Much academic attention has been given to the Four Great Schools of the Jin and Yuan dynasties, the golden age of Chinese medicine. In his book, The Evolution of Chinese Medicine, Asaf Goldschmidt investigates the medical history of the Song dynasty, the period prior to and often overshadowed by this golden age. Scholars have suggested three reasons why medicine began to flourish in the Song.Footnote ¹ First, various emperors became personally involved in medical scholarship and education. Second, a large number of literati, dejected by their failure in the civil service examinations, took up medicine to become literati physicians (ruyi 儒醫).Footnote ² Third, the production of medical books was facilitated by advancements in printing technology. All of these factors laid the foundation for the rapid development of medical knowledge during the Song.

Previous studies in Chinese have discussed the indispensable role played by the state in the advancement of science.Footnote ³ In this book, Asaf Goldschmidt discusses other contributory factors that should be taken into account. He investigates the abrupt change in the trajectory of Chinese medicine which took place during the Song. He states that he aims to examine how external forces like imperial policies, dissemination of knowledge, and environmental factors like epidemiological changes spurred the integration of three earlier medical genres into a comprehensive system (p. 13). In general, he has been successful in clarifying these issues.

The first part of the book consists of four chapters analyzing the changes in Chinese medicine during the Northern Song, taking broader contemporary changes into account; the second part includes two chapters focusing on the consequences of the changes mentioned in the first part. The last chapter studies the reevaluation of medical practice and its underlying doctrines, which resulted, as Goldschmidt argues, in the integration of classical doctrines and literature on drugs and formulas.

Goldschimdt devotes much of his book to discussing studies of shanghan 傷寒 during the Song. He identifies six out of the ten books published by the Bureau for Revising Medical Texts (Jiaozheng Yishuju 校正醫書局), and discusses only shanghan and treatment (pp. 90–91; in fact, there should be eleven books in total, not ten: Goldschmidt has also missed out Qianjin yifang 千金翼方 [“Supplement to Invaluable Prescriptions for Ready Reference”]). Goldschmidt notes the new bureau was established to publish medical texts in response to epidemics striking the empire between 1045 and 1060. Having shanghan experts among the leading editors, the bureau naturally favored solutions from shanghan medical texts. It also reprinted the Shanghanlun 傷寒論 (“Treatise on Shanghan”), thus reviving interest in this eight-hundred-year-old classic.

Goldschmidt has made no attempt to identify the nature and cause of the epidemics that wreaked havoc during Emperor Renzong's reign. This shortcoming casts doubts on some of his conclusions. In this regard, consideration should be given to climatic change during the Northern Song dynasty. From 985 to 1192, China entered its third “little ice age” in five thousand years.Footnote ⁴ Chapter 12 of the Songshi 宋史 (“History of the Song Dynasty”) records extremely cold weather in Kaifeng in 1054, and says that the government used pulverized tongtianxi 通天犀 (rhinoceros horn) to treat patients. Cao Shuji speculates that the disease that raged through Kaifeng at that time was typhus, which is particularly prevalent in severely cold weather.Footnote ⁵ It is possible that the decision to print and disseminate a new edition of the Shanghanlun during this same period was due to a spell of life-threateningly cold weather and therefore a potential typhus epidemic.

Furthermore, Goldschmidt mentions that an increasing number of recorded epidemics originated in southern regions (p. 69), and that a new epidemiological frontier was created by contact with them: the ongoing population shift to South China; the rising volume of trade with the South; the lengthening of trade routes; and intensifying urbanization, when the southern regions hosted a larger number of endemic diseases than North China (p. 70). He also notes that the Shanghanlun focuses predominantly on treating the contagious diseases that devastated southern China (p. 101), and that the government promoted knowledge of Shanghan in the belief that it could explain the pathology and treatment of epidemics (p. 71). However, in fact, the Chinese terms for the epidemic diseases that broke out in the southern regions were nüe 瘧 and zhang 瘴.Footnote ⁶ One contemporary observer, Zhou Qufei 周去非, clearly stated in his Lingwai daida 嶺外代答 (“Information about the Lingnan Region”) of 1178 that zhang cannot be cured purely with medicines originally developed to treat shanghan. If the southward shift of population had been the main cause of the increase in the incidence of disease, one would have expected medical research to focus on treating nüe and zhang rather than shanghan.Footnote ⁷

More solid substantiation is required if Goldschmidt is to prove several of his other arguments. Scholars are in agreement that the unprecedented imperial attention paid to medicine in the Northern Song raised its status. Goldschmidt goes further, suggesting that in previous dynasties medicine was a lowly art despised by the elites (p. 40). He quotes Han Yu's comment that scholar-officials looked down on witches, physicians, and musicians (p. 19), and he notes that in the Xin Tangshu 新唐書 (“New History of the Tang Dynasty”) physicians were classified as folk craftsmen. Goldschmidt also notes the Northern Song government was the first Chinese regime that “commissioned and sponsored a number of formularies” (p. 107). In fact, emperors of the preceding Tang dynasty, who took an interest in medical studies,Footnote ⁸ were the forerunners.

If Goldschmidt had consulted Chapter 461 and Chapter 462 of Fangjizhuan 方技傳 (“Biographies of Craftsmen and Technicians”) in the Songshi, he would have noticed that physicians' biographies, such as that of Pang Anshi 龐安時 and Qian Yi 錢乙, were included among those of Buddhist monks, Daoist priests, and specialists in astrology, calendrical studies, and fortune telling. Perhaps scholar-officials despised physicians, but it does not mean they despised their medical skills. One should not jump to the conclusion that medicine had low status in society. During the Tang and Song dynasties, many scholar-officials studied medicine because they had a keen interest in the nurture of life.Footnote ⁹

Goldschmidt's study has overlooked the role of Buddhist monks and Daoist priests in Song medical practice. Many Buddhist monks actively participated in medical charity activities and community services,Footnote ¹⁰ and Daoist priests (such as Ma Zhi 馬志 and Wang Huaiyin 王懷) helped compile Materia Medica and medical formularies.Footnote ¹¹ Their role should not be ignored.

In his third and fourth chapters, Goldschmidt emphasizes that the new epidemiological frontier in the South prompted migrants to include drugs found on new soil to their pharmacopeias (p. 135). Such an assumption needs support, but Goldschmidt does not cite any diseases or remedies specific to the South.

There are a few contradictory statements in the book. For example, Goldschmidt introduces Sun Qi 孫奇 and Sun Zhao 孫兆 as distinguished physicians on p. 88, but later (p. 148) remarks that Sun Zhao should be regarded as a scholar-official rather than a doctor.

Also, some of the basic sinological detail in the book is erroneous. There are confusions between characters with similar pronunciation in modern Chinese, for example: Yang Shangshan 樣上善 (p. 28) should be 楊上善; Pang Anshi 龐安石 (pp. 94, 144, and 237) should be 龐安時; Qinglishan jiufang 慶歷善救方 (p. 86) should be 慶曆善救方; Huangdi bashiyi nanjing 黃帝八十一南經 should be 黃帝八十一難經; and the famous physician Li Shizhen is not 李時診 (p. 250) but 李時珍. Other mistakes appear to be confusions of character forms, for example: Huang Longxiang should be 黃龍祥, not 黃龍樣 (p. 242); Fan Xingzhun should be 范行準, not 範行準 (p. 242); Lu Jiaxi should be 盧嘉錫 (or 卢嘉锡 in simplified characters), not 戶嘉錫 (p. 245); Yabuuchi Kiyoshi 籔內清 (p. 246) should be 藪內清. There are other mistakes, such as Shanghan zijiji 傷寒滋濟集 (p. 148), which should be Shanghan cijiji 傷寒慈濟集: the correct title appears in both the Song shi 宋史 and the Tong zhi 通志. Shanghan zhiweilun 傷寒指微論 (p. 150) should be Shanghan lun zhiwei 傷寒論指微: this title appears in Chapter 7 of the Xueyiji 學易集 by Liu Qi 劉跂. Finally, Goldschmidt mistakes Li Longji 李隆基, best known to posterity as Emperor Xuanzong 玄宗 of the Tang dynasty, as the physician who compiled the Guang ji 廣濟, a formulary (p. 216).

Despite these minor technical failings and the reservations detailed above, this book addresses areas not considered in previous scholarship. Its greatest contribution is that it provides a clear overall picture of the evolution of medicine during the Song dynasty, and thus supplements our understanding of the background prior to the emergence of the Four Great Schools in the Jin and Yuan dynasties. There are other merits of this book that are worthy of notice: firstly, it provides abundant examples of the government's involvement in medical development; secondly, shanghan plays a special role in the history of Chinese medicine, and Goldschmidt has provided a convincing discussion on how shanghan came into prominence during the Song. Finally, the book provides a unique view of the Song-period integration of shanghan theories and drug therapy with classical medicine.