The Treatise on Cold Damage and the Formation of Literati Medicine: Social, Epidemiological, and Medical Change in China, 1000-1400

• Main Author: Boyanton, Stephen
• Language: English
• Published: 2015
• Subjects: History; Science
• Online Access: https://doi.org/10.7916/D8TB15ZX

This dissertation explores the profound changes that occurred in literate Chinese medicine during the Song (960-1279), Jin (1115-1234), and Yuan (1276-1368) dynasties—changes which established the pattern of the text-based Chinese medical tradition from that time to the present day. In particular it examines the transformation of the Han dynasty (206 BCE-220 CE) text, the Treatise on Cold Damage (Shanghan lun 傷寒論), from one member of a diverse tradition of texts giving instruction on the treatment of cold damage disorders (shanghan 伤寒, a class of potentially epidemic, febrile illnesses) into the preeminent—almost the only—canonical text about such illnesses and a touchstone for medical thinking on all types of illnesses. I argue that a two primary factors account for the Treatise’s remarkable rise in status: the rise in the frequency of epidemics caused by Chinese society’s crossing of epidemiological frontiers, both in terms of population and in terms of geographic distribution, and a crisis of trust in medicine which was part of a much broader epistemic crisis brought about by the radical changes in social structure, commerce, governance, and material culture during the Song. The increase in epidemics gave added weight to the topic of cold damage, but the decisive factors singling out the Treatise were related to its usefulness in addressing the medical crisis of trust. Medical authors were unanimous in their condemnation of the status quo in medicine. The focus of their criticisms was the figure of the common physician (shiyi 世醫). Common physicians, the dominant practitioners of text-based medicine in the Northern Song, belonged to social stratum just below that of the elite. For elite medical authors, common physicians were the primary problem with medicine: they were inadequately or incorrectly educated, failed to appreciate the complexity of illness, and lacked elite ethical values. While elite authors agreed that common physicians were the problem, they disagreed on how to resolve this problem. Three approaches developed a more elite form medicine—which I term “literati medicine.” It was among the proponents of one of these approaches—“literati-physician medicine,” which held that only members of the elite could be proper physicians—that the Treatise on Cold Damage became central to medical thought and practice. Literati physicians found the Treatise useful for a variety of reasons. In terms of their social relations, both within the clinical encounter and in broader society, it was a useful tool for arguing for their own superiority over their common physician competitors. In terms of their clinical doctrines, it provided a model by which to deal with what they saw as the central problem in medicine: the protean nature of illness. As long as that remained the central problematic of their medical tradition, the Treatise retained its central place. By the Yuan, literati physicians dominated all of literati medicine and ultimately all of textually based medicine, making the Treatise a central text for all physicians. The history of the Treatise’s transformation into one of the most fundamental texts of the Chinese medical tradition is therefore rooted in the formation of literati medicine, and its struggle for both social legitimacy and clinical efficacy. The Treatise’s continued importance from the Yuan to modern times is the result of the survival of literati medicine for nearly one thousand years. In spite of many changes, modern Chinese medicine remains committed to a vision of illness as irreducibly complex and to an approach to cure—individualization of treatments—first learned from the Treatise on Cold Damage during the Song dynasty.