Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China by Marta E. Hanson (review)

Rich, detailed, and hugely impressive in scope, Marta Hanson's history of the "warm diseases" or the wenbing disease classification, from the earliest references in the canonical medical literature through to the present day, is a welcome addition to the Needham Research Institute Series of texts on East Asian medical history. It is not often one comes across a book that manages to combine so elegantly temporal range and geographical sweep, while not sacrificing the rigorous attention to detail and in-depth knowledge and insight that will make this work such a valuable resource for scholars.

Wenbing is a disease concept unique to Chinese medicine. It does not have a specific biomedical equivalent but covers a range of illnesses from the common cold and respiratory illness to high fevers and epidemic diseases. It has been a feature of the medical landscape for almost two thousand years, from the first references to it in the early classical medical textbook from the Han dynasty, Zhang Ji's Treatise on Cold Damage and Miscellaneous Disorders right through to the SARS epidemic of the twenty-first century. With a focus on the late imperial period and the linked themes of climates, constitutions, and contagions, Hanson assiduously tracks the changing discourse around wenbing through an impressive array of medical and nonmedical primary sources. She begins with the treatment of wenbing in Zhang Ji's Treatise on Cold Damage, and the critical reception Zhang Ji's approach received from Song physicians following the book's publication in the eleventh century by the government of the Northern Song. Come the Ming dynasty we see the emergence of a distinction in approach between northern purgatives and southern restoratives, and how the impact of the epidemics that raged in the late Ming was to give rise to a new consciousness of contagion through poisons, pathogenic local qi, and person-to-person transmission.

Unusually, if not uniquely, for a historical text in this field, interwoven with the chronological approach, is Hanson's second, and perhaps most pervasive theme, that of geography. She demonstrates how important the Chinese geographic imagination was to the understanding of wenbing, and how physicians' geographic conceptions underpinned their medical practice, from lineage affiliation to diagnosis and treatment. In particular, there was a clear a north-south split, with climatic differences perceived as giving rise to different constitutions, disease patterns, and recommended therapeutic approaches. The north was associated with dry and cold climes, and a population who were robust and in need of purging; the south, by contrast, was hot and wet, and its people had a propensity for overindulgence and weak constitutions characterized by depletion. Hanson deftly shows how in the Ming dynasty this medical regionalism provides a lens through which aspects of contemporary medical culture can be viewed, and which serves to cast light on the discourse about best medical practices, the debate around universality versus regionalism, and anxieties about the perceived indulgent lifestyles of those in the wealthy regions to the southeast.

Hanson's third theme is epidemiology, and she demonstrates how the epidemics that affected China in the late Ming period challenged the traditional understanding of wenbing and the conventional approaches to treatment. This resulted in a questioning of what had gone before and, in particular, the categorization of wenbing with the Cold Damage tradition.

From the perspective of the biography of wenbing, Hanson's narrative demonstrates the effects of time, culture, society, politics, and place on the development of understanding of disease. In doing so, although her focus is on wenbing and late Ming epidemics in particular, she provides illuminating insights into the development of traditions, the transmission of medical knowledge, and the adaptation of past experience for use by later generations, that give the work a much wider resonance and applicability. As such, the picture she paints...