If you are looking for an explanation of early Chinese medical skills and a historical account of medical writings, as the title and subtitle separately promise, you are in for a surprise. The aim of Miranda Brown's book is more fundamental: to show that what we think we know about the history of early medicine is largely erroneous―a figment of the assumptions of philologists and editors at many points over the past two thousand years. Her success makes it an indispensable study.
Brown combines striking intellectual dynamism with a broad command of her field. Her interpretations are reliably original. She tends to open up new topics by finding weaknesses in the conventional wisdom and reconstructing what was actually the case. Scholars of Han China tend to be preoccupied by institutional patterns, often ideal ones, but she has the learning and acuity to confront ideology with the actual conduct and thought patterns of individuals. Here she shows that the current historiography of both European and Chinese medicine has led consistently to the wrong questions with respect to China. The productive questions have to be uncovered by open-minded critical reading of Chinese sources with close attention to context.
Her scholarly revisions are a guide to how the research should be done. She begins by examining accounts of court physicians in two early historical compilations. The physician He (Yi He 醫和, probably legendary), whom historians of medicine have often depicted as China's first naturalist healer, was instead extolled by authors before modern times for “his ability to discern the will of Heaven and to foretell the future”. He was part of an episode involving the famous political advisor and diplomat Zichan 子產 (d. 521 bc). He was, in fact, a kind of rhetorical double of Zichan; together they explain the moral failings responsible for the fall of a state.
The biography of another famous physician in Memoirs of the Grand Historian is more complicated. Chunyu Yi 淳于意 (fl. ca. 180-154 bc), Director of the Great Granary in Qi, earlier had been trained in doctoring. When an edict demanded a count of experts on prognosis, Chunyu claimed that he was one of this group. Called upon to submit details of his skills, his training, and his practice, he summarised a number of cases that he had examined in Qi and elsewhere, explaining in each instance how he formed his judgment. Since the format of his biography's case records “mirrors the logic and structure of . . . legal case summaries”, they indicate that the author was an official. That and inconsistencies of date show, Brown suggests, that Sima Qian “fashioned the image of the figure by cobbling together” the biography from “sick logs and records of consultation kept by officials”.Footnote 1 I will return to Chunyu below.
The second half of the book is devoted to a different question, namely how historical thinking about medicine began. Brown makes an excellent case that the imperial bibliographer Liu Xiang 劉向 (77-76 bc) took the first step when he compiled a list of exemplary healers (including the three mentioned above). By organising the imperial library and editing the books in it, he brought attention to seldom-read texts such as those from which he compiled the list. The result encouraged physicians “to imagine themselves as part of a continuous past, stretching back to the dawn of time”, as seen in the chapter on Huangfu Mi 皇甫謐 (ca. ad 215–282).
The chapter on Zhang Ji 張機 (ad 150–219) demonstrates how the agendas of later interpreters down to the twentieth century shaped representations of him. The information about his life comes principally from Zhang's preface to his Treatise on Cold Damage and Miscellaneous Disorders (Shanghan zabing lun 傷寒雜病論). It explains that he worked out the therapies in the book after a series of epidemics wiped out most of his clan. In a tour de force, Brown shows convincingly that this view of the man did not appear in the preface until, in the eleventh century, an editorial bureau appointed by the Song government rescued the book from near-oblivion and republished it as part of the state's large-scale effort “to present the arts of healing as a pursuit worthy of gentlemen” and to rank the book with earlier medical classics.Footnote 2 Brown's book is a work of the highest scholarly quality in a field where the standard has generally been low. It is also witty, a rare amenity in Sinological writing.
I find only one instance in which the book overlooks important points. First, the twenty-five case records in Chunyu Yi's biography refer to him as “your minister Yi” (chen Yi 臣意), a form of the first person used in official documents. They thus cannot be the “records of consultation” in which, for his own use, he systematically registered his clinical encounters. We have no idea how drastically Chunyu revised some of the latter to produce the case reports (demanded by the government) that his biography includes. Second, Brown likens the records to logs of therapy in routine reports by officials, but Chunyu's records are what the biography says they are – accounts of prognoses elicited by an official inquiry. Ten of the twenty-five state that the disorder is mortal. Chunyu does not treat the patient, who duly dies. The other fifteen prognoses judge that the disease is treatable, and he treats it successfully.
Chunyu's biography is complicated and in places inconsistent. No one who has written about it (including myself) has treated it as successfully as Brown has done. Still, Chunyu's accounts so consistently answer the queries about prognosis put to him that, as Michael Loewe and others have proposed, he might well have been the author of many of the records.
The book is nicely printed and bound. Its price of 39 cents per page puts it above the average for scholarly books in its field.
