Authority or Alternative? Rethinking Gender and the Use of Medical Knowledge in Song China, 960-1279. — Page 3:
Whose Knowledge?
11 Francesca Bray reminds us in her book, Technology and Gender: Fabrics of Power in Late Imperial China, that medical techniques for menstrual regulation, which might cause a miscarriage, could at the same time provide women "room for maneuver" (276, 331-334). Here I search for evidence that shows there was indeed room for patients, men and women, to negotiate and seek alternatives. One story from Yijian zhi relates:
When Shi Kangzu was the magistrate of Guangde, he served [the deity] King Zhang piously with caution. Later when he was transferred to Wencui, he had an ulcer on the left side of his chest […] for half a year he tried hundreds of treatments but none of them worked […] He then prayed earnestly in front of King Zhang's shrine, and dreamed of [King Zhang] speaking to him: "If you want to recover, just take Xiangfu (Nutgrass Galingale Rhizome, Rhizoma Cyperi) along with natural ginger sauce." He woke up and called his son to look it up in the Classic of Materia Medica. What the book said about these two ingredients matched his symptoms. He then consulted a doctor, and the doctor also thought that prescription was reasonable. He then removed the root hair of Xiangfu, soaked it in the ginger sauce, and drank it along with two qian of rice soup. After he took only a few doses, the pus flowed out and the tumor gradually disappeared. He recovered after that. (1794, my translation)
Just as medical books incorporated prescriptions of diverse origins, people in the Song acquired recipes from miscellaneous sources. Unidentified sources were not separated from orthodox ones. Although Kangzu in this story got this recipe from his dream-a mysterious source, one may call it, he was able to analyze the ingredients by using medical classics. He checked medical books by himself before checking with a doctor.
12 Scholars have been debating how to use stories as historical sources from Yijian zhi, a book that records "strange" stories the author insists are true. Edward Davis distinguishes Yijian zhi from the "zhiguai" (or "strange tales") tradition long existing in traditional Chinese literature: "[I]n [zhiguai] homodiegetic techniques ('I saw this,' 'I heard this from…') serve the largely heterodiegetic end of sheer storytelling, whereas in [Yijian zhi] the homodiegetic aim of telling what happened is, on occasion, shaped by heterodiegetic forms" (18). In other words, "strange tales" are fiction that were told as if they were real, while stories in Yijian zhi are aimed at telling unusual but true stories. This definition justifies Davis' use of Yijian zhi as one of his crucial sources in studying the practice of spirit-possession rituals in the Song. For me, the usefulness of Yijian zhi lies in the unexplained details that the storyteller had taken for granted, and the way that he told the story-the way that he made sense of the unusual. What had been taken for granted in the above story, for example, is Kangzu's ability to look up herbs in medical books and the accessibility of those books.
13 Another story in Yijian zhi tells how Kangzu was cured of a twenty-year heart ailment by adopting a prescription from the state-sponsored book mentioned earlier, Prescriptions of Sacred Benevolence:
During the reign of Chunxi (1174-1190), [Kangzu] served as the controller-general in Wenzhou. The prefect Han Ziwen saw [his suffering from the disease] and felt sympathy for him, then looked through the section on lumbago in Prescriptions of Sacred Benevolence, and showed Kangzu both Cold and Hot causes of the disease and let him choose for himself. Kangzu said: "I am such an old man and have been weak for so long. How would I dare to use prescriptions for the Hot!" He tentatively picked up a prescription from the Cold category, and took it along with antlers. After ten days the pain was eased […] After more than a month, his crouched back became straight and no longer hurt, and his heart disease was cured as well. He told some doctors about this, and none of them were able to explain what had happened. (1794)
As Robert Hymes has pointed out, in the Song, doctors were not the only group of people with medical knowledge. There is occasionally a "scholar who had learned enough from medical texts to treat his family and friends" (33). Inferring from cases like the two stories above, one probably would not have to be all that well-learned to consult medical texts. What Kangzu and the prefect did was simply look for specific herbs and prescriptions from the books that responded to the symptoms. Medical texts of this kind were therefore more like reference books than something that had to be studied before use. In addition, as in the previous story, doctors were not portrayed as omnicompetent, authoritative figures. Rather, it was the patient who looked for opportunities, did research, and made choices. Patients, or non-specialists, occasionally appealed to the "non-scholarly tradition" and some associated with religious activities; nonetheless, as we will see more cases in the next part, non-specialists also encroached on the doctors' professional realm by using knowledge from the "scholarly tradition" and presenting a different perspective on their own treatment. And that, of course, is closely related to the revolutionary development of printing, the state policy of widely distributing their publications, and the largely improved accessibility of medical books by this time.
Women in Medical Practice
14 It is not anything surprising that women in the Song, especially those from the upper class, read books (Ebrey 120-124). Stories from Yijian zhi suggest that women held medical opinions as well. And just as we have seen from previous stories, their medical knowledge came from diverse sources, including the "scholarly tradition." In the first story below, the woman's knowledge and ability to talk about medicine is part of the unexplained details that the author took for granted, while in the second story, there seems to be a different angle to telling the story from the two stories of Kangzu.
15 This is the first story: A young official met a lady when touring West Lake, and they developed a romantic relationship. But the man failed to persuade the lady's parents to betroth her to him before leaving for another post. Five years later when he came back, he encountered this lady again and they lived together for half a year. One day the lady suddenly confessed to him that she was in fact a ghost-she had died four years earlier right after he left. She then taught him how to survive intercourse with a ghost:
"My yin influence has penetrated your whole body. You will soon have serious diarrhea. Then you should take only the Stomach-Soothing Powder (pingwei san) to nourish and stabilize your essence (jing) and blood." Having heard this, the man was stunned for quite a while, and then said: "I once read the episode about Sun Jiuding encountering a ghost in Yijian zhi. Sun also took this powder. Yet I thought the properties of the ingredients in this recipe were moderate. How can it be so effective?" The lady said: "It uses Cangzhu (Rhizoma Atractylodis), the highest grade of herbs, to repel malignant influences." (754-55)
Unlike in some ghost stories, the lady in this one is not a spirit coming from nowhere nor a "fox lady" of the sort that often appears in "strange tales." She is the daughter of a gentry family. And the recipe that she suggested, the "Stomach-soothing Powder," is not anything esoteric either, but a classic prescription listed in Prescriptions of the Medical Bureau for Benefiting the People Under the Great Peace (Taiping huimin hejiju fang, Prescriptions of the Medical Bureau hereafter).[4]HJJF 3.76. First compiled in 1107-10, expanded and distributed throughout the empire by the court during the Southern Song. Furthermore, her pointing out the crucial role of Cangzhu in this recipe echoes the Northern Song imperial doctor Kou Zongshi's comment on this herb in his Expanded Commentaries of Materia Medica (Bencao yanyi):
Ancient prescriptions and the Classic of Materia Medica did not distinguish Cangzhu and Baizhu (Rhizoma Atractylodis Macrocephalae, or Largehead Rhizoma Atractylodis) but simply listed zhu. Since the Hermit Tao distinguished two kinds of zhu,[5]Referring to "Baizhu" and "Chizhu" recorded in Tao Hongjing (452-536)'s <em>Variorum of Materia Medica</em>. people often favored Baizhu. Today people simply treasure the rare and only use Baizhu, oftentimes leaving Cangzhu aside. However they do not realize that Cangzhu is the most crucial ingredient in some classic recipes such as the Stomach-soothing Powder and has immediate effect. (7.2a)
According to Kou, it was his insight to recognize the importance of Cangzhu and its medicinal properties. Judging from its insignificance in earlier texts, valuing Cangzhu was very likely a Song development. The lady-ghost's medical suggestion therefore shows that she is not only familiar with the classic tradition but also knowledgeable of new Song development in materia medica.