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Miranda Brown

The Art of Medicine in Early China

The Ancient and Medieval Origins of a Modern Archive

Book review by Anthony Campbell. The review is licensed under a Creative Commons Licence.
Contrary to what the title of the book implies, Brown explicitly states that, unlike many previous authors, she has not written a study of how medicine was practised in ancient China or of the medical theories that existed then. Such matters are touched on only peripherally. What she writes about is how representations (her emphasis) of ancient healers have been reinterpreted in both Europe and China. In other words, she focuses on how previous writers have shaped our view of ancient Chinese medicine rather than on ancient Chinese medicine itself. This is a book about Chinese medical historiography.

When I first read this I thought that the book would be of interest only to a scholarly audience and not to someone like me who mainly wants to try to understand how modern Western acupuncture relates to ancient Chinese ideas. But as I read more of the book I realised that it does shed light on this question, even if indirectly.

Like many Westerners, I formed my view of the origins of Chinese medicine, and especially Chinese acupuncture, largely through the writing of Joseph Needham and Lu Gwei-djen, which I had read quite a number of years ago. Celestial Lancets: A History and Rationale of Acupuncture and Moxibustion appeared in 1980 and in 2000 these authors published an influential volume on medicine in Needham's monumental study Science and Civilisation in China. Needham had the help of many Chinese scholars in his work, including Gwei-djen, and I assumed more or less unquestioningly that his views were the most authoritative and up to date that were available in English. But Brown finds that his interpretations need to be revised, although not in exactly the way that other critics have argued.

Needham attached a lot of significance to the "fathers of medicine": important innovators who broke with "superstitious" ideas of disease as caused by evil spirits and so forth, and instead introduced theories and treatments that can be seen as prefiguring modern science. He was by no means alone in taking this view. Chinese medical historians in the twentieth century expressed similar views, citing many of the same descriptions as were used by Needham. The sinologist Nathan Sivin, one of Needham's collaborators, has criticised this approach for "chronicling the careers of Great Men". Critics have pointed out the anachronistic character of such claims; can we say there was such a thing as "clinical science" in ancient China or are we projecting a modern concept into the past? And is the idea of the medical fathers, whom modern Western historians often compare to Hippocrates or Galen, also an unwarranted imposition of Western ideas on ancient China?

At one time Brown thought that this was what Needham and other modern historians were doing: using Chinese sources to flesh out a Europe-centred story of the development of modern science. But later she concluded that this was wrong, and that these modern Western historians were following a traditional way of thinking that had already existed in China for many centuries. The notion of medical fathers was already deeply rooted in China before Needham and others described it. So Brown does not see the medical fathers as a modern invention although she thinks their significance is quite different from what Needham imagined. They are not very useful to tell us about ancient Chinese medicine but they do show how early Chinese authorities provided modern historians like Needham with a framework in which to study the past.

The book therefore is intended to explain the real significance of the medical fathers for our understanding of ancient Chinese medicine. It has two main parts. Part 1 presents detailed accounts of three medical fathers from remote antiquity, at least two of whom are mythical or semi-mythical. All three have been taken to be important in the alleged transition from "superstion" to "science". Part 2 takes us into the historical period and looks at how mediaeval Chinese historians described (and often reconstructed) the three "personas" that are the subject of Part 1. Finally, there is an epilogue in which the story is brought up to date in the modern age.

The first medical father to be discussed in Part 1 is Attendant He, who has been treated as a real historical character by many scholars, including Needham. ("Attendant" means something like "personal physician" to a noble family or the imperial household.) He is often regarded as the first identifiable medical figure, coming after a succession of entirely legendary beings such as the Yellow Emperor, the Divine Husbandman, and Lord Thunder. But Brown is unconvinced by this description and regards him as a literary creation of chroniclers who were more concerned with politics than with medicine.

Attendant He is supposed to have lived in the sixth century BC and is credited with rejecting spiritual explanations of disease in favour of material (if cosmic) causes. But claims for his supposed clinical acumen are suspect, Brown thinks; he seems to have had the character of a seer who could foretell the future. There is a story about his prophecy of the death of a noble patient, Lord Ping (this prophetic theme crops up quite often in relation to ancient healers at this time). Brown analyses the sources of our knowledge of Attendant He in considerable detail and concludes that he was probably a later literary creation by chroniclers whose concern was mainly political. We cannot reliably infer much about the beliefs of healers at this time from what is said about Attendant He.

The second character discussed in Part 1, Bian Que, is undoubtedly mythical. He is often represented as half-man and half-bird. Like Attendant He, Bian Que has near-miraculous powers of discerning disease before any symptoms appear. There is a famous story in which he warns a young ruler that unless he is treated he will die in middle age. The ruler ignores this advice and duly dies at the predicted time. Brown treats this as an allegory; she thinks that the story was created by court politicians in the Warring States period (453-221 BC) to show the need for political wisdom and reform; only later was it reinterpreted as forming part of Bian Que's medical biography.

The third medical father in Part 1 is Chunyu Yi. Unlike the previous two characters he may have been a historical healer who lived in the second century BC, but he was subsequently reinterpreted in quite a different way. To distinguish this second version of Chunyu Yi, Brown refers to him by his title as the Granary Master. She thinks that the writings attributed to the Granary Master were produced in the first century BC; they show the sage reasoning like a Han official. In his role as the Granary Master Chunyu Yi was used to support the development of an official form of medicine in the Han period, but this does not tell us what medical ideas were like 100 or more years earlier.

All three medical fathers described in Part 1 have a legendary or semi-legendary character. Part 2 deals with a later period for which we have better records. This is when the concept of a list of exemplary healers arose.

We start, in Chapter 4, with Liu Xiang. He was not himself a healer but a historian and archivist, who in 26 BC began organising the large number of texts that made up the imperial collections. He brought together the narratives of the medical fathers, including those described in Part 1, and made them into a resource for later generations. This marks the beginning of a systematic approach to the writing of medical history in China.

Chapter 5 considers the work of an important healer, Zhang Ji (150-210 AD). He has been called the Chinese equivalent of the Roman/Greek physician Galen. In the preface to his book The Cold Damage Disorders he writes that he took up the study of medicine following the death of most of his clan in an epidemic. There is a significant parallel here with Confucius, who was also thought to have written in response to a time of adversity. But Brown questions the authenticity of Zhang Ji's preface, which may have been written later; the tragic story of Zhang Ji's decision to study medicine emerges only in the eleventh century, eight centuries after his death. Another interesting feature is that, like the early seers described in Part 1, Zhang Ji is credited with having forecast the development of disease decades before any symptoms appeared. Brown thinks that although there may have been a historical healer by that name his literary persona was largely the creation of elite healers in the Song dynasty (960-1279 AD). These writers wished to recast him in the image of Confucius, to make it appear that the role of physician was suitable for an upper-class gentleman.

The sixth chapter is about another important personage from late antiquity, Huangfu Mi (approximately 215-282 AD). He is presented today largely as an editor of ancient works, but early mediaeval writers saw him quite differently, as a healer in his own right. He was highly educated and came from the topmost social class. The original account of his life related that after a riotous youth he became ill and took to using a medication known as cold food powder, meaning that it was taken with cold food. It is thought to have been a mixture of five minerals and was evidently dangerous, because it seriously damaged Huangfu Mi's health for many years. He eventually managed to wean himself off the medication and to cure himself, partly by taking cold baths (generally considered dangerous in China), and this led him to become an expert physician with particular skill in the difficult art of using cold food powder correctly.

Like Zhang Ji, Huangfu Mi underwent a transformation during the Song dynasty, many centuries after his death. Now he was praised, not as a medical innovator and healer, but for his preservation and organisation of ancient medical knowledge, and his writings on cold food powder were largely ignored. The work for which he is best known is the AB Classic. In this he transmitted the learning of the Yellow Emperor along with other ancient authorities including those discussed in Part 1. One of the works credited to the Yellow Emperor and endorsed by Huangfu Mi was The Basic Questions. The authenticity of this ascription was being questioned even in the eleventh century, but the Song officials wanted to support the Yellow Emperor's authorship, as did various scholars of the time. It therefore suited the proponents of this view to cite Huangfu Mi as the ultimate authority on the question.

As this outline will make clear, this is a scholarly book with a lot of textual argument; it provides the Chinese text alongside the author's (very readable) translations, so its primary relevance is to other experts in the field. As such, it may seem to have little to interest the non-professional reader, and it is true that such readers will quickly find themselves in a world populated by unfamiliar characters with mostly unknown names. (A chronology of the Chinese dynasties is provided, which is helpful.) But Brown writes well, with some nice touches of humour, and she has useful summaries here and there that make her arguments easier to follow (some more technical material is relegated to an appendix). I initially picked up the book just to see what it said on one or two topics that interested me, but I found myself being progressively drawn in to read more.

Brown acknowledges that she contradicts a lot of received ideas, and no doubt there will be plenty of scholars who disagree with her interpretations. But I think that her book is useful for the non-professional reader who wants to get a perspective on modern popular writing on Chinese medicine on the internet and elsewhere, which often makes large claims for the scientific prescience of the ancient Chinese healers. Knowing the way in which these ideas have developed makes it easier to assess how relevant they are in a modern context.

The views of modern historians of Chinese medicine evidently derive to a surprising extent from those of mediaeval Chinese writers. "When Joseph Needham took up the writing of Chinese medical history beginning in 1954, he not only had the assistance of Chinese collaborators, but also the accumulated efforts of thousands of years of scholarship." Before reading Brown's book I had assumed that this was an unqualified advantage that gave Needham's writing unparalleled authority, but now I can see that it may have been a mixed blessing. It did provide him with a huge abundance of material that was already available and sifted for importance. But it also meant that he was constrained by the biographies of medical healers that had existed from mediaeval or late imperial times and by the interpretations that earlier writers had placed on this material. "It shows that the historiographical practices of antiquity are not gone; such practices live on, embedded in the very fabric of our modern retellings."


%T The Art of Medicine in Early China
%S The Ancient and Medieval Origins of a Modern Archive
%A Brown, Miranda
%I Cambridge University Press
%C New York
%D 2015
%G ISBN 9781107097056
%P xv+237pp
%K medicine, history
%O hardback; illustrated
%O appendix, notes, index

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