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  • Medicine and Society in Late Imperial China: A Study of Physicians in Suzhou, 1600–1850
  • Hilary A. Smith
Yüan-ling Chao, Medicine and Society in Late Imperial China: A Study of Physicians in Suzhou, 1600–1850 New York: Peter Lang, 2009. xii + 206 pp. $84.95 cloth.

Suzhou and the lower Yangzi River region, central to the material and intellectual life of the Chinese empire in the seventeenth through nineteenth centuries, have proved almost as fertile for today’s China scholars as they have long been for Chinese farmers. By the late imperial period, many farmers in the region had shifted from rice and wheat production to cotton and silk, and had grown rich in the process. New sources of wealth unsettled old social strata. At the same time, a burgeoning publishing trade gave more people access to education, the traditional route to official power by way of the civil service examinations.

In this affluent, educated area, as Benjamin Elman (1984) has shown, low passing quotas combined with high numbers of aspirants made the chances of succeeding in the examinations ever slimmer. Shut out of officialdom, Confucian scholars had to find other ways to make a living. This is where medicine comes in. As a practice grounded in classics, and characterized by benevolence and humaneness, medicine was a reasonable alternative for unemployed scholars. The trouble, from the perspective of the literati physicians, was that not all patients thought extensive book learning the best indicator of quality in a doctor.

In this book, Yüan-ling Chao argues that as literati became doctors in growing numbers, long-standing competition between Confucian physicians (ruyi 儒醫) and hereditary physicians (shiyi 世醫) intensified. She sees debates in contemporary medical literature as an effort on the part of Confucian physicians to define and protect their niche in this competitive world. For example, she explores a debate about how to interpret a well-known adage about doctors in the Book of Rites, one of the Five Classics in the Confucian canon, advising patients to refuse treatment by any doctor “who is not sanshi 三世 (three generations).” Early commentators mostly interpreted sanshi to mean a doctor who was at least the third generation of a hereditary lineage of physicians. By the fourteenth century, however, some writers were arguing that the “three generations” referred to three generations of texts, not people, and that the Book [End Page 581] of Rites had really been warning patients to stay away from doctors not versed in those texts. After all, they pointed out, many of the most renowned doctors in history had not come from medical families but had excelled because they knew, perfectly, how to apply classical knowledge. Arguments of this kind only multiplied and intensified in the succeeding centuries.

Chao also frames the development of the wenbing 溫病 (warm factor disorders) school within literate medicine through the lens of competition. In the late imperial period, some southern physicians began to assert that southerners suffered from warm factor disorders insufficiently elucidated in the Treatise on Cold Damage Disorders (Shanghan lun 傷寒論), the text that informed a great deal of elite medical practice at the time. By the nineteenth century, as Marta Hanson (2011) has shown, a self-identified school of wenbing physicians emerged; the wenbing “lineage” that they created for themselves helped articulate a distinctive regional identity. Here, Chao suggests that in addition to crafting a regional identity, those who focused on warm factor disorders were also defending (or at least representing) the worth of hereditary medical knowledge. Many of the warm factor writers, she suggests, were hereditary physicians, while those who insisted on the universality of the Treatise on Cold Damage tended to be Confucian intellectuals first.

Despite the anxiety that an increasingly crowded medical marketplace generated among physicians, however, not all responded by drawing boundaries around their turf and denigrating other sources of expertise. Chao examines a fascinating exception in the Wuyi huijiang 吳醫匯講 (WYHJ, Collected Discourses of Suzhou Physicians), which some have referred to as China’s first medical journal. The editor’s Explanatory Notes solicit submissions from anyone who has something of medical value to contribute, even if he writes in a “vulgar” way—which suggests a broad-minded...

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