Abstract
This case is one of the few that reveal the working conditions of a doctor such as Xu Shuwei. Following his diagnosis, Xu Shuwei prepared a medication and administered it to the patient. However, members of the patient’s family were impatient with the effects of the medication. They strongly requested that Xu apply a more radical treatment strategy, namely sweating. This case suggests that even laymen were likely to have some medical knowledge, and were apt to insist that doctors alter their treatments. A physician’s only resort was to take the complainers’ logic seriously and to persuade them that his strategy was correct. Unlike most of Xu’s cases, the course of treatment took almost 2 weeks.
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Notes
- 1.
For historical discussion of palpating the pulse and further information on pulse diagnosis see Sivin 1987, pp. 313–326; Kuriyama 1999, pp. 18–37 and 75–91; Hsu 2010; and Sivin 2015, pp. 70–71.
- 2.
The characters xiangren 鄉人 have two possible meanings. The first is a person from the author’s home town and the second is a general term for a villager or someone from the countryside. It seems to me more appropriate to use the former.
- 3.
Ancient Piling was located in present-day prefectural city of Changzhou 常州 (Jiangsu province), which is located about half way between Nanjing and Shanghai and about 80 km from Yizheng, Xu’s hometown. His family moved to Changzhou in 1127 following the fall of the Northern Song dynasty.
- 4.
The character fan 煩 has three meanings in the context of Chinese medicine: (1) heat sensations; (2) vexation, agitation, or irritation; (3) internal heat that causes heart vexation (see Zhongyi da cidian, 2nd ed., p. 1473). Although the first meaning actually arises from the Treatise, I think that here ‘vexation’ rather than ‘heat sensation’ fits better since we are talking about a symptom and not its cause.
- 5.
This type of pulse indicates that although the syndrome is external treating it with a diaphoretic is contra-indicated, since the physician has to first treat the underlying deficiency and only then sweat the patient.
- 6.
- 7.
Xue can be and often is translated as ‘blood’. However, this translation reduces the meaning of the word to the western modern meaning, ignoring other aspects of the word which are unique to Chinese medicine. In classical medical discourse, which emphasized functions over materials and structures, xue meant the yin vitalities of the body more often than the familiar red fluid that flows from wounds. I therefore leave this term untranslated, as I do with qi.
- 8.
This refers to Minor Construct the Middle Decoction with Chinese Angelica [danggui] and Radix Astragali [huangai]. This formula appears in the Treatise (line 100), see Mitchell, Ye, and Wiseman 1999, pp. 419. For further information see Scheid et al. 2009, p. 267 (also, pp. 264–267 for Minor Construct the Middle Decoction).
- 9.
- 10.
A similar almost identical discussion appears in Xu Shuwei’s Shanghan fawei lun, p. 45.
- 11.
- 12.
Here Xu stresses that in addition to following the Treatise physicians need to integrate the doctrines of the Eight Rubrics originating from the Yellow Emperor’s Inner Canon.
- 13.
Xu refers here to the fact that medications cannot be randomly administered; rather, there is a designated order of application due to their effects and mutual interactions. He also alludes to the fact that physicians should first treat the underlying pathogen or pathology and only then treat the secondary symptoms.
- 14.
Here Xu refers to Emperor Wu of Chen (陳武帝) (r. 557–559), personal name Chen Baxian (陳霸先). In the identical case in the Puji Benshi fang, Xu refers to Chen Baxian as Emperor Wu of Liang. He was mixing up emperors Wu from two different dynasties, the Liang and the Chen. Emperor Wu of Liang (梁武帝) (r. 502–549)’s personal name was Xiao Yan (蕭衍). Fan Yun (451–503), who held several prominent positions during the Liang dynasty of the Disunity Period, was his friend, and was granted the authority of a prime minister without being one.
Almost identical story with the same mistake appears in the Yishuo (juan 1), but there it specifically mentions Chen Wudi. The original story, though with a little different narrative, appears in the Nanshi (juan 57)
- 15.
The ceremony of the Nine Honors was an ancient ceremony in which the emperor bestowed nine types of gifts on a select group of esteemed officials to show his appreciation for their service.
- 16.
On the basis of this anecdote, Xu Wenbo practiced during the fifth century. Xu is also famous for his treatment of women medical disorders, see Medicine for Women in Imperial China pp. 38, 163.
- 17.
Fan Yun is quoting Confucius’ Analects, 4. 8; see D.C. Lau 1979, 73.
- 18.
Warming Powder (Wenfen 溫粉) is a formula recorded in Zhu Gong’s Leizheng huoren shu, juan 13, p. 89. It is made of Atractylodes Rhizome (白术), Ligusticum root (藁本), Chuanxiung Root (川芎), and Dahurian Angelica Root (白芷). This medication stops excessive uncontrolled sweating in Cold Damage disorder. See Zhongyi da cidian, 2nd ed., p. 1781.
- 19.
Literally, “as a tortoise-mirror.”
Bibliography
Other Sources:
———. 1979. Confucius: The Analects (Lun yu). New York, London: Penguin Books
Mitchell, Craig, Feng Ye, and Nigel Wiseman. 1999. Shang Han Lun (On Cold Damage); Translation and Commentaries. Brookline, MA: Paradigm Publications.
Scheid, Volker, Dan Bensky, Andrew Ellis, and Randall Barolet. 2009. Chinese Herbal Medicine: Formulas and Strategies. Seattle: Eastland Press.
Yu, Bohai 于伯海, et. al. 1997. Shanghan jinkui wenbing mingzhu jicheng 伤寒金匮温病名著集成 [Collected Famous Works on Cold Damage, Golden Casket, and Febrile Disorders]. Beijing, Huaxia chubanshe.
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Goldschmidt, A. (2019). Case Number 4. In: Medical Practice in Twelfth-century China – A Translation of Xu Shuwei’s Ninety Discussions [Cases] on Cold Damage Disorders. Archimedes, vol 54. Springer, Cham. https://doi.org/10.1007/978-3-030-06103-6_5
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