Social Relations and Affective States in Classical Chinese Medical Practice: Zhang Jiebin and the Problem of Renqing

The year 1624 is significant in the transmission history of the most venerable "classic" of Chinese medicine, the Inner Canon of the Yellow Sovereign (Huangdi neijing; hereafter, Inner Canon). That was when a prominent physician, Zhang Jiebin (hao Jingyue; ca. 1563–ca. 1642), published an abridged, annotated, and rearranged version titled The Canon Categorized (Leijing), which quickly gained influence and has been a valued reference work for doctors and students of classical Chinese medicine ever since.

Like any commentator on a classic text, Zhang approached his task with certain (conscious or unconscious) assumptions and strategies, and he wrote from an individual realm of experience and point of view, building on the authority of antiquity to advance contemporary interpretations.¹ Moreover, in his voluminous writings apart from the Leijing, Zhang promoted some controversial ideas and took some strong stands.² That said, his annotations in the Leijing are predominantly informative and explanatory rather than argumentative, Zhang having placed his essays and diagrams of opinion and advocacy in two appended supplements, to which his annotations often refer readers. At one point, however, the Leijing text swells with a long, plaintive, perturbed disquisition (translated in the Appendix) on the various ways in which human affectivities (qing or renqing) interfere with doctors' work in correctly diagnosing and treating illnesses—not incidentally diverging from the meaning of the target phrase in the Inner Canon, one which previous scholars had scarcely noted.³ What compelled Zhang to respond at such length, and so viscerally, to the phrase bushi renqing ("do not neglect renqing") in the Inner Canon? The present study discusses this somewhat startling gloss in relation with its late-Ming cultural context, the Inner Canon section to which it pertains, and the conditions of medical practice in early seventeenth-century China.

Zhang wrote this particular gloss in the wake of a century of contested revision in the Neo-Confucian view of human nature and the mind, associated mainly with the thought of Wang Yangming (1472–1529) and his followers. This revision was highly consequential for the valuation of human feelings and desires, which came to be seen less as potentially wayward aspects of life, to be channeled and constrained, but more as vehicles of self-actualization and creative self-expression, and as attributes of unique individual personalities.⁴ Beyond the religio-philosophical sphere, the consequent heightening of attention to people's sentiments is evident in several realms of late-Ming discourse. Most widely studied has been the so-called "cult of qing" in certain literary genres and literaryaesthetic modalities, a cultural movement notable for its unorthodoxy in promoting the full and frank expression of emotion.⁵ In jurisprudence, too, officials who judged cases or weighed policies that directly affected the populace tended to look positively on qing (meaning either "particular circumstances" or "sentiments") as a leavening force or guide vis-àvis the possibly rigid or overly abstract application of codified laws or metaphysical principles.⁶ In the medical profession, increased discussion of the detrimental effects of emotional imbalance and extremes on the health of individuals appears in the burgeoning publications by doctors.⁷ Zhang Jiebin's argument in the Leijing gloss examined here suggests that the everyday sentiments, attitudes, dispositions, etcetera, not only of patients but of others in society, also had become of concern as factors in the provision of medical care. To a degree, his gloss encapsulates longstanding doctors' complaints about their clients, colleagues, and competitors, but it is significant in the late Ming discursive environment for laying such complaints on the foibles of qing and renqing.

Zhang Jiebin and His Leijing

At present, the predominant view on the backgrounds of post-Tang, literate doctors—at least the better-educated and socially notable ones whose identities can be ascertained today—is that most of them either were scions of families that specialized in medicine and passed down proprietary medical knowledge from generation to generation, or they were men who failed to advance very far in the civil service examinations, who withdrew from disappointing official careers...