the Inner Canon of the Yellow Emperor Basic Questions58 The curi-ous matter however is that a comparison of the original Inner Canonessay with Wang Lunrsquos essay of the same title reveals a significantdivergence

The following table presents the Inner Canonrsquos entire chapter lsquoOndifferent methods being regionally appropriatersquo according to the fiveregions (wufang ) that divide the essay into five jie [See Figure 4a] The top row translates the introduction to the essay andthe bottom row translates its conclusion The five columns one foreach of the five regions are divided according to the six majordifferences emphasised in the essay 1 land 2 customs 3 consti-tutions 4 illnesses 5 treatments 6 origins of treatments The orderof the five columns from left to rightmdashEast West North SouthCentralmdashfollows the order of the original text Figure 4a presents acomplete translation of this chapter

The chapter with the same title in the Inner Canon however sharesneither geographic concepts nor therapeutic recommendations withWang Lunrsquos essay on acrid and hot foods59 Instead of a northwest-southeast axis the Inner Canon version differentiated five regionsRather than preferences for or avoidance of acrid hot substances

ASME 22_f3_115-170IIII 41207 511 PM Page 137

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 24: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

138 marta e hanson

Fig 4a Inner Canon of the Yellow Emperor Basic QuestionslsquoOn different methods being regionally appropriatersquo di 12 1ndash5 jie

the Inner Canon discussed fondness for salty or sour foods and a ten-dency to eat fish fermented foods or cowrsquos milk In contrast toexpressing a concern about the simplistic understanding of novicereaders as did Wang Lun or the misuse of a famous formula forfevers as did Xue Ji the Inner Canon version emphasised the fiveregional origins of five types of therapy lsquostone needlesrsquo (bianshi )in the east lsquotoxic medicinalsrsquo or lsquopotent drugsrsquo (duyao ) in the

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 511 PM Page 138

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 25: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 139Pre

fato

ry

The

Yel

low

Em

per

or

Ask

ed

As

for

when

phys

icia

ns

trea

t illn

esse

s w

hy

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illn

ess

Ques

tion

[yet

] cu

re a

ll Q

i Bo r

esponded

[D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

1

Thus

the

easter

n r

egio

n

The

wes

tern

reg

ion i

s T

he

norther

n r

egio

n i

s T

he

south

ern r

egio

n

T

he

central

reg

ionrsquos l

and

Lan

dis t

he

pla

ce w

her

e hea

ven

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

is w

her

e hea

ven

is l

evel

and t

her

eby

and e

arth

first b

ring

ja

de

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]

and e

arth

mat

ure

and

dam

p

It i

s w

her

e hea

ven

[thin

gs]

to l

ife

[It i

s] t

he

an

d s

tones

w

her

e hea

ven

The

land i

s hig

h

[ther

e nourish

[th

ings

] an

d

and e

arth

enge

nder

the

land o

f fish

and s

alt

an

d e

arth

bring

in t

he

ar

e] c

ave

dw

ellin

gs

w

her

e ya

ng

[qi]

is

m

yria

d t

hin

gs

[wher

e] o

cean

shore

s

har

vest

lsquoThe

peo

ple

win

d

cold

ic

e a

nd

abundan

t T

he

land i

s

mee

t w

ater

[w

ays]

her

e liv

e in

cav

es a

nd

[bitte

r] c

old

lo

w l

ying

wat

er a

nd

it i

s often

win

dy

the

soils

are

wea

k I

t is

wat

er a

nd s

oil

are

har

d

wher

e fo

gs a

nd d

ews

and s

trong

asse

mble

2

The

peo

ple

her

e ea

t T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

e to

The

peo

ple

her

e fa

vor

Num

erous t

he

peo

ple

Custom

sfish

and f

avor

salty

wea

r [s

ilks]

but

coar

sere

side

in t

he

wild

and

sour

[foods]

and e

ather

e ea

t div

erse

[fo

ods]

foods a

ll ar

e pea

cefu

l cl

oth

and s

traw

co

nsu

me

milk

fe

rmen

ted [

foods]

an

d d

o n

ot

get

fatigu

ed

in t

hei

r ab

odes

and

[ie

f

rom

har

d w

ork

]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

cau

ses

hea

t T

he

peo

ple

her

e hav

eT

her

efore

the

peo

ple

Constitutions

within

hum

ans

[and]

ple

ntifu

l fo

ods

and a

reher

e al

l hav

e fine

salt r

ule

s ove

r Blo

od

th

us

corp

ule

nt

[ie

t

ightly

disper

sed]

the

peo

ple

her

e al

l hav

e

pore

s an

d a

red

dish

a dar

k co

mple

xion a

nd

com

ple

xion

open

[ie

lo

ose

ly

disper

sed]

pore

s

ASME 22_f3_115-170IIII 41207 511 PM Page 139

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 26: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

140 marta e hansonFig

4b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

pat

hoge

nic

Hid

den

[pat

hoge

nic

]T

hei

r ill

nes

ses

are

Thei

r ill

nes

ses

are

often

Illn

esse

sca

rbuncl

es (

yong

) [q

i] c

annot

har

m t

hei

rco

ld [

in t

he

body]

spas

ms

(luan

)

and

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

bodie

s [s

o]

thei

rgi

ves

rise

to i

llnes

ses

of

num

bnes

s in

the

trunk

num

bnes

s or

cold

nes

s in

)ill

nes

ses

arise

from

fu

llnes

s (m

anbing

)an

d l

imbs

(bi

)th

e ex

trem

itie

s (j

ue)

within

an

d c

old

or

hot

[disord

ers]

5

Thei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e T

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

trea

tmen

ts a

re t

oxi

ctrea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

nee

dle

s (bians

hi)

[ie

p

ote

nt] d

rugs

an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

(duy

ao)

)an

dm

assa

ge(anq

iao

)

6

This i

s w

hy

stone

This i

s w

hy

toxi

cT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Origi

n o

f nee

dle

s al

so c

ame

from

dru

gs a

lso c

ame

from

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge a

lso

Tre

atm

ents

the

easter

n r

egio

n

the

wes

tern

reg

ion

from

the

norther

n

south

ern r

egio

n

cam

e from

the

central

regi

on

regi

on

Concl

usion

Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

Fig

4b

lsquoOn d

iffe

rent

met

hods

bei

ng

regi

onal

ly a

ppro

priat

ersquo (

Yifa

fan

gyi

lun

pian

) di

12

1ndash5 jie

Inne

r Can

on o

f the

Yellow E

mpe

ror B

asic Q

uestions

(Hua

ngdi n

eijin

g s

uwen

c

first c

entu

ry B

CE)

ASME 22_f3_115-170IIII 41207 511 PM Page 140

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 27: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 141

60 Lu and Needham 1980 pp 1ndash2 They suggested that lsquoIn this case acupunc-ture would have been associated with the south-eastern quasi-Indonesia aquatic ele-ment while moxa would have come down to join it from the northern quasi-Tungusicnomadic element and the pharmaceutical influence would have come from thewestern Szechuanese and quasi-Tibetan elementrsquo

61 Leung 2002 pp 171ndash2 has already clearly examined the change from thefive regions model to the northwest-southeast model from the Han to the Mingdynasty She argued that the same divergence indicated further refinement on therelationship between the environment and the human constitution in the writingsof late-Ming physicians such as Wang Lun and Zhang Lu (1617ndash1700)

west lsquomoxibustionrsquo and lsquocauterisationrsquo ( jiuruo ) in the north thelsquonine needlesrsquo ( jiuzhen ) in the south and lsquoguiding-pullingrsquo (daoyin

) and lsquopushing down-lifting uprsquo or lsquomassagersquo (anqiao ) in thecentre

In addition to noting that these regional designations followed thefive phases system of correlations Lu and Needham hypothesisedthat this ancient account of the origins of ancient therapies may havealso acknowledged the confluence of bordering societies into lsquoa com-mon Sinic stockrsquo60 Whether or not their hypothesis holds this pas-sage nevertheless provided the earliest idioms for discussing regionalvariations in land climate customs constitutions and illnesses fromthen on within the Sinic cultural-political sphere

Although the title lsquoOn different methods being regionally appro-priatersquo is the same in the two texts neither Wang Lun nor Xue Jimentioned the lsquofive regionsrsquo either in the essay of the same title oranywhere else in their published works61 The rhetorical reference tothe Inner Canon as the canonical authority in medicine did not meanthat medical authors strictly adhered to or quoted the lsquoletter of thecanonrsquo though they certainly borrowed concepts and idioms estab-lished therein

The most important dichotomy for the land that later physiciansdrew upon was between the high plateaus of the north and the lowlying regions of the south for the climate the cold and winds of thenorth contrasted with the fogs and dews of the south For constitutionsthe dichotomy between open (loosely dispersed) pores (shuli ) andfine (tightly dispersed) pores (zhili ) continued as a relevant idiomto explain human variation despite the later irrelevance of the specificassociation with eastern and southern constitutions respectively InXue Jirsquos response to Wang Lunrsquos essay for example he contrastedthe loose pores (couli shutong ) of those in the southeasternregions from those with tightly closed pores (couli zhimi ) in

ASME 22_f3_115-170IIII 41207 511 PM Page 141

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 28: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

142 marta e hanson

62 See especially lsquoEssay on the genuine words of the Golden Casketrsquo ( Jinkui zhenyanlun pian ) in Ren 1986 di 4 zhang 3 p 17

63 A search of the phrase lsquoyifa fangyirsquo (Different methods being region-ally appropriate) in the Siku quanshu electronic database turned up the following fivetexts between the Huangdi neijing suwen and Xue Jirsquos Xueshi yian which republishedthe Mingyi zazhu Suwen rushi yunqi lun ao (Marvellous introductoryremarks on the theory of the [five] circulatory phases and [six seasonal] qi accord-ing to the Suwen) juan 3 lsquoLun liubing di 28rsquo 28 (On six diseases 28)Shanghan weizhi lun (On Cold Damage and profound purpose) juan 1lsquoZhibing suizheng jiaxian yaopianrsquo (Treatment of disease by increasing and decreasing drugs according to the pattern) Taiyiju zhuke chengwen ge

(The Imperial Medical Bureaursquos examination essay model [ques-tions] in various disciplines) juan 1 lsquoDi er daorsquo (Second issue) Puji fang

(Formulas for General Benefit) juan 240 lsquoJiaoqimen yiqiu jiaoqirsquo (Foot qi section a type of foot qi) Yuji weiyi (Subtle reasoning of

the jade power [of the universe]) juan 14 lsquoJiufarsquo (Moxibustion methods) andjuan 23 lsquoBian beifang jiaoqi suode zhi yoursquo (Essay on the causeof obtaining northern foot qi ) None of these citations of lsquoyifa fangyirsquo quoted thesame content of the original Suwen essay of the same title

the northwestern regions Xue Jirsquos dichotomy only maintained thecorrelation between eastern constitutions and loose pores and con-tradicted the correlation between southern constitutions and tightpores in the original Inner Canon version The correlation between apreference for salting foods in the east and sour foods in the southbear no relation even to the five sapors-five regions associationsmdashEast-sour West-pungent North-salty South-bitter and Central-sweetmdashin other sections of the original Inner Canon Basic Questions62

Wang Lun was not the first medical scholar to refer to the titleof the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo and yet largely ignore its specific content about the five regionsand origins of the five therapies In at least five medical texts pub-lished before his Enlightened Physicians medical authors cited the sametitle from the Inner Canon to give a patina of ancient authority totheir contemporary criticisms of clinical problems in medical prac-tice they thought arose from regional variations in the environmentclimate and constitutions63 Their citation of the title of the origi-nal Inner Canon essay on regionalism in other words was a usefulresource for them to discuss tensions fissures and diversity morebroadly in the contemporary literate medical sphere They rarelyquoted the Inner Canon original verbatim however because the fiveregions model that it summarised no longer corresponded with thesocial or political reality they experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 142

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 29: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

(3) On avoiding simplistic environmental determinism

Wang Lun explicitly confronted medical regionalism again in thesecond essay titled lsquoIf someone asked about the methods for treatingdisease of Li Gao and Zhu Zhenhengrsquo In a comparison of thecontrasting therapeutic styles of two physicians Li Gao (1180ndash1251)and Zhu Zhenheng (1281ndash1358) for instance Wang called attentionto misperceptions among his contemporaries of different therapeuticstrategies between northern and southern physicians His underlyingpoint however cautioned his novice readers about following sim-plistic regional determinism in their medical practices He began byquestioning why some people thought that Li Gaorsquos methods wereonly suited for the north whereas Zhu Zhenhengrsquos treatments wereonly good for the south

Nowadays some say that the methods of Dongyuan [Li Gao] are appro-priate for use in the north and the methods of Danxi [Zhu Zhenheng]should be practised in the south Why is this This is because Dongyuanwas a northern physician and Luo Qianfu [ie Luo Tianyi c 13th century] transmitted his methods so that they could becomeknown in Jiang[su] and Zhe[ jiang] Danxi was a southern physicianand Liu Zonghou [ie Liu Chun c 14th century] passed on histeachings so that they could be well known in Shaanxi Suppose some-one said that the [Divine Husbandmanrsquos] Materia Medica and the InnerCanon [of the Yellow Emperor] being teachings of the Divine HusbandmanYellow Emperor and Qi Bo could only by applied in the north64

Just because the ancients lived in the north this did not make theInner Canon a lsquonorthernrsquo medical text Similarly although Li Gao wasa northern physician and Zhu Zhenheng practised in the south theirmedical ideas were not limited to those regions Their disciples infact successfully transmitted their medical works outside of theirnative regions Li Gaorsquos disciple Luo Tianyi brought his work southto Jiangsu and Zhejiang in central China and Zhu Zhenhengrsquos dis-ciple Liu Chun introduced his work northwest to Shaanxi provinceWang concluded this opening section with a rhetorical question towhich the obvious answer was no No the teachings of the divinesovereignsmdashthe Divine Husbandman and the Yellow Emperormdasharenot regionally limited but rather universally valid65 By extension the

northern purgatives southern restoratives 143

64 Mingyi zazhu juan 3 p 10665 On the largely early Han-dynasty idea of legendary sages as culture-givers of

knowledge based on a universal standardmdashsuch as the Divine Husbandman and

ASME 22_f3_115-170IIII 41207 511 PM Page 143

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 30: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

144 marta e hanson

the Yellow Emperormdashsee the section on lsquosovereigns as innovatorsrsquo in Sivin 1995bpp 188ndash90

66 Wang Lun did not refer to the same lsquofive regionsrsquo of the Inner Canon but rathermentions the north lsquobeifangrsquo south lsquonanfangrsquo Lingnan and Jiang Hu

and ignores the three other original regionsmdashwest lsquoxifangrsquo east lsquodongfangrsquo and centre lsquozhongyangrsquo This example further supports the argument that

when later medical authors refer to the Inner Canonrsquos lsquoYifa fangyi lunrsquo chapter 12 fromBasic Questions they refer to the general concept of regional variation or biases inmedical practices but do not adhere closely if at all to the specific content of theoriginal Basic Questions chapter

67 Mingyi zazhu juan 3 106

therapies of the northern doctor Li Gao and the southern doctorZhu Zhenheng are as universal

In the following passage Wang Lun succinctly challenged suchsimplistic regional determinism by citing the origin of such ideas inthe Inner Canon This time he referred to the five regions modelwhich he did not mention in his first essay on lsquoDifferent methodsbeing regionally appropriatersquo66 To complicate the simplistic north-south division of the opening sentence Wang added the geographicdistinctions of provincesmdashShaanxi Jiangsu and Zhejiang when hementioned the disciples Luo Tianyi and Liu Chunmdashand the regions ofJiang Hu and Lingnanmdashwhen he discussed dominant climatic factors

As for the appropriateness of different treatments for the different ill-nesses that arise in the five regions the Inner Canonrsquos [essays on] lsquoOndifferent methods being regionally appropriatersquo and the lsquoGreat treatiseon the five regularities of governancersquo discuss this in detail For exam-ple it is colder in the north hotter in the south damper in the regionof lakes and rivers and more miasmic in Lingnan Wherever thesetypes of qi (ie Cold Hot Damp and Miasmic) are prevalent therewill also be more of that kind of disorder but this does not mean thatof the northern disorders there are none due to Heat or that of thesouthern disorders there are none due to Cold As for treating colddisorders with hot [formulas] and treating hot disorders with cold [for-mulas] this principle is the same in all five regions so how could itdiffer in the north and south67

Although these provinces and regions did not fit easily into theancient model of five regions they did coincide well with contem-porary Ming conceptions of geography Despite regional prevalencein morbidity the pathogenic factorsmdashhot and coldmdashas well as thefevers and chills they caused transcended the north and south divisionThe key point for the physician was to know when the regional cli-mate was at play and when to make an exception for the individual

ASME 22_f3_115-170IIII 41207 511 PM Page 144

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 31: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 145

68 The full title was originally to the northern-Song imperial medical bureaursquospublication Formulary of the pharmacy service for benefiting the people in an era of great peace(Taiping huimin heji jufang early 12th century) Goldschmidt 2005p 80

69 Ibid

patient By arguing for more subtle diagnostic skills among physiciansWang Lun portrayed himself as the impartial model to follow

In the concluding section of this essay Wang returned to the com-mon misconception with which he introduced the essay namely thatZhu Zhenhengrsquos formulas were most appropriate for treating patientsin the south and Li Gaorsquos were best suited for the north Havingplaced himself in the textual lineage of Zhu Zhenheng by structur-ing his Enlightened Physicians largely around Zhursquos doctrines he soughtto give his predecessor proper credit in medical history as someonewho penetrated the mysteries of the Inner Canon and realised that theSong Imperial Formulary was biased toward illnesses due to damp andhot pathogens

However in the human viscera Fire resides in two places of the sixclimatic qi of heaven Hot resides in three or half [of them] Thus ofall the illnesses under heaven Hot is more and Cold less [a significantfactor] Examine the Inner Canonrsquos section on lsquodisease extremitiesrsquo ofthe lsquoMajor essay on arriving at the genuine essentialsrsquo Furthermoreit is even more common that Damp and Hot [factors] combine withFire to cause illnesses From Taipursquos [ie Wang Bing (c eighthcentury)] commentary [on the Inner Canon] up to the Bureau Formulary(Jufang )68 there was a bias toward using Damp and Hot medi-cines Thus Danxi [ie Zhu Zhenheng] uncovered and penetrated themysteries of the Inner Canon examined the bias in the Imperial Formularytoward illnesses due to Damp and Hot [factors] combined with Fireand supplemented what his predecessors had left incomplete Thosewho followed did not understand this and seeing that he often usedPoria cocos ( fuling lsquoChina-rootrsquo) Lotus (lian ) Jasmine (zhi )and Phellodendron (huangbai or lsquoCork-treersquo) types of bitter andcold drugs [thought] that this was because they were better suited forthe south How superficial69

Zhursquos frequent use of bitter and cold medicines in his formulas wasnot because he was a southern physician but rather because his pre-decessors had not fully developed the use of these types of drugsZhu had the insight to develop what his predecessors had left incom-plete and which he alone was able to make whole By aligning him-self with Zhu Zhenhengrsquos teaching Wang Lun presented himself asthe inheritor of the most comprehensive medical knowledge to date

ASME 22_f3_115-170IIII 41207 511 PM Page 145

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 32: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

146 marta e hanson

70 Li Yun 1988 p 74371 Gujin yitong daquan 1998 juan 7 p 446

Rhetorically Wang employed the facile regional conception of thenorthern formulas of Li Gao for northerners and the southern for-mulas of Zhu Zhenheng for southerners to assert the opposite namelythe universal validity of his Enlightened Physicians for all potential readersthroughout the empire north and south

V Northwest-southeast and northern-southern in a Mingmedical compendium

Neither Wang Lun nor Xue Ji specifically cited the earlier geographicconcept lsquoHeaven is insufficient in the northwest earth is incompletein the southwestrsquo to explain either regional or corporal differencesthough they both accepted the geo-climatic northwest-southeast polar-ity based on it Both meanings of this concept however appear inanother mid-sixteenth-century text titled the Compendium of the MedicalTradition Past and Present (Gujin yitong daquan preface1556) edited by Xu Chunfu (1520ndash1596) He was born intoa hereditary family of officials in Anhui province but he favouredmedicine and ended up becoming an imperial physician in the MingImperial Medical Academy70 Xu Chunfu published this Compendiumfive years after Xue Jirsquos commentary on the Enlightened Physicians (pref-ace 1551) They may have even crossed paths in the Imperial MedicalAcademy In a lsquoGenuine guide to acupuncture and moxibustionrsquo(zhenjiu zhenzhi ) Xu Chunfu quoted verbatim the entire pas-sage of the Inner Canonrsquos lsquoOn different methods being regionally appro-priatersquo to provide the regional origin story of acupuncture andmoxibustion71

Zhu Zhenhengrsquos medical regionalism according to Xu Chunfursquos Compendium

The use of the concept lsquoHeaven is insufficient in the northwest earthis incomplete in the southwestrsquo to explain regional differences in cli-mate and constitutions appeared only in an essay titled lsquoMedicinesdiffer just as the customs of the four regions differrsquo (sifang fengtu butongfuyao yi yi ) Xu Chunfu attributed this passage

ASME 22_f3_115-170IIII 41207 511 PM Page 146

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 33: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 147

72 Danxi yiji 1995 Danxi xinfa juan 5 p 480 Jiuling shanfang ji juan 1073 Danxi yiji 1995 Jufang fahui pp 47 50 Danxi xinfa pp 196 200 209

21574 Gujin yitong daquan 1998 juan 3 p 198

to Zhu Zhenheng although an essay by this name could not be foundin any of his writings The closest parallels are found in Dai Liangrsquosbiography of Zhu Zhenheng titled lsquoDanxi weng zhuanrsquo in whichhe also cited the geo-climatic polarity that lsquoheaven is insufficient inthe northwest and earth is incomplete in the southeastrsquo in referenceto Zhursquos medical thought on regionalism72 Zhu Zhenheng discussedregional variation elsewhere in his work however which substanti-ates why Xu Chunfu and his readers associated this medical region-alism so directly with him73 Still the debate expressed in the followingpassage attributed to Zhu Zhenheng belongs more to Xu Chunfuand sixteenth-century Ming medicine than to Zhu Zhenheng andmedicine in the Yuan dynasty The passage opened with the fol-lowing statement

Danxi said the northwest region is windier and colder and so thosewho suffer from external afflictions are greater The southeast regionis fundamentally low lying and damp therefore those who suffer fromDamp and Hot [pathogenic factors] are numerous Since the north-ern region has high plateaus heaven is insufficient in the northwestresulting in greater windiness [Since] the southern region is low lyingearth is incomplete in the southeast resulting in more dampnessAccording to the local conditions each has its irregularity that whichgives rise illnesses mostly follows the locale with which it comes incontact74

Up to this point in the passage the concept of the tilting northwest-southeast axis does not differ significantly from one of its sources inthe lsquoMajor essay on the regulations of the five regularitiesrsquo (Wuchangzheng dalun ) of the Inner Canon of the Yellow Emperor BasicQuestions The rest of the passage however diverged from the InnerCanon original by emphasising northern and southern (not northwesternand southeastern) differences in climate bodily constitutions eatingand living habits illnesses and appropriate therapies

The passage attributed to Zhu Zhenheng used the same idiomsof lsquopowerful and robustrsquo (xiongzhuang ) and lsquosoft and fragilersquo (rou-cui ) that Dai Liang used to distinguish northern and southernconstitutions in his preface to Zhu Bishan The most striking paral-lel to these idioms outside of medicine can be found in the commentary

ASME 22_f3_115-170IIII 41207 511 PM Page 147

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 34: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

148 marta e hanson

75 Wusao hebian lsquoZuojia yupingrsquo 3ab I thank Katy Carlitz for showing methese citations on late-Ming views of northern and southern musical styles For moredetailed distinctions between northern and southern musical styles and a statementthat they only diverged in the Yuan dynasty see Yuanqu xuan preface 1ab

76 Ibid77 Jiuling shanfang ji juan 13

on northern and southern differences in musical styles of the late-Ming scholar Zhang Qi (c late 16th to early 17th century) Heused the same terms of a lsquopowerful and robustrsquo quality in northernmusic to contrast with the lsquosoft and fragilersquo (roucui ) quality ofsouthern music Northern music is more martial presumably becauseof its clanging instruments and percussion whereas southern musicis softer clearer and sharper implicitly because it relies on stringsand flutes75 Whether describing corporeal or musical differencesboth authors favoured northern qualities over southern ones

The following statement of northern and southern differences indrug therapies attributed to Zhu Zhenheng suggests why some peo-ple during the sixteenth century thought that his therapeutic meth-ods were best suited to southern patients

Physicians must decided on a treatment according to the season anddistinguish what is appropriate according to the land Treating north-ern disorders it is appropriate to consider attacking [formulas] to strikedown the external pathogenic (xie ) [qi ] as the most common [treat-ment] as for treating southern illnesses it is appropriate to considerprotecting [formulas] to nourish internal qi as the basic [treatment]Why is this so76

Attacking external pathogenic xieqi frequently covered most north-ern diseases and protecting and nourishing the patientrsquos internal qiusually best treated southern diseases The essay goes on to say thatthe weaker constitutions looser pores and indulgent diet of peoplein the southeast made them too weak to bear the drastic purgativescommonly prescribed in the north Patients in the northwest con-versely could handle purgatives because they had strong constitu-tions ate ordinary food and lived simply The structure argumentand specific examples in this passage in fact directly relate back toDai Liangrsquos account of his interactions with the Suzhou doctor ZhuBishan77 Xu Chunfu appears to have taken some of Dai Liangrsquos com-ments about Zhu Bishan and wove them into this passage on med-ical regionalism attributed to Zhu Zhenheng

ASME 22_f3_115-170IIII 41207 511 PM Page 148

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 35: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 149

Despite regional prevalence in constitutionsmdashrepletion of qi in thenorth and depletion of qi in the southmdashthe essay concluded that thiscould not be the case for everyone in each region It made a pointcomparable to the one Wang Lun made when he wrote that justbecause the climate in the north is colder and the southern climateis hotter that general pattern should not lead one to conclude sim-plistically that no illnesses are due to heat in the north or none aredue to cold in the south

Both Wang Lun and Xu Chunfu cited these examples of medicalregionalism in a comparable way They argued that while the edu-cated physician should understand these regional variations he mustnot be rigid in his practice or biased one way or the other XuChunfu attributed this essay to Zhu Zhenheng perhaps because itscentral concern about regional variation remained the serious lsquooffenceof a biased perspectiversquo ( yipian zhi bi ) in medicine ZhuZhenheng admonished learned doctors to consider the individualpatientrsquos condition and determine a treatment accordingly Similarto Wang Lunrsquos concluding statement on Zhu Zhenheng Xu Chunfualso presented Zhu Zhenheng through this citation as the type ofimpartial and unbiased physician he expected readers of the Compendiumboth to emulate and ideally become themselves These two elitephysicians of the literate sector of classical medicine created an unbi-ased persona in their medical primer and compendium respectively inresponse to the polarising tendencies of northern-southern medical region-alism among their contemporary competitors and potential critics

VI Li Zhongzi and late-Ming medical regionalism

Medical regionalism is useful for the historian as a lens into whatMing physicians thought was lsquoaskewrsquo in human society and problematicin medical practice Li Zhongzi (1588ndash1655) the author ofthe influential late-Ming medical primer Required Readings for Physicians(of the Orthodox) Lineage (Yizong bidu 1635) offered the mostrevealing path back to these issues Among the Ming medical authorsdiscussed he wrote the most extensive discussion of medical region-alism in two separate essays One from Required Readings and onefrom a book he published seven years later titled On the Subtleties ofNourishing Life Revised and Supplemented ([Shan bu] Yisheng weilun

1642)

ASME 22_f3_115-170IIII 41207 511 PM Page 149

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 36: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

150 marta e hanson

78 See Bao Laifa et al (eds) 1999 vol 1 pp 789ndash92 See also Li Yun 1988pp 272ndash3

79 Mingyi zazhu juan 1 pp 1ndash280 Yizong bidu juan 1 p 80 Unschuld 1985 203 also noted Li Zhongzirsquos defense

of these authors against charges of one-sideness81 See especially lsquoSummer The Last Century (1550ndash1644)rsquo in Brook 1998

pp 153ndash237

Li Zhongzi came from an elite family of officials who lived inJiangsu province in Yunjian now modern-day Songjiang prefecturejust southwest of Shanghai Li was the son of Li Shanggun ( jin-shi 1590) who in 1593 was promoted to an official position as a sec-retary in the Ministry of War Li Zhongzi succeeded far enoughalong the examination system to become a Government Student Hehad also earned himself a literary reputation According to his ownaccount because he had fallen ill himself he began to study theHan medical canons and the works of the lsquoFour medical mastersrsquo(sidajia ) namely Zhang Ji (c 196ndash220) Liu Wansu LiGao and Zhu Zhenheng78 These were the same physicians WangLun promoted as essential reading in the opening essay of his EnlightenedPhysicians79

In Required Readings Li discussed from several angles the diversityof medical doctrines and practices that he found in the medical cor-pus In an essay lsquoOn the four mastersrsquo (Sidajia lun) he explained thisdiversity in part as the result of a history of supplementing andimproving upon onersquos predecessors similar to Wang Lunrsquos view ofmedical history80 Li argued however that such differences were alsodue to marked contrasts in economic status eating habits anddwellings His new emphasis on constitutional contrasts between thewealthy and noble on one side and the poor and ignoble on theother contrasted with Xue Jirsquos earlier geo-climatic explanations ofnorthern and southern constitutions Over the course of the roughly75 years that separated Xue Ji and Li Zhongzi Ming China expe-rienced an economic and commercial transformation that markedlyincreased the distance between the wealthy and the poor81 Li Zhongzirsquosnew deployment of economic status as a marker of corporeal as wellas quality of housing lifestyle behaviours and eating habits resonatedwell with the changes in society and the economy his readers wouldhave experienced

ASME 22_f3_115-170IIII 41207 511 PM Page 150

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 37: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 151

82 Yizong bidu juan 1 p 8183 Ibid

(1) On regional and class differences in human constitutions

In addition to this general thinning of primordial qi among all humansin the second essay Li described differences in medical practice interms of economic status related to the same northern and southerncultural distinctions Dai Liang first mentioned in the fourteenth cen-tury In the essay lsquoOn the treatments for the wealthy and the poor notbeing the samersquo (Fugui pinjian zhibing you bie lun )Li argued that people from opposite class statuses had such significantlydifferent body types that they required separate kinds of medicaltreatments82 To illustrate his point Li used an example of two physi-cians who like Li Gao and Zhu Zhenheng in Wang Lunrsquos essayrepresented northern and southern regional styles of medicine

Li compared the northern Jin-dynasty physician Zhang Congzheng(1156ndash1228) and the southern mid-Ming doctor Xue Ji the

commentator and publisher of Wang Lunrsquos Enlightened Physicians Bothwere well known by Lirsquos time for having established different ther-apeutic strategies and founded opposite currents of thought in med-ical practice Zhang Congzheng was considered the founder of thelsquoAttack and purge current of learningrsquo ( gongxia pai ) becauseof his emphasis on descending prescriptions and purgatives Xue Jiwas considered to be the representative of the lsquoWarming and restor-ing current of learningrsquo (wenbu pai ) because of his advocacyof warming prescriptions and restorative tonics

Having read Zhang Zihersquos [ie Zhang Congzheng] Confucianrsquos ServeTheir Kin the drugs he used are only attacking (dagong ) and cut-ting down (dafa ) [ie drastic purgatives] [yet] toward [treating]disease [he was] miraculous And having read Xue Lizhairsquos [ie XueJi] Sixteen Kinds the drugs he used are only warming (dawen ) andrestoring (dabu ) [yet] toward [treating] diseases [he was] also mirac-ulous How could the use of drugs between these two men be oppositeand yet both be equally effective83

Li quoted from the Inner Canon Basic Questions chapter 78 titled lsquoOnevidence of the four lapsesrsquo (Wei si shi lun ) about differencesbetween the poor and the wealthy the noble and the ignoble

[If one] does not suit [formulas] according to [where] the wealthy andnoble ( fugui ) and the poor and ignoble ( pinjian ) dwell the

ASME 22_f3_115-170IIII 41207 511 PM Page 151

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 38: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

152 marta e hanson

84 The original text ends with the following conclusion lsquoCi zhi zhi san shi yirsquo(The three errors of this treatment) See lsquoWei sishi lunrsquo (On

evidence of the four errors essay 78) in Ren 1986 di 78 p 24985 Yizong bidu juan 1 p 81

thickness of [their] sitting [mats] the hotness or coldness of [their]bodies [If one] does not adjust what is appropriate [for them] to drinkand eat cannot differentiate the brave from the meek and cannotunderstand the comparison [then they have] completely confused them-selves and are insufficiently enlightened84

Similar to Dai Liangrsquos representative passage already quoted Liextended the class distinctions to corporeal ones by comparing howthe different foods and dwellings of the wealthy and the poor con-tributed to their contrasting constitutions and susceptibility to exter-nal pathogens

In general the wealthy and noble labor their minds and the poor andignoble labor their bodies The wealthy and noble feed themselves richfoods and grains the poor and ignoble fill themselves with sprouts andbeans The wealthy and noble have winding buildings with broad hall-ways the poor and ignoble have hatched huts in poor alleyways

Those who labor their minds have a depleted center weak sinewsand brittle bones Those who labor their bodies have full centersstrong bones and powerful sinews Those who feed themselves on richfare always have delicate organ systems Those who fill themselves onsprouts and beans always have strong organ systems Those who livein winding buildings with broad hallways have loose pores so that thesix pathogenic factors can easily reside [in their bodies] Those wholive in thatched huts in alleyways have tight pores so that the exter-nal pathogenic factors have a hard time getting [into their bodies]

Thus the maladies of the wealthy and noble are well suited to [pre-scriptions] that restore the upright (zheng) [qi that has been depleted]and the maladies of the poor and ignoble will benefit from [prescrip-tions] that attack the deviant (xie) [qi that has invaded their bodies]85

Li argued that Zhang Congzheng emphasised purgative drug ther-apy because he was treating commoners who worked the land withtheir hands Their firm visceral systems and tight pores closed theirbodies to external attack Because they rarely weakened from withinwhen they fell ill it was most often due to external factors such aspathogenic Wind and Cold that had passed through their bodilydefences Strong acting purgatives that attacked these external factorswere the best way to expel these climatic pathogens from the bodies

ASME 22_f3_115-170IIII 41207 511 PM Page 152

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 39: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 153

86 Yizong bidu juan 1 p 81

of his northern patients By contrast Li explained that Xue Ji favoureddrugs with a warming and replenishing effect because his southernpatients were wealthier and their more luxurious lives had weakenedand softened their bodies Their pores were loose their bodies vul-nerable to external attack and their inner qi in need of strengthen-ing For these reasons they required the restorative prescriptionsXue Ji prescribed to strengthen their bodies Unlike their northerncounterparts their bodies could not withstand drastic purgatives Lirelated the contrasts in therapeutic strategies to the differences ineconomic status diet and quality of life of the patients the doctorsZhang and Xue saw most frequently in their medical practices

The patients Zhang Congzheng cured were poor and ignoble so theycould withstand his drastic purgatives The patients Xue Ji cured weremainly the wealthy and noble so they were well suited to his restora-tives How in Zhang Congzhengrsquos entire life could it be the case thatnot one restorative prescription was effective How in Xue Jirsquos entirelife could it be the case that not one purgative prescription was effectiveIt is just that when they wrote books and established their perspec-tives they simply did not happen to mention these cases

There are those who say that [because] Zhang Congzheng wasnorthern it was suitable to act this way and since Xue Ji was south-ern it was appropriate for him to act in the way he did This is anoutsiderrsquos perspective Even though there were poor and ignoble fam-ilies for whom it was best to use restoratives it is just [the case thatfor Zhang Congzheng] there were more cases requiring purgatives andless requiring restoratives Even though there were wealthy and noblefamilies for whom [sometimes] it was also best to use purgatives it isjust [the case that for Xue Ji] there were fewer cases requiring purga-tives and more requiring restoratives

In these cases one ought to take what is appropriate to the regionas a distinguishing [characteristic] and what is the natural endowmentof the person as a differentiating [factor] As a base line determinewhether the person is in his prime or elderly whether depleted or fullDo not be stuck on the one approach regarding the personrsquos residenceand diet and determine treatment only on those two bases86

The main lesson to be learned from this discussion of human vari-ation is not that these economic and climatic differences determineda patientrsquos illness but rather that they were stereotypical and couldwell lead the physician astray Similar to Wang Lun and Xu Chunfu

ASME 22_f3_115-170IIII 41207 511 PM Page 153

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 40: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

154 marta e hanson

87 The exception is Zhang Jiebin (1563ndash1640) in his Classified Canon (Lei jing 1624) published just two decades earlier He wrote a lengthy commen-tary on the Inner Canon Basic Questions essay lsquoYifa fangyi lunrsquo that elaborated thedifferences of the original five regions from the Former-Han dynasty version ZhangJiebinrsquos commentary however did not revise or restructure the original essay as LiZhongzi significantly did See Lei jing juan 12 pp 199ndash200

88 [Shan bu] Yisheng weilun juan 2 pp 694ndash5 The bold characters in slightly largerfont size are those that Li added to the original Inner Canon essay The parenthesesindicate characters and phrases from the original text that Li left out in his version

earlier Li Zhongzi used medical regionalism to criticise over-simplifiedmedical principles and biased approaches to medical care Comparableto how Wang Lun corrected what he thought was a popular mis-conception of Zhu Zhenhengrsquos writings as only for the south Liargued that the physicians Zhang Congzheng and Xue Ji were notregionally biased or partial but rather had finely adapted their treat-ments to the needs of their poorer and wealthier patients respec-tively He too constructed a persona of the unbiased literate physicianin response to accusations circulating in public of the regional par-tiality of those physicians he considered his worthy predecessors

(2) Li Zhongzi on winds and soils and the five regions

In his second book On the Subtleties of Nourishing Life Li devoted one longessay on regional differences titled lsquoOn localityrsquo ( fangtu lun )In contrast to most of his predecessors Li closely followed the struc-ture of the Inner Canon of the Yellow Emperor essay on lsquoOn differentmethods being regionally suitablersquo87 I have reproduced a full trans-lation of the text in the figure below88 [See Figure 5b] The mostobvious innovation to the original Inner Canon essay is integration ofthe five phases in the opening passages for each region Li addedthe five phases five seasons and five climatic configurations of qiunder each category Li Zhongzirsquos version of the Inner Canonrsquos lsquoOndifferent methods being regionally appropriatersquo differentiated theancient five regions of the Former Han dynasty into commonly knownprovincial and regional names of the Ming dynasty the east nowbecame Southern Zhi (ie Jiangsu centred around Nanjing the for-mer capital of the Ming) Zhejiang Shandong and Fujian the westcomprised Shaanxi and Sichuan the north was now Shanxi andNorthern Zhi (ie Hebei centred around Beijing the capital of theMing) the south included Jiangxi Guangdong Yunnan and Guizhou

ASME 22_f3_115-170IIII 41207 511 PM Page 154

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 41: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 155

and finally the central region encompassed Henan and Hunan Litranslated the abstract five regions into concrete administrative bound-aries that any Ming reader would recognise he rhetorically realignedthe ancient symbolic system with the current social realm of theMing body politic Lirsquos version integrated the five phases doctrinewhich did not exist in the original Inner Canon essay and mapped itonto the current Ming empire his readers would comprehend

Resuming the structure of the Inner Canon essay Li Zhongzi pro-ceeded with a description of the dominant types of food people atein each region and basic differences in their lifestyles The chart ofhis revisions reveals several obvious asymmetries In the section ofthe essay on bodily constitutions for each region for instance Liadded the most commentary on the southern and eastern regionsFor the bodily constitutions of northerners the original Inner Canonessay said nothing nor did Li Zhongzi have anything to add Thecharacteristics of having full yang qi and resistance to external inva-sion that later became associated with the lsquonorthernrsquo constitutionwere originally attributed to the lsquowesternrsquo constitution both in theInner Canon essay and again in Lirsquos revision Li added only a state-ment that the dominant illnesses in the north are due to being struckby cold This lack of further detail on the northern regions com-pared to the detail on the southern and eastern regions suggests thathis medical experience and priorities were also regionally focused inthe southeast where he lived and practised medicine

Li returned to the five phases in his comments on regional ill-nesses and new statements on the rationale for herbal formulas foreach region in the east the physician should prescribe formulas thatincrease the foundation of Earth twofold in order to control thepathogenic Wind in the west strong attacking formulas were themost appropriate therapy even though they could be deadly in the north since most illnesses were caused by cold it was appro-priate to increase the Fire source in order to diminish the concealedyin [ie pathogenic cold] in the south it was appropriate to takeWater as the ruler in order to control the brilliance of yang qi andin the centre one should give formulas that assist the Wood phaseas the ruler in order to control the pathogenic Earth phase in thebody Instead of expressing anxiety about a more indulgent southernlifestyle in contrast to a more frugal restrained northern one howeverhe blamed excessive emotions foods and sexual relations for the ill-nesses of those who lived in the western region of China Li Zhongzi

ASME 22_f3_115-170IIII 41207 511 PM Page 155

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 42: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

156 marta e hanson

Fig 5a On the Subtleties of Nourishing Life Revised and Supplemented[Shan bu] Yisheng weilun juan 2 lsquoOn Localityrsquo

1

2

3

4

5

6

ASME 22_f3_115-170IIII 41207 512 PM Page 156

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 43: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 157Pre

fato

ry

(The

Yel

low

Em

per

or

aske

d

As

for

when

phys

icia

ns

trea

t ill

nes

ses)

why

is it th

at th

ey use

diffe

rent

trea

tmen

ts fo

r th

e sa

me

illnes

s

Ques

tion

([ye

t] cu

re a

ll)

(Qi

Bo r

esponded

) [D

iffe

rent] f

eatu

res

of

the

land c

ause

it

to b

e so

T

he q

iof

the f

ive r

egio

ns

is n

ot

uniform

th

us

the c

oars

e

labor

and vari

ous

[thera

pie

s w

ere

] com

bin

ed to

geth

er

in ord

er

to tr

eat

[illness

es]

how

could

[o

ne]

unders

tand th

e

overa

ll c

onto

urs

[of

these

thera

pie

s]

Those

who h

ave l

ived a

long l

ife a

nd t

urn

ed g

rey d

id n

ot

dis

tinguis

h b

oundari

es

[as

for]

engagem

ent

wit

h t

he f

our

regio

ns

and t

he c

onst

ants

of

man

how

could

one n

ot

study t

hem

to t

heir

lim

it

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

5 R

egio

ns

The e

ast

ern

regio

n

The w

est

ern

regio

nT

he n

ort

hern

regio

nT

he s

outh

ern

regio

nT

he c

entr

al

regio

n

Pro

vince

sto

day i

s South

ern

Zhi

today i

s Shaanxi

today i

s N

ort

hern

Zhi

today i

s Ji

angxi

today i

s H

enan

(Nanjing a

nd e

nvir

ons)

and S

ichuan

(Beijin

g a

nd e

nvir

ons)

Guangdong a

nd

Hunan

and H

ubei

Zhejiang

Shandong

and S

hanxi

Guangxi Y

unnan

and F

ujian

and G

uiz

hou

5 P

has

esIt

s im

age i

s W

ood

Its

image i

s M

eta

lIt

s im

age i

s W

ate

rIt

s im

age i

s Fir

eIt

s im

age i

s Eart

h

5 S

easo

ns

Its

seaso

n i

s sp

ring

Its

seaso

n i

s autu

mn

Its

seaso

n i

s w

inte

rIt

s se

aso

n i

s It

s se

aso

n i

s hig

h

sum

mer

sum

mer

1

(Thus

the

easter

n r

egio

n

(The

wes

tern

reg

ion i

sT

he

norther

n r

egio

n i

sT

he

south

ern r

egio

n i

sT

he

central

reg

ionrsquos

Lan

dis)

the

pla

ce w

her

e

the

terr

itory

of

gold

and

wher

e hea

ven a

nd e

arth

wher

e hea

ven a

nd e

arth

land i

s le

vel

and

hea

ven a

nd e

arth

first

jade

the

pla

ce o

f sa

nd

secu

re a

nd s

tore

[th

ings

]m

ature

and n

ourish

ther

eby

dam

p

It i

s

bring

[thin

gs]

to l

ife

an

d s

tones

) w

her

e hea

ven

Those

who e

ncounte

r[thin

gs] T

hose

who

wher

e hea

ven a

nd e

arth

Those

who e

ncounte

r

and e

arth

bring

in t

he

the w

ind q

iof

the

encounte

r th

e w

ind

enge

nder

the

myr

iad

the w

ind q

iof

the

har

vest

Those

who

nort

hern

regio

n o

ften

qi

of

the s

outh

ern

th

ings

T

hose

who

east

ern

regio

n o

ften

encounte

r th

e w

ind q

i[c

atc

h]

cold

re

gio

n o

ften [

catc

h]

encounte

r th

e w

ind

[catc

h]

win

d

of

the w

est

ern

regio

n[d

isord

ers

] T

he

land

hot

[dis

ord

ers

] (

and

qi

of

the c

entr

al

[dis

ord

ers

] [

It i

s] t

he

oft

en [

catc

h]

dry

ness

is h

igh

[ther

e ar

e] c

ave

w

her

e ya

ng

[qi]

is

regio

n o

ften [

catc

h]

land o

f fish

and s

alt

[dis

ord

ers

] T

he l

and

dw

ellin

gs

win

d

cold

abundan

t)

The

land i

s dam

p [

dis

ord

ers

] I

ts

[wher

e] o

cean

shore

s has

hig

h p

late

aus

(lsquoT

he

ice

and [

bitte

r] c

old

lo

w l

ying

wat

er a

nd

land i

s le

vel

wit

h

mee

t w

ater

[w

ays]

peo

ple

) her

e liv

e in

cav

es

soils

are

wea

k I

t is

mois

ture

it

is

the

and i

t is o

ften

win

dy

the

wher

e fo

gs a

nd d

ews

centr

al

hub o

f th

e

meta

l qi

is s

evere

and

asse

mble

V

aporo

us

four

regio

ns

and t

he

deadly

th

e w

ater

and

mia

smas

overp

ow

er

meeti

ng p

oin

t of

the

soil

are

har

d a

nd s

trong

people

m

yri

ad t

hin

gs

ASME 22_f3_115-170IIII 41207 512 PM Page 157

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 44: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

2

The

peo

ple

her

e ea

t fish

T

he

peo

ple

her

e do n

ot

The

peo

ple

her

e lik

eT

he

peo

ple

her

e fa

vor

Num

erous t

here

fore

Custom

san

d f

avor

salty

foods

wea

r si

lk c

loth

[silk

s]to

res

ide

in t

he

wild

sour

[foods]

and e

atth

e peo

ple

her

e ea

t

their

benefits

are

but

wear

coar

se c

loth

and c

onsu

me

milk

fe

rmen

ted [

foods]

div

erse

[fo

ods]

and d

o

abundant t

here

fore

and s

traw

[T

hey]

eat

[They]

do n

ot

use

not

get

fatigu

ed [

ie

(all)

are

pea

cefu

l in

thei

r coagula

ted m

ilk

incense

It

is

afrom

har

d w

ork

]

abodes

and t

here

fore

(s

u

) and j

unket

pla

ce w

here

yang

they d

o a

s th

e p

lease

(lao

)dom

inate

s

[and]

appre

ciat

e th

eir

foods

3

[Sin

ce]

fish

ari

se f

rom

(T

he

peo

ple

her

e hav

eT

her

efore

(th

e peo

ple

The

Majo

r Ess

ay o

n

Constitutions

dam

pness

and h

eat

ple

ntifu

l fo

ods

and)

their

her

e al

l hav

e fine

[ie

th

e R

esonance

and

they

cause

hea

t w

ithin

bodie

sar

e (thus) c

orp

ule

nt

tigh

tly

disper

sed]

pore

s Appea

rance

of

Yin

hum

ans T

he s

alt

Skin

and p

ore

s are

and)

many h

ave

a and Y

ang

[ie

I

nner

ente

rs t

he k

idneys

clo

sed t

ightl

y

Blo

od

reddish c

om

ple

xionrsquo T

he

Canon

Basi

c

kid

neys

are

cla

ssifie

d

and q

iare

full

sour

sapor

govern

s Q

uest

ions

5]

said

wit

h W

ate

r W

ate

r re

stra

int

[ie

the d

am

p q

iof

a

govern

s Fir

e

Fir

e i

s st

ringency]

there

fore

pla

ce

[if]

contr

acte

d

cla

ssifie

d w

ith t

he

they a

ll h

ave f

ine

then h

arm

s th

e f

lesh

heart

th

e h

eart

rule

s pore

s H

ot

qi

dam

ages

and t

endons

the B

lood

[and]

salt

the i

nte

rior

dam

p q

i

rule

s ove

r Blo

od

whic

h

dis

pers

es

on t

he

cause

s people

to h

ave

exte

rior

and w

ith

fevers

and y

in d

am

age

their

pre

fere

nce f

or

[so]

the

peo

ple

her

e al

l so

ur

[foods]

th

e l

iver

hav

e a

dar

k co

mple

xion

channel

is h

arm

ed

and o

pen

[ie

lo

ose

ly

disper

sed]

pore

s

158 marta e hanson

ASME 22_f3_115-170IIII 41207 512 PM Page 158

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 45: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 159Fig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

4

Thei

r ill

nes

ses

are

all

Ther

efore

exte

rnal

The i

llness

es

here

are

Thei

r ill

nes

ses

are

spas

ms

Thei

r ill

nes

ses

are

Illn

esse

sca

rbuncl

es (

yong

)pat

hoge

nic

[qi

] ca

nnot

most

ly c

old

str

oke

it(lu

an)

and n

um

bnes

soften

par

alys

is (

wei

)

and a

bsc

esse

s (y

ang

har

m (

thei

r bodie

s [s

o]

is a

ppro

pri

ate

to

in t

he

trunk

and l

imbs

(bi

num

bnes

s or

cold

nes

s in

) It

is

thei

r ill

nes

ses

arise

incre

ase

the F

ire

) It

is

appro

pri

ate

the

extrem

itie

s (j

ue)

appro

pri

ate

to

from

within

) i

n a

llso

urc

e i

n o

rder

to

to t

ake W

ate

r as

the

when q

ihas

double

the E

art

h

case

s th

eir

illness

es

dim

inis

h t

he c

onceale

d

rule

r in

ord

er

tore

treate

d

and c

old

or

foundati

on i

n

ari

se f

rom

excess

es

yin

(H

idden

[pat

hoge

nic

] c

ontr

ol

the b

rillia

nce

hot

[disord

ers]

[O

ne]

ord

er

to c

ontr

ol

of

the s

even e

moti

ons

cold

[in

the

body]

giv

es

of

yang

ought

to a

ssis

t W

ood

the p

ath

ogenic

consu

mpti

on o

f fo

od

rise

to i

llnes

ses

of

fulln

ess

as

the r

ule

r in

ord

er

Win

d

and d

rink

and m

ale

-(m

anbing

))

to c

ontr

ol

the

fem

ale

[re

lati

ons]

path

ogenic

Eart

h

5

Thei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

eT

hei

r ap

pro

priat

e

Tre

atm

ents

trea

tmen

t is s

tone

nee

dle

strea

tmen

ts a

re t

oxi

c [ie

trea

tmen

t is m

oxi

bustio

ntrea

tmen

t is n

eedle

strea

tmen

t is g

uid

ing-

(bians

hi)

pote

nt] d

rugs

(du

yao

) an

d c

aute

riza

tion (

jiuru

o(z

hen

)pulli

ng

(dao

yin

)

severe

att

ack

)an

d m

assa

ge (

anqiao

[form

ula

s]

whic

h c

an

)

als

o c

ause

a q

uic

k

death

6

Origi

n o

f T

his i

s w

hy

stone

This i

s w

hy

toxi

c dru

gsT

his i

s w

hy

moxi

bustio

nT

his i

s w

hy

the

nin

eT

his i

s w

hy

guid

ing-

Tre

atm

ents

nee

dle

s al

so c

ame

also

cam

e from

the

and c

aute

riza

tion c

ame

nee

dle

s ca

me

from

the

pulli

ng

and m

assa

ge

from

the

easter

nw

este

rn r

egio

n

from

the

norther

n r

egio

n

south

ern r

egio

n

also

cam

e from

the

regi

on

central

reg

ion

ASME 22_f3_115-170IIII 41207 512 PM Page 159

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 46: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

160 marta e hansonFig

5b (

cont

)

5 R

egio

ns

Eas

tW

est

North

South

Cen

tral

Concl

usion

(Ther

efore

th

e sa

ges

com

bin

ed t

he

various

[ther

apie

s] s

o a

s to

tre

at e

ach c

ontrac

ted [

illnes

s] a

ccord

ing

to w

hat

is

appro

priat

e [to i

t]

Hen

ce

as f

or

case

s of

using

diffe

rent

ther

apie

s an

d c

uring

all

the

illnes

ses t

his i

s bec

ause

[th

ey]

gras

ped

the

circ

um

stan

ces

of

[eac

h]

illnes

s an

d u

nder

stood t

he

ove

rall

conto

urs

of

ther

apy

)

Danxi

said

T

he n

ort

hw

est

ern

regio

n h

as

most

ly w

ind a

nd c

old

th

ere

fore

there

are

many o

f th

ose

who s

uff

er

from

exte

rnal

aff

licti

ons

who l

ive t

here

[Li

Zhongz

i quote

d t

he

entire

pas

sage

that

Xu C

hunfu

attribute

d t

o Z

hu Z

hen

hen

g an

d i

ncl

uded

in h

is M

edical C

ompe

ndiu

mof1556

juan

3

Tra

nslat

ed i

n f

ull

under

sec

tion I

V] T

his

is

not

far

from

the c

ase

when [

one]

is i

gnora

nt

of

the c

ause

of

surp

lus

or

deple

tion

yet

[one]

wis

hes

to e

xert

onese

lf f

orc

efu

lly t

o d

raw

up a

pla

n o

f acti

on

Fig

5b

lsquoOn l

oca

lity

15rsquo

(Fan

gtu

lun

di s

hiwu)

juan

2

On

the

Subtletie

s of N

ourish

ing

Life

Revised

and

Sup

plem

ented

(Sha

n bu

Yishe

ng w

eilu

n p

r 1

642 C

E)

ASME 22_f3_115-170IIII 41207 512 PM Page 160

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 47: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 161

89 On lsquoThe pharmacology of systematic correspondencersquo see Unschuld 1985179ndash188

90 See Leung 2002 pp 168ndash9 pp 196ndash7 for this insight on Zhang Congzhengrsquosinnovation and examples of other doctors who specified certain drugs for differentregions thereafter in the Ming and early Qing

91 Synonym is jin yu zao Ceratophyllum demersum L (anglmdashhornwort) Fegravevreand Meacutetailieacute 2005 p 161

92 This term most likely refers to haidai Laminaria japonica Aresh (anglmdash

did not here nor elsewhere give a clue to why he held such a neg-ative view of westerners Perhaps for him they represented peopleon the frontiers of China proper who were not integrated into thesocial expectations of moderation in Chinese culture The drasticpurgatives previously associated with the therapeutic style of thenorthern physician Zhang Congzheng became the regionally appro-priate therapy for those who lived in the west where potent drugswere thought to have originated

Lirsquos comments on the appropriate responses to regional illnessesmdashin the south north east west and centremdashprovided the generalrationales of an herbal formula appropriate for each area Li Zhongzirsquosrevision of the Inner Canonrsquos essay on regionalism not only interpo-lated the five phases into the Han original it offered strategies forregionally appropriate herbal formulas that did not exist in the FormerHan dynasty when the Inner Canon was compiled89 This process ofintegrating herbal medicines into the five regions model appears tohave begun with the same Zhang Congzheng whose drastic purga-tives Li Zhongzi defended as appropriate for Zhangrsquos poorer north-ern patients90

In the first essay of his famous Confucianrsquos Serve Their Kin (Rumenshiqin ) titled lsquoThe rules of the seven formulas and the tenprescriptionsrsquo (qifang shiji shengmo ) Zhang Congzhenglisted the most appropriate drugs for each of the five regions Duringthe Jin dynasty regional diversity in preferred drugs appears to havebeen so common that Zhang systematised them into the pre-existingfive regions model from the Inner Canon

As for the central region its form is the Earth [phase] and so thereare many cases of illnesses [there] of the spleen and stomach [iebecause both are correlated to Earth] The foods dwellings feelingsand longevity [of the centre] are shared in all four regions As forusing drugs [they] also use miscellaneous [things] in their various for-mulas and [thereby] treat patients For example the east has Ceratophyllumdemersum L (zao )91 and seaweed (dai )92 the south has dingmu

ASME 22_f3_115-170IIII 41207 512 PM Page 161

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 48: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

162 marta e hanson

kombu) As materia medica it could also refer to da ye zao Zostera marina L(anglmdasheelgrass grass wrack) Fegravevre and Meacutetailieacute 2005 pp 91 161

93 This term most likely refers to dingmushu which has however two syno-nyms ciqiu Kalopanax septemlobus (Thunb) Koidz [= Kalopanax pictus (Thunb)Nakai] and liangzimu Cornus macrophylla Wall (anglmdashlargeleaf dogwood) Fegravevreand Meacutetailieacute 2005 pp 69 106 275

94 Fresh form is shengjiang dried form ganjiang Zingiber officianale Rosc(anglmdashginger) Fegravevre and Meacutetailieacute 2005 p 228 Hu 1980 p 10

95 Full term is fuzi Aconitum carmichaelii Debx (anglmdashSichuan Aconite or monkshood) Synonyms wutou and jitouzi Fegravevre and Meacutetailieacute 2005pp 139 473 Hu 1980 p 32

96 Full term is renshen Panax ginseng CA Mey [= Panax schinseng Nees] (anglmdashginseng) Fegravevre and Meacutetailieacute 2005 p 373 Hu 1980 p 49

97 Full term is fuling Poria cocos (Schw) Wolf (anglmdashTuckahoe Indian breadVirginia truffle) Fegravevre and Meacutetailieacute 2005 p 138 Hu 1980 p 31

98 Fegravevre and Meacutetailieacute 2005 p 300 Hu 1980 p 6799 Rumen shiqin juan 1 p 21

100 For support of this argument that mid- to late-Ming physicians preferred drugsover acupuncture and moxibustion see Furth on the pharmaceutical strategies ofthe Ming doctor Cheng Congzhou (1581ndash) 1999 pp 224ndash65 See also Cullen onliterate male practitioners and their preference for drug therapies in his analysis ofthe medical care in the 16th-century novel Jinpingmei 1993 pp 115ndash22

93 the west has ginger ( jiang )94 and aconite ( fu )95 and thenorth has ginseng (shen )96 and [the edible fungus] Poria cocos (ling

)97 and the central region has Ephedra sinica (mahuang )98 [With]far reaching ambition [one] may possibly bring [the various regionaldrugs] together [into formulas ie like spokes of a wheel] and par-ticipate in combining them [ie into new effective formulas]99

By the late-Ming dynasty the considerable pharmaceutical literatureincluding lsquomateria medicarsquo (bencao ) and lsquoformulariesrsquo ( fangshu

) had become the main therapeutic resources for literate physi-cians such as Li Zhongzi and his potential readers Zhang Congzhengrsquoscomments on the drugs of the five regions influenced Li Zhongzimost clearly in his remarks on the need to control lsquoearthrsquo (whichcorresponded to spleen and stomach illnesses) in the central regionInstead of Zhangrsquos specific drugs however Li listed regionally appro-priate therapeutic strategies for using drugs Li did not elaborate atall on the other four therapeutic methods in the original Inner Canonessaymdashthe stone needles of the east the moxibustion and cauterisa-tion of the north the nine needles of the south or the daoyin andmassage practices of the centre This omission suggests that thesetherapeutic techniques were of only antiquarian interest for an elitephysician like himself whose practice consisted mainly of writing pre-scriptions100 He concluded his revision with the same quotation that

ASME 22_f3_115-170IIII 41207 512 PM Page 162

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 49: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 163

101 Summary of arguments in Leung 2002 pp 201ndash3

Xu Chunfu quoted and attributed to Zhu Zhenheng on lsquoThe fourregions wind and soil not being the samersquo By quoting Zhu on the lsquofourregionsrsquo Li related the ancient five regions model to the northwest-southeast polarity with which most of his readers would already befamiliar This northwest-southeast polarity not only mirrored a geo-graphic and social reality for physicians it was for them a medicalfact that guided their choice of therapies and structured their assess-ments of a skewed physical and human geography

Conclusion

The Ming medical discourse on regional diseases revealed three typesof social diagnosis 1) conflicts over diverse practices in the literatesector of medicine 2) concerns about universal validity over regionalbiases and 3) anxieties about the health consequences of the increas-ingly indulgent lifestyles in the wealthy regions to the southeast Thegreater value placed on all things associated with the northwest andthe north can be traced back to their historical place as the politi-cal and cultural centres of Chinese culture These geographic divi-sions were also more important in Chinese medical discourse thanthe urban-rural divide that dominated European medical discoursebecause of Chinarsquos political history going back to the north-southdivision of the Northern Jin and Southern Song dynasties101

These geographic divisions also reveal actual social fissures in themedical sphere that were regionally based The northern official-scholar Dai Liang made the northern-southern conflict visible in hisbiography of the Jiangnan physician Xiang Xin and in his prefacefor the Suzhou physician Zhu Bishan Just over a century later inthe first decade of the sixteenth century Wang Lun by contrastchallenged critics who sought to diminish Zhu Zhenhengrsquos work asmerely southern He also warned his novice readership to avoid sim-plistic environmental determinism and to become more discerningin their practice During the mid-sixteenth century Xue Ji on theother hand emphasised corporeal differences and expressed concernabout the regional limits of drug therapies for epidemics Xue Jirsquosemphasis on regional constitutionalism contrasted markedly withWang Lunrsquos critique of regional essentialism Near the end of the

ASME 22_f3_115-170IIII 41207 512 PM Page 163

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 50: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

164 marta e hanson

102 Unschuld 1985 179ndash188 A comparable integration of Jin-Yuan innovationsin materia medica and herbal formularies can be seen in the work of his discipleGuo Peilan for whose Collected materia medica (Bencao hui ) Li Zhongziwrote a preface Unschuld 1986 120ndash22

Ming in the 1620s by contrast Li Zhongzi explained ZhangCongzhengrsquos use of lsquonorthern purgativesrsquo and Xue Jirsquos own biastoward lsquosouthern restorativesrsquo as rooted in the economic differencesbetween the north and the south

The commercial transformation of Chinese society between thetime of Xue Ji in the 1550s and Li Zhongzi in the 1620s increasedthe chasm between the rich and poor to such an extent that eco-nomic status became a newly resonant maker of even corporealdifference Furthermore Lirsquos updating of the Inner Canon Basic QuestionrsquoslsquoDifferent methods being regionally appropriatersquo added the five phasesdoctrine and herbal medicine strategies that had been integrated intothe Chinese formulary literature since the innovations in drug ther-apy of the Jin-Yuan period102 Sympathetic with Wang Lunrsquos argu-ments for impartiality however Li Zhongzi also cautioned physiciansagainst regional determinism The ideal persona of an unbiased andimpartial elite physician emerged from this medical debate on lsquonorth-ern purgatives and southern restorativesrsquo as a compelling (if not new)social identity for Ming literati physicians and a persuasive market-ing strategy in the publishing realm Although the debate clearlyexpressed nostalgia for the frugality restraint and hardiness associ-ated with the northwest their portrayal of the more leisurely indul-gent and delicate southern patient could also be read as an affirmationof southern cultural distinctiveness if not actual superiority Thesesouthern medical authors presented their own syntheses of medicalknowledge as balanced comprehensive and universal

A synchronic approach to Ming medical regionalism uncovered awide range of sixteenth-century sources that used the geo-climaticnorthwest-southeast polarity in multiple ways The illustrations in theYuan and Ming editions of the Broad-Ranging Record on Many Mattersencyclopaedia depicted the world askew since the time Gong Gongknocked down the north-western pillar Mount Buzhou holding upheaven Ming physicians used the northwest-southeast polarity intheir writings on medical diversity because at that time it was awidely held lsquosocial factrsquo that corresponded not only with their senseof political history but also with their social and medical experienceThe Ming medical debate over northern purgatives and southern

ASME 22_f3_115-170IIII 41207 512 PM Page 164

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 51: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 165

restoratives occurred within this symbolic system From the per-spective of the sociology of knowledge it was also fundamentallyabout southern physiciansmdashsuch as the official-physician Wang Lunthe southern physician Xue Ji the medical compiler Xu Chunfuand the scholar-physician Li Zhongzimdashstrategically carving out anew social niche for themselves as the impartial medical authoritiesfor all citizens of the Ming empire in all their diversity north andsouth noble and ignoble

Acknowledgements

I would like to thank the following people and institutions for invit-ing me to present earlier versions of this article Ruth Rogaski andTJ Hinrichs organised a Chinese medical text reading workshop atPrinceton University in the spring of 2000 which gave me the oppor-tunity to first discuss with other scholars my initial interpretations ofWang Lunrsquos Enlightened Physicians Professors Liu Dun and ChengChen-yi mdashinvited me to present the earliest version of this arti-cle at the Ninth International Meeting of the History of ChineseScience Hong Kong University 9ndash12 October 2001 I also learnedfrom many colleagues when I presented this research for a panel Ichaired on lsquoCultural Authority in Chinese Medical Historyrsquo at theTenth International Conference of the History of East Asian ScienceTechnology and Science Society Shanghai Communications University20ndash23 August 2002 I would also like to thank Professor HsiungPing-chen who invited me to present an earlier version of this research at the Modern History Institute of Academia Sinica23 September 2002 Finally I am grateful to Professor Li Jianmin

for inviting me to the conference on lsquoMedical Perspectiveson Chinese Historyrsquo 13ndash15 December 2005 I completed this revi-sion in large part because of his encouragement support and espe-cially patience I would also like to thank the first two anonymousreviewers who gave me sound criticism and Ms Beatrice Yang whotranslated it into Chinese for Li Jianminrsquos edited volume Cong yiliaokan zhongguo shi (Medical Perspectives on Chinese History)Two reviewers from Asian Medicine offered further suggestions andinsightful criticisms which I have integrated as much as possible intothis final and shorter English version Michael Helme invented theChinese footnotes into the AM format for footnotes and referencesimproving the manuscript in the process Vivienne Lo deserves a

ASME 22_f3_115-170IIII 41207 512 PM Page 165

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 52: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

166 marta e hanson

final accolade for her editorial magic wand All remaining problemsand errors remain my own

References

The following abbreviation LHML indicates the titles and editions of medicaltexts according to Xue Qinglu et al (eds) 1991 Quanguo Zhongyi tushu lianhe mulu

Primary sources

Danxi yiji (Collected Medical Works of Danxi) Zhu Zhenheng (1282ndash1358) ReprintmdashBeijing Renmin weisheng chubanshe 1995

Gujin luli kao (Examination of the Calendar Past and Present) Xing Yunlu jinshi 1580 Zhang Yining 1301ndash1370 electronic edition of the

Wenyuange Siku quanshu ReprintmdashShanghai Shanghai guji chubanshe 1987Gujin yitong daquan (Compendium of the Medical Tradition Past and

Present) Xu Chunfu completed 1556 LHML 11510 ReprintmdashCuiZhongping Wang Yaoting (eds) Beijing Renmin weisheng chuban-she 1998

Huainanzi in Sibu beiyao (Essentials of the Four Branches of Literature)ReprintmdashShanghai Zhonghua shuju 1990 [1935]

Huangdi neijing suwen amp lingshu (Inner Canon of the YellowEmperor Basic Questions amp Divine Pivot) ReprintmdashRen Yingqiu 1986[1960] Huangdi neijing zhangju suoyin (Phrase Index to the InnerCanon of the Yellow Emperor) Beijing Beijing renmin weisheng chubanshe

Jiuling shanfang ji (Collected Works from the Mountain Villa of NineDivinities) Dai Liang (1317ndash1383) electronic edition of the Wenyuange Siku quan-shu ReprintmdashSibu congkan Shanghai Shanghai yinshu guan 1927 Also ReprintmdashShanghai guji chubanshe 1987

Lei jing (Classified Canon) by Zhang Jiebin this version published in1624 by Jinchang tong yong quan LHML 000333 ReprintmdashLi Zhi-yong (ed) Zhang Jingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe1999

Lei jing tuyi (Illustrated Commentary of the Classified Canon) Zhang Jiebin this version published in 1624 as an appendix to the Leijing by Jinchang

tong yong quan LHML 000333 ReprintmdashLi Zhiyong (ed) ZhangJingyue yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Mingyi zazhu (Miscellaneous Writings by Enlightened Physicians) Wang Lun 1502 CE completed this version commentated on and reprinted by Xue

Ji in 1549 CE LHML 049032 ReprintmdashWang Xinhua (ed) Zhongyi gujixiaocongshu Nanjing Jiangsu kexue jishu chubanshe 1985

Mingyi zhizhang (Guide for Enlightened Physicians) by Huang Fuzhong earliest edition 1579 CE this version edited by Wang Kentang in 1622

CE LHML 049162 ReprintmdashZhang Yinsheng (ed) Ming Qing zhongyilinzheng xiaocongshu Beijing Zhongguo zhongyiyao chubanshe 1997

Puji fang (Formulas for General Benefit) Zhu Su (d 1425) completed1390 earliest extant edition 1618 LHML 029951 in electronic edition of theWenyuange Siku quanshu ReprintmdashTaipei Shangwu1982 Beijing Renmin weishengchubanshe 1958ndash1960

Rumen shiqin (Confucians Serve Their Kin) Zhang Congzheng LHML 14879 ReprintmdashDeng Tietao (ed) Zihe yiji (ZihersquosCollected Writings on Medicine) Beijing Renmin weisheng chubanshe 1996

ASME 22_f3_115-170IIII 41207 512 PM Page 166

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 53: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 167

Sheng shou wannian li (Imperial Longevity Permanent Calendar) editedby Zhu Zaiyu 1536ndash1611 in electronic edition of the Wenyuange Siku quanshu ReprintmdashTaipei Shangwu yinshuguan 1981 Shanghai guji chubanshe1987

[Xinbian qunshu leiyao] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanjing Japanese Zhishun (ed) 1699ReprintmdashBeijing Zhonghua shuju chuban 1999

[Zuantu zengxin leiju] Shilin guangji [ ] (Broad-Ranging Recordon Many Matters) by Chen Yuanliang Xiyuan jingshe reprintMing Hongzhi edition (r 1488ndash1505) ReprintmdashTaipei facsimile Fu Sinian libraryAcademia Sinica

[Zuantu zengxin qunshu lei yao] Shilin guangji [ ] (Broad-Ranging Record on Many Matters) by Chen Yuanliang Jian an chunzhuangshuyuan Yuan Zhishun edition (r 1330ndash33) ReprintmdashBeijing Zhong-hua shuju chuban 1999

Su Shen liangfang (The Superlative Formulas of Su (Shi) and Shen (Kuo))by Su Shi 1036ndash1101 Shen Kuo 1031ndash1095 Dong Ji fl 1078ndash1093preface 1075 earliest extant edition Jiaqing reign (1522ndash1566) LHML 029401in electronic edition of the Wenyuange Siku quanshu ReprintmdashBeijing Zhong huashu ju 1985 [1935]

Wenyuange Siku quanshu electronic edition [1782] Zhongwendaxue chubanshe

Wusao hebian (Combined Compilation of Sao (poems) of Wu (region)) editedand compiled by Zhang Qi (late 16th-early 17th century) facsimile of theMing Chongzhen edition (1628ndash1644) ReprintmdashTaibei Shangwu chubanshe1966

Xueshi yirsquoan ershisi zhong (Mr Xuersquos Medical Case Histories 24 Kinds)Wanli blockprint (r 1628ndash1644) LHML 115731 and Xuezhi yirsquoan shiliu zhong

(Mr Xuersquos Medical Case Histories 16 Kinds) 1628 blockprintLHML 115741

[Shan bu] Yisheng weilun [ ] (On the Subtleties of Nourishing Life Revisedand Supplemented) Li Zhongzi completed 1618 reprinted in 1642 LHML115202 ReprintmdashBao Laifa (ed) Li Zhongzi yixue quanshu Beijing Zhongguozhongyiyao chubanshe 1999

Yizong bidu (Required Readings for Physicians (of the Orthodox) Lineage) Li Zhongzi printed in 1637 LHML 115191 ReprintmdashBao Laifa (ed)Li Zhongzi yixue quanshu Beijing Zhongguo zhongyiyao chubanshe 1999

Yuanqu xuan (Selected Yuan Dynasty Verses) Zang Maoxun flourished c 1553ndashc 1621 4 volumes ReprintmdashTaibei Zhonghua shuju 1966

Secondary sources

Allan S 1991 The Shape of the Turtle Myth art and cosmos in early China AlbanySUNY

Bao Laifa (ed) 1999 Li Zhongzi yixue quanshu (Complete MedicalWorks of Li Zhongzi) Beijing Zhongguo zhongyiyao chubanshe

Barrett T H 1993 lsquoLieh tzursquo in M Loewe (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California 298ndash308

Birrell A 1993 Chinese Mythology An introduction BaltimoreLondon The JohnsHopkins University Press

Brokaw C J and Kai-wing Chow (eds) 2005 Printing and Book Culture in Late ImperialChina Berkeley University of California Press

Cheng Weizhong (ed) 1999 Xue Lizhai yixue quanshu (TheComplete Medical Works of Xue Lizhai (Xue Ji )) Beijing Zhongguozhongyiyao chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 167

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 54: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

168 marta e hanson

Cullen C 1993 lsquoPatients and Healers in Late Imperial China Evidence from theJinpingmeirsquo History of Science 31 99ndash150

Despeux C 2005 lsquoVisual Representations of the Body in Chinese Medical andDaoist Texts from the Song to the Qing Period (Tenth to Nineteenth CenturyrsquoAsian Medicine 11 10ndash52

Douglas M 1982 [1973] Natural Symbols Explorations in Cosmology New YorkPantheon Books

Eyler J M 1992 lsquoThe Sick Poor and the State Arthur Newsholme on povertydisease and responsibilityrsquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 275ndash96

Fan Ka Wai 1995 lsquoDong Jin zhi Song dai jiaoqibing zhi tantaorsquo (Discussion of Beriberi from Eastern Song to Jin Dynasty) Xin

shi xue 61 155ndash77mdashmdash 2004 Liu Chao Sui Tang yixue zhi chuancheng yu zhenghe

(Transmission and Integration of Chinese Medicine from the Six Dynastiesthrough the Tang Dynasty) Hong Kong Chinese University of Hong Kong

Fee E 1992 lsquoHenry E Sigerist His interpretations of the history of disease andthe future of medicinersquo in C E Rosenberg and J Golden (eds) Framing DiseaseNew Brunswick NJ Rutgers University Press 297ndash317

Feher M with R Naddaf and N Tazi (eds) 1989 Fragments for a History of theHuman Body Part Three New York Zone Books

Feng Huimin and Li Wanjian 1994 Mingdai shumu tiba congkan(Prefaces Postscripts (and Titles) in Ming Dynasty Book Cata-

logues) 2 vols Beijing Shumu wenxian chubansheFegravevre F and G Meacutetailieacute 2005 Dictionnaire RICCI des plantes de Chine chinoismdashfranccedilais

latin anglais Paris Association RiccimdashLes Eacuteditions du CerfField S trans 1986 Tian Wen A Chinese Book of Origins New York New DirectionsFurth C 1999 A Flourishing Yin Gender in Chinarsquos Medical History 960ndash1665 Berkeley

University of California PressGoldschmidt Asaf 2005 lsquoThe Song Discontinuity Rapid Innovation in Northern

Song Dynasty Medicinersquo Asian Medicine 11 53ndash90mdashmdash 2006 lsquoHuizongrsquos Impact on Medicine and Public Healthrsquo in P Ebrey and

M Bickford (eds) Emperor Huizong and Late Northern Song China the politics of cultureand the culture of politics Cambridge Mass Harvard University Press

Graham A C 1990 The Book of Lieh-tz5 A classic of Tao New York ColumbiaUniversity Press

Grant J 2003 A Chinese Physician Wang Ji and the lsquoStone Mountain Medical CaseHistoriesrsquo London RoutledgeCurzon

Hanson M 1997 ldquoInventing a Tradition in Chinese Medicine From UniversalCanon to Local Medical Knowledge in South China The Seventeenth to theNineteenth Centuryrdquo University of Pennsylvania PhD Thesis

mdashmdash 1998 ldquoRobust Northerners and Delicate Southerners The Nineteenth-CenturyInvention of a Southern Wenbing Traditionrdquo in special issue ldquoEmpires and Hygienerdquoof Positions East Asia Cultures Critique 63 515ndash49 Revised for E Hsu (ed) 2001Innovation in Chinese Medicine Cambridge Cambridge University Press 262ndash92

Hawkes D 1985 The Songs of the South An ancient Chinese anthology of poems by QuYuan and Other Poets London Penguin Books

mdashmdash1993 lsquoChrsquou tzrsquoursquo in M Loewe (ed) Early Chinese Texts A BibliographicalGuide Berkeley The Society for the Study of Early China and The Institute ofEast Asian Studies University of California 48ndash55

He Shixi 1991 Zhongguo lidai yijia zhuan lu (Record of theBiographies of Chinese Physicians Throughout History) 3 volumes Beijing Renminweisheng chubanshe

ASME 22_f3_115-170IIII 41207 512 PM Page 168

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 55: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

northern purgatives southern restoratives 169

Hinrichs TJ 2004 ldquoThe Medical Transforming of Governance and Southern Customsin Song Dynasty China (960-1279 CE)rdquo PhD diss Harvard University

Hu Shiu-ying with editorial assistance of YC Yong and Paul PH But 1980 AnEnumeration of Chinese Materia Medica Hong Kong The Chinese University Press

Kleinman A 1980 Patients and Healers in the Context of Culture an exploration of theborderland between anthropology medicine and psychiatry Berkeley University of CaliforniaPress

Le Blanc C 1993 lsquoHuainanzirsquo in Loewe M (ed) Early Chinese Texts ABibliographical Guide Berkeley The Society for the Study of Early China and TheInstitute of East Asian Studies University of California189ndash95

Leung A K-C (published under Chinese name ) 2002 lsquoJibing yu fangtu zhiguanxi Yuan zhi Qing jian yijie de kanfarsquo (The Relationship Between Illness and the Environment Perspectives on the Med-ical World from the Yuan to the Ming) in Huang Kewu (ed) lsquoXingbie yuyiliaorsquo disan jie guoji hanxue huiyi lunwenji (Gender and Medical History Papers from the Third International Conferenceon Sinology) Taibei Zhongyang yanjiuyuan jishisuo 165ndash212

Leung A K-C 2003a lsquoMedical Learning from the Song to the Mingrsquo in R vonGlahn and P Jakov Smith (eds) The Song-Yuan-Ming Transition in Chinese HistoryCambridge MA Harvard University Asia Center 374ndash98

mdashmdash 2003b lsquoMedical Instruction and Popularization in Ming-Qing Chinarsquo LateImperial China 241 130ndash52

Li Yun (ed) 1988 Zhongyi renming cidian (Biographical Dictionaryof Chinese Physicians) Beijing Guoji wenhua chubanshe gongsi

Li Zhiyong (ed) 1999 Zhang Jingyue yixue quanshu ( The Com-plete Medical Works of Zhang Jingyue (Zhang Jiebin )) Beijing Zhongguozhongyiyao chubanshe

Loewe M (ed) 1993 Early Chinese Texts A Bibliographical Guide Berkeley The Societyfor the Study of Early China and The Institute of East Asian Studies Universityof California

Lu Gwei-djen and J Needham 1980 Celestial Lancets A History amp Rational of Acupunctureamp Moxa Cambridge Cambridge University Press

Major J S 1993 Heaven and Earth in Early Han Thought Chapters three four and fiveof the Huainanzi with appendix by C Cullen Albany State University of NewYork Press

Needham J 2000 lsquoMedicine in Chinese culturersquo Science and Civilization in ChinaVolume VI 6 edited with an introduction by Nathan Sivin Cambridge CambridgeUniversity Press 38ndash66

Pelling M 1996 lsquoCompromised by Gender The role of the male medical practi-tioner in early modern Englandrsquo in H Marland and M Pelling (eds) The Taskof Healing Medicine Religion and Gender in England and the Netherlands 1450ndash1800Rotterdam Erasmus Publishing 101ndash33

Ren Yingqiu 1986 [1960] Huangdi neijing zhangju (Phrase Index to the Inner Canon of the Yellow Emperor) Beijing Beijing renmin weishengchubanshe

Rosenberg C E 1962 The Cholera Years The United States in 1832 1849 and 1866Chicago University of Chicago Press

mdashmdash 1992a lsquoCholera in Nineteenth-century Europe A tool for social and eco-nomic analysisrsquo Explaining Epidemics and Other Studies in the History of MedicineCambridge England Cambridge University Press 109ndash21

mdashmdash 1992b lsquoFraming Disease Illness society and historyrsquo in C E Rosenbergand J Golden (eds) Framing Disease Studies in Cultural History New BrunswickNJ Rutgers University Press xiiindashxxvi

ASME 22_f3_115-170IIII 41207 512 PM Page 169

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170

Page 56: NORTHERN PURGATIVES, SOUTHERN RESTORATIVES: MING

170 marta e hanson

Rosenberg C E and J Golden (eds) 1992 Framing Disease Studies in Cultural HistoryNew Brunswick NJ Rutgers University Press

Rupke N (ed) 2000 Medical Geography in Historical Perspective Medical History SupplementNo 20 London The Wellcome Trust Centre for the History of Medicine atUniversity College London

Schatzki T R and W Natter 1996 lsquoSociocultural Bodies Bodies Sociopoliticalrsquoin T R Schatzki and W Natter (eds) The Social and Political Body New YorkThe Guilford Press 1ndash25

Sivin N 1993 lsquoHuang ti nei chingrsquo in M Loewe (ed) Early Chinese TextsA Bibliographical Guide Berkeley The Society for the Study of Early China andThe Institute of East Asian Studies University of California 196ndash215

mdashmdash 1995a lsquoState Cosmos and Body in the Last Three Centuries BCrsquo HarvardJournal of Asiatic Studies 551 5ndash37

mdashmdash 1995b lsquoText and Experience in Classical Chinese Medicinersquo in D Bates (ed)Knowledge and the Scholarly Medical Traditions Cambridge Cambridge UniversityPress 177ndash204

Sun Tiansheng 1994 lsquoChuantong yixuezhong de yixue dili sixiang yanjiursquo (A Study of Medico-geographical Thought in

Traditional Chinese Medicine) Renwen dili (Human Geography) 9368ndash74

Unschuld P 1985 Medicine in China A History of Ideas Berkeley University ofCalifornia Press

mdashmdash 1986 Medicine in China A History of Pharmaceutics Berkeley University ofCalifornia Press

Unschuld P trans 1990 Forgotten Traditions of Ancient Chinese Medicine A Chinese Viewfrom the Eighteenth Century The I-hsuumleh yuumlan liu lun of 1757 by Hsuuml Ta-Chrsquoun BrooklineMass Paradigm Publications

Widmer E 1996 lsquoThe Huanduzhai of Hangzhou and Suzhou A study in seven-teenth-century publishingrsquo Harvard Journal of Asiatic Studies 561 77ndash122

Wu Yiyi 1993ndash4 lsquoA Medical Line of Many Masters A prosopographical study ofLiu Wansu and his disciples from the Jin to the Early Mingrsquo Chinese Science 11 60

Xiao Fan 1993 lsquoHan Song jian wenxian suojian gudai zhongguo nanfang de dili huanjingyu difang bing ji qi yingxiangrsquo

(Perspectives from Han to Song Sources on the Environments and LocalDiseases of Ancient Southern China and Their Influence) Zhongyang yanjiuyuanlishi yuyan yanjiusuo jikan 631 67ndash171

Xu Senyu (ed) 1986 Zhongguo congshu zonglu (Catalogue ofChinese Collectanea) Shanghai Shanghai guji chubanshe

Xue Qinglu et al (eds) 1991 Quanguo zhongyi tushu lianhe mulu(Union Catalogue of Books on Chinese Medicine) Beijing Zhongyi

guji chubanshe Abbr LHMLZimmerman F 1987 [1982] The Jungle and the Aroma of Meats An ecological theme in

Hindu medicine trans J Lloyd Comparative Studies of Health Systems and MedicalCare series Berkeley University of California Press Originally published as Lajungle et le fumet des viands Paris Editions du Seuil

ASME 22_f3_115-170IIII 41207 512 PM Page 170