This Content Downloaded From 130.216.158.78 On Mon, 02 Jan 2023 09:50:59 UTC

Medical Practice in the Ming Dynasty—A Practitioner's View: Evidence from Wang Ji's
"Shishan yi'an"
Author(s): Joanna Grant
Source: Chinese Science , 1998, No. 15 (1998), pp. 37-80
Published by: International Society of East Asian Science, Technology, and Medicine
Stable URL: https://www.jstor.org/stable/43290458
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide
range of content in a trusted digital archive. We use information technology and tools to increase productivity and
facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
https://about.jstor.org/terms
International Society of East Asian Science, Technology, and Medicine is collaborating with
JSTOR to digitize, preserve and extend access to Chinese Science
This content downloaded from

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
All use subject to https://about.jstor.org/terms
Chinese Science 15 (1998): 37-80
Medical Practice in the Ming Dynasty

- A Practitioner's View: Evidence from
Wang Ji's Shishan yi' an
Joanna Grant
[Joanna Grant completed her PhD. thesis on " Aspects of Gender and Culture
in Ming Dynasty Medical Histories " at the School of Oriental and African
Studies, University of London, in March 1997.]
AUTHOR'S NOTE : The research upon which this article is based was made
possible by generous funding received from the Wellcome Trust. I would also
like to thank my supervisor Dr. Christopher Cullen and the many reviewers,
colleagues, and friends who have given me such invaluable assistance in the
preparation of this article.
* * *
perhaps the most famous work of the Ming physician Wang Ji

The perhaps (1463-1539),
(1463-1539),Shishan the y mosta collection
and constitutes i and 'aofn Soverconstitutes
one hundredfamous ill HI? work (Stone-mountain a collection of the Ming of over medical physician one hundred case Wang histories) case Ji histo- is
case histo-
ries taken from his clinical practice in Qimen, Anhui province, over a period of
fifteen years.1 The value of this text as source material lies in the potential of
case histories to reveal aspects of clinical medical practice not accessible either
through studies of its historical context or through examinations of theoretical
texts. Much is now known about the general theoretical principles that underlie
1 Wang Ji's style name, zi was Shengzhi 1Éj ¿I, and his nickname, hao , was
Shishan Ç|JL| (Stone-mountain), which relates to the fact that Wang Ji's ancestors had
come from Stone-mountain in Anhui. The words "Stone-mountain" in the title of this
book Shishan yi'an Ç|JL|f|^ (Stone-mountain medical case histories) therefore denote
Wang Ji. All references to the Shishan yi ' an in this article, unless otherwise stated, are
taken from the following edition: Siku quanshu (photographic reprint, 1987),
vol. 765, pp. 325-409.
37

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
38 Chinese Science 15 (1998)
both traditional Chinese medicine and

to a lesser extent, their temporal, r
whereas anthropologists of contemp
observe and document the various dimensions of traditional Chinese medicine
as it is currently practised, including the interrelationship between theory and
practice, the patient/physician encounter, and interactions with other sectors of
the contemporary health system,3 historians have had little opportunity to ex-
plore the world of clinical medical practice in a historical context.4 As a result,
while much has been written about continuity and change from a theoretical
perspective, medical practice remains a little-known area.
In this article I draw on the information given in the Shishan yi'an in order
to build up a picture of various aspects of Wang Ji's medical practice. I begin by
examining the nature of the text itself, in terms of its author, its historical ante-
cedents, its purpose, and its reliability as a source material. This is followed by a
description of the structure of text, both overall and in relation to the individual
cases. I then focus on the data contained within the case histories to reconstruct
certain features of Wang Ji's medical practice, including his theoretical beliefs
and their implementation in clinical practice, his interaction with other medical
healers, and the dynamics of the patient/physician relationship.
The Nature of the Shishan yi'an
The Author of the Text
Wang Ji lived and worked in Qimen, in the Huizhou prefecture of southern An-
hui, during the late fifteenth and early sixteenth century. He was an important
part of Xin'an medical culture during perhaps its most influential and productive
period.5 Powerful social and economic changes affected the entire region at this
time, and their impact was noticeable on many aspects of medical culture. The
social mobility characteristic of the period meant that physicians came from a
variety of backgrounds and often had differing reasons for deciding to pursue a
career in medicine. However, despite their diversity of background, physicians
appeared as more of a cohesive group than they had previously. The increasing
2 See, for example, Needham et al. 1954-; Sivin 1987; Porkert 1974; Unschuld 1985.
3 Influential anthropological studies include Kleinman 1980; and Farquhar 1994.
4 There is, however, some research emphasizing practice as opposed to theory. See,
for example, Cullen 1993, which describes the social dimensions of healing to be found
in a Ming dynasty novel; and Furth n.d., which analyses gender differences in over 400
case histories from the Qing dynasty.
5 Xin'an iff??, in reference to the Xin'an mountain in Qimen, was the term used by
many sixteenth-century scholars to refer to the Huizhou area.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Joanna Grant: Medical Practice in the Ming Dynasty 39
contact between physicians, both in terms of direct contact resulting from im

proved transport networks and greater mobility and in terms of indirect conta
resulting from the boom in publishing and increased access to books, created
environment in which the physicians were highly aware of each other. In add
tion, one effect of the general prosperity and merchant patronage also charac
teristic of the period was to increase the variety and quantity of medical book
being produced, and many new genres, such as general readers and medical cas
histories, emerged to satisfy the needs of a new and diverse readership.
According to Wang Ji's biography, in his youth he had studied the classics
and made repeated attempts at the civil service examinations, but after repeated
failures he decided to become a physician like his father before him.6 His rep
tation is said to have spread far and wide, with people coming from all around t
receive treatment. Contemporary evidence also substantiates the assertion tha
Wang Ji was well known and respected in his own lifetime. Not only did
produce at least eleven medical texts on a variety of subjects, but versions of hi
biography appear in the Qimen xian zhi jjíPHI&íÈ (Qimen gazetteer) datin
from the Wanli period (1573-1620), and also in the comprehensive medical tex
Gujin yitong daquan (Complete synthesis of medical knowledge
past and present) compiled by Xu Chunfii another Xin'an physician and
contemporary of Wang Ji. Wang Ji also had more case histories included in the
Mingyi leť an (Cases of famous physicians arranged by category), a
sixteenth-century case history compilation, than almost any other physician.
Despite the increasing transmission of medical knowledge through the medium
of published works, the master/disciple relation was still an important mecha-
nism for transmitting and disseminating knowledge, and Wang Ji's disciples, of
whom at least seven can be positively identified, played a key role in ensuring
the spread of his medical theories throughout the region.
Wang Ji was also greatly influenced by a number of other contemporary
physicians. In particular the writings of Xue Ji (1486-1558) and Wang
Lun (1453-1510) from Zhejiang, Han Mao (A. 1522) from Sichuan,
and Wei Guiyan (A- 1525) were very influential on Wang Ji's own
writings and theories. No doubt the presence of Huizhou merchants throughout
China at this time accounts for the texts of these physicians reaching Wang Ji so
soon after publication. Travelling merchants also enabled Wang Ji to obtain
information on the acupuncture and moxibustion skills of Ling Hanzhang
and Li Qianhu from neighbouring provinces. Such transporta-
tion networks played an important role in the distribution of medical texts and
stimulation of intellectual debate during this period, and enabled Wang Ji to
keep track of contemporary developments in the field of medicine on a national,
as well as regional, basis.
6 Shishanyťan fulu [appendix]: 21-47.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
In Wang Ji we see reflected many

medical culture in the early sixteenth
tor - repeated failure in the civil ser
realise the Confucian virtues of bene
typical. The three most common mod
that is hereditary transmission, the m
through published materials, are al
learnt from his father, he passed his
quired knowledge from books and wr
writing, in terms of both the types o
classics, revised editions, and general
(Confucian benevolence, correcting
medical texts to the public), are also
the extent of his influence and his ab
opments are a reflection of the incre
which was a distinctive feature of Xin'a
The Case History Genre
Physicians' case histories (yi'an Ü5PD

their disciples) of their medical pract
by the physician, and in doing so ofte
healing, from diagnosis and treatment
ceptions. The writing of case histo
through Chinese medical history
corded in chapter 105 of the Shiji jļjf
Prior to this there are also certain
sicians and patients to be found in
zhuan 1eL'M (Zuo commentary of the
chunqiu (Spring and autumn ann
of oracle bone inscriptions. Although
Ming medical works, either inserted
separate section, it was not until the
case histories emerged as a distinct ge
The Ming dynasty witnessed a sudd
case histories. In addition to Wang Ji
1531, is one of the earliest extant exa
the case histories of Anhui's Sun Y
7 For a concise and systematic accoun

from their beginnings to their emergen
Mincai 1994.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
JrI Ž.~F were both published in the sixteenth century, as was the first collectio
of case histories, the Mingyi leť an (Cases of famous physicians ar-
ranged by category) compiled by Jiang Guan £Eīg[ (1503-1565) and his so
Jiang Yingsu ¿USït . Interest was also taken in the style of case history writing
with Han Mao, in his Hanshi yitong (Mr. Han's comprehensive sur-
vey of medicine) of 1522, proposing a standard format for their transcription
under the six rubrics of looking ( wang Ü), listening/smelling (wen fit)), askin
( wen P4J), touching (qietJJ), aetiology (bingyuan and treatment (zhifan
shu Zamíří)- A number of reasons can be cited for the emergence of the case
history genre at this time, including the advances made in publishing technol
ogy, and market demand from the increasing number of would-be physicians
from the ranks of merchants and failed literati, who were perhaps unable to ob
tain an apprenticeship but wanted access to practical information about clinica
medicine.
The length, style, and content of case histories varies enormously. Those of
Wang Ji are not in the form of brief notes taken at the patient's bedside, but con-
stitute rather longer accounts of the illness from onset to recovery. These ac-
counts often contain additional contextual information which can be extremely
useful in the reconstruction of a practitioner's view of Ming dynasty medical
practice. For example, from the Shishan yi 'an we can gather information about
other contemporary systems of healing and the patient/practitioner relationship,
as well as the types of illness a Ming dynasty physician would be likely to come
across and the therapies he might utilize to effect a cure.
Case histories such as these are an invaluable, although somewhat neglected,
source material, as they represent one of very few remaining opportunities to
enter into the world of historical clinical medical practice. Whereas theoretical
medical texts, the basic unit of research into Chinese medical history to date,
tend to emphasize the premises of Chinese medicine over its practical applica-
tion, case histories, by focusing on the physician's response to individual pa-
tients, give us greater access to the actual practice of this art. This glimpse into
the practical arena not only provides us with an opportunity to examine the rela-
tionship between a physician's theoretical exhortations and his clinical practice,
but also allows us to explore the multiplicity of interactions that the physician
had with the world around him.
The Purpose of Writing Case Histories
Physicians' biographies and the prefaces to their medical works often record
their reasons for entering the medical profession. Typical explanations include
failing the civil service examinations, wanting to express Confucian filial piety
by helping an ill relative, or wanting to be of service to society. Similar motiva-
tions were also cited in the prefaces to many of Wang Ji's works for his decision
to write them, but the prefaces to the Shishan yi 'an give no clue as to why he

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
specifically wanted to set his clinical

various comments made in the text gi
pelled to record and publish his case h
case histories, those of Chunyu Yi, w
tigation after he had been accused of
there could be a legal aspect to the ris
in the Ming dynasty, some 1500 year
Shishanyi'an would indicate that this
Ji gives throughout the Shishanyi'an
be broadly divided into three main cat
to some extent. The first of these I h
tional purposes, the second "self-prom
retical and clinical ideas while deriding
the strange," that is noting down thin
Wang Ji's intention that his cases ar
can learn is made clear by his practice
tain cases explaining the general prin
the end of one case he explains how i
spells out the relevance of this princ
fers from depletion and exhaustion . .
hoarseness which cannot be treated, o
ple] all cannot be saved. Doctors mu
treatment of disorders, and the need
medicines and flexible to the extent o
son if the symptoms warrant it, are
gives.10 Recommendations such as th
ticular theoretical outlook, but seem
which has been acquired over years o
use to those starting out in medical pr
Confirmation of this intention to e
can be found in the last chapter of t
number of cases by other physicians r
ders using other emotions, according
introduction to this section he descri
tion books about the treatment of emotional disorders has necessitated his
searching out of examples of treatment by previous sages in order to instruct
those in the future.11 This is further validated by the fact that in none of the
8 This suggestion was raised in a debate stimulated by a paper by Christopher Cullen

(1995).
9 Shishan yi 'an 2: 1-2.
10 Shishanyi'an 3: 24-25; 2: 17-18; 3: 22-24.
1 1 Shishan yi 'an 3 : 14-15.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Joanna Grant : Medical Practice in the Ming Dynasty 43
cases that follow is the name of the physician mentioned; what is important is
not who the physician was, but the way in which a cure was brought about.
This didactic element found in the Shishan yi'an is consistent with earlier
suggestions that the rise of medical case histories as a genre in the Ming dynasty
may have been linked with the increase in "how to" books which were being
published at that time, primarily to enable students to pass examinations and
gain experience in certain fields such as law and medicine, given that young
gentry men were finding it increasingly harder to gain entry into the civil service
and turning their attention to alternative careers.12 This link is further confirmed
by a comment made by Cheng Zeng ^ in his preface to the Shishan yi'an
which draws attention to the resemblance between legal and medical case histo-
ries.13
The evidence from the Shishan yi'an suggests that, despite being a prolific
and well respected physician, Wang Ji practised in a somewhat unstable and
competitive environment in which he faced a good deal of criticism of his re-
plenishing theories and resistance to his warming treatments, from both patients
and other practitioners.14 In this context, the recording of case histories can be
seen as an exercise in self-promotion, by explaining one's theoretical viewpoint
and providing clinical examples which demonstrate how these views were
proved to be justified in actual practice, and by exposing the theories of others
to be fundamentally misguided and ineffective, if not harmful, when put into
practice. In many ways the Shishan yi'an reads as just such an exercise, with a
theoretical introduction and additional theoretical paragraphs and essays setting
out Wang Ji's ideas, case histories which show just how effective his favoured
treatments of ginseng and astragalus root were in practice, and incessant refer-
ences to the incompetence of his contemporaries. At the end of one case he ac-
tually states that he has only recorded it because he fears that otherwise incor-
rect assumptions will be passed down, and that he will be powerless to prevent
it.15 Wang Ji is thus recording for posterity his view of the ideal medical prac-
tice, based on his own theoretical framework and born out of frustration with the
contemporary situation, in the hope that it will act as a guide and inspiration for
later generations.
Also consistent with the view that Wang Ji is promoting his vision of medi-
cal practice as an inspiration for future scholars of like mind is his quoting of
like-minded contemporaries, whose views not only serve to complement and
reinforce his own, but to some extent also bolster his own reputation through
12 Suggestion made by Cullen 1995.

13 See the preface by Cheng Zeng to the Shishan yi'an dated 1531, and included in
all Ming editions of the text. This preface can also be found in the Yiji kao 1936: fascicle
3, p. 557a.
14 The evidence for this will be discussed later.
15 Shishan yi'an 2: 25-27.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
44 Chinese Science 15 (1 998)
association. In the last fascicle, Wang J

two case histories, taken, largely verb
explains his decision to quote from th
from the Yitong. I have become fully
cord with my own. Therefore I have re
The first case history he quotes conc
having taken yin (ü£) supplements f
that everyone suffers from yin deplet
Wang Ji heartily endorses, having criti
contemporary medical practice himsel
case are so similar to those of the Shis
been written by Wang Ji. The secon
form, relates the variety of treatmen
(Hj) depletion. Wang Ji adds at the e
from the Yitong. His treatment of illn
cines appropriate to the circumstances
act according to the situation. Therefor
Thus, again, Wang Ji endorses the pr
although he is not the author of the cas
y Van, the overall effect is of a consis
coherent statement of Wang Ji's theo
medical practice. Therefore, in this co
understood as the desire to pass on a d
how medicine should be practised, in th
of emulation.
The input of the disciples who recor
One must presume that by compilin
16 Shishan yťan 3: 18-20. I have been a

edition of the Hanshi yitong HiSSli! [Mr
1794, vol. 5.1: 10, 12, 13, 19; 2:3.
17 Shishan yi 'an 3 : 1 9.
18 Shishan yi'an 3: 19. The Zazhu
cellaneous writings of illustrious physicians
annotated by Xue Ji and published in
so copies were no doubt circulating well bef
19 Shishan yi'an 3: 27-29. In this case Wa
contemporary physicians think that all co
which replenish yin. Wang Ji also criticizes
cal essay included in the appendix to th
zazhu jiyong shen zhulun" [Discursive essay on the taboo
against the use of ginseng in the Miscellaneous writings of illustrious physicians
shan yi'an fulu [appendix]: 1-7.
20 Shishan yi 'an 3 : 1 9-20.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
histories, one not only shows proper respect, but also increases one's own pres
tige by association if the publication is successful. Therefore, the motivation o
the disciples is also a form of self-promotion, of themselves as well as of thei
master. The publishing of physician's manuscripts by disciples is also com
mented on by Wu Yiyi in his article on the Jin dynasty physician Liu Wansu
%''%%' "The most promising or favorite student would be likely to receiv
some manuscripts, so that he could carry on the master's theory; at the same
time, books served as a token of authentic transmission. In order to enhance an
to carry forward the master's scholarship, and to demonstrate their position
successors, the students would have the materials published."21 This may well
have been the situation in the case of Wang Ji, as we know that not only did
Chen Jue collect and compile his master's Shis han y i 'an and publish his col-
lected works, the Wangshi yixue qishu , but two other disciples, Zhou Chen an
Xu Zhong, also recorded some of his case histories which are reproduced in th
appendix to the ShishanyVan.11
The Chinese have a long and full literary tradition, and part of this has al-
ways been the practice of "recording the strange," examples of which can be
found in the dynastic histories, and which was to some extent the inspiration
behind some of China's earliest examples of fictional writing, the Han dynasty
zhi guai GStž), which describe unusual people and strange happenings. In
medical context, we also find collections of strange or unusual case histor
being published today.23 It is therefore no surprise to find that an intention
"record the strange" was partly responsible for motivating Wang Ji to write th
ShishanyVan. Also, given that many of these case histories were probably tran
scribed some time after the event, it may well be that somewhat strange or un
usual cases more easily sprang to mind. For example, one woman has no pulses
but as it is her natural disposition, she is therefore not ill. Wang Ji ends the ca
by writing: "If the two hands lack a pulse, but the person is as before, then th
is the way in which theory (//' g|) lacks the immense variety to be found in
practice (shi iļī). Therefore I have recorded it."24 Other examples include a ma
who had worms coming out of his penis, and another whose navel protruded
extraordinary distance.25 After both of these cases Wang Ji comments that h
has recorded them because of their strangeness.
Therefore, the evidence from the case histories themselves would suggest
that the writing of the Shishan yi'an served a number of purposes, encompas
ing various notions of educating future generations, producing an account of
theory in practice in reaction to a contemporary context which failed to reco
21 Wu Yiyi 1993-94: 63.

22 ShishanyVan fulu [appendix]: 23-46.
23 For example, Shanghai Zhongyi xueyuan Zhongyi wenxian yanjiusuo 1994.
25 Shishan yi 'an 1 : 33; 1 : 32.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
nize the value of both his theory and

which had occurred during his years a
more comparative research, it is imp
factors also motivated writers of oth
followed.
The Shishan yi 'an as Source Material
There are a number of important dimensions to this source material which

need to be taken into consideration before embarking on an analysis of its con-
tents. First, it is necessary to take into account the temporal distance between the
events taking place and their transformation into a written format. Some of the
cases narrate the course of an illness over a duration of several months or even
years, and it is unclear at what stage of this on-going process notes were taken,
or how long after the event they were written up into a recognisable case history
format. Therefore it seems possible that we are dealing with events as they were
remembered after a period of some time, and thus liable to the distortion inher-
ent in the act of recollection. Also, although the authorship of the cases is gener-
ally credited to Wang Ji, according to the original preface they were in fact re-
corded by the disciples who accompanied him, and their writings were given to
Wang Ji's chief disciple, Chen Jue |$jÜ #§, who was responsible for compiling the
work. Nevertheless, the Shishan yi' an was published in Wang Ji's lifetime, only
one year after some of the cases are said to have taken place, and Wang Ji him-
self wrote a self-appraisal and a theoretical essay for inclusion in the text. There-
fore it is very likely that the ideas conveyed in the Shishan yi1 an are Wang Ji's
own, and that he approved the compilation before publication.
Second, one must bear in mind that case histories are a literary genre. Wang
Ji's case histories conform to certain conventions of the genre, and in doing so
become one step removed from a simple blow-by-blow description of the en-
counter. In addition, these case histories are not an impartial account of Wang
Ji's medical practice but a reflection of the perceptions of the physician himself,
in this case as seen through the eyes of his accompanying disciples. These case
histories were purposefully selected out from Wang Ji's clinical experience;
usually they would seem to illustrate certain points of theory or to demonstrate
the efficacy of certain treatments. Therefore they are no doubt somewhat ideal-
ized, only including relatively successful cases, which show Wang Ji in a good
light, and omitting any cases which resulted in a spectacular failure, or where
another physician succeeded where he could not. This means that the cases in-
cluded in Shishan y Van cannot be taken as representative of Wang Ji's medical
practice as a whole, or indeed that of other Ming dynasty practitioners. Nor can
they reflect the views of practitioners belonging to other medical traditions, or

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
those of the patient.26 What they do reveal, however, are the particular concern
interests, and beliefs of an individual sixteenth-century physician.
Despite the fact that these cases may have been specifically selected and that
they reflect the biases of their compilers, this does not preclude their use as
source of information for the examination of various aspects of medical prac-
tice. They are nevertheless accounts of actual clinical encounters as perceived
by those who recorded them, and the descriptions they give of the way in whi
the clinical encounter was conducted, of the type of treatments utilized, and
the interaction of the physician with both his patients and other healers, are st
able to provide illuminating insights into the practice of medicine in sixteent
century Anhui. Moreover, for the Shishan yi'an to have been sufficiently pop
lar to run to several editions,27 and for it to be included in the medical section
the Qing dynasty imperial collectanea (Siku quanshu it must have
been perceived by its readers to be a largely believable account of clinical medi-
cal practice. Therefore, while certain factors, such as its inherent bias towards
success and the possible distortion caused by inaccurate recollection of events,
need to be taken into consideration, the Shishan yi'an can be regarded as a use-
ful source of information for an investigation of certain aspects of Ming dynasty
medical practice.
The Structure of the Shishan yVan
Overall Structure
The Shishan yi'an is divided into three fascicles (juan ^), and followed by an
appendix (fulu The first chapter begins with a short theoretical discussion
outlining Wang Ji's beliefs regarding yin (^) and yang (|y§) depletion in rela-
tion to those of Danxi.28 This is followed by replies to letters sent to him by two
26 When discussing medical practice, it is important to remember that medicine was

not solely the province of those literate physicians whose texts remain, but was practised
by healers from a wide variety of disparate traditions. Arthur Kleinman (1980: 50) has
proposed a provisional model of the internal structure of health care systems, which in-
cludes professional, folk, and popular sectors. Its applicability in the context of pre-
modern China is discussed at length in Cullen 1993.
27 According to the Quanguo Zhongyitushu lianhe mulu
(Union catalogue of Chinese medical works in Chinese libraries) there are over nine
separate editions of the Shishan yi 'an. This does not include the edition found in the Siku
quanshu , or in Wang Ji's collected works, entitled Wang Shishan yishu bazhong
9:5 ill Blr A# (Eight medical books of Stone-mountain Wang). See Zhongguo
Zhongyi yanjiuyuan tushuguan 1991: 627.
28 Danxi is the style, zi taken by Zhu Zhenheng (1281-1358), one
of the so-called "four masters of the Jin and Yuan dynasties." He was responsible for

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
patients. The main body of the chapt

gories,30 such as periodic fever ( n
chapter contains a total of 51 cases al
are also two short theoretical discussi
late. The third chapter begins with a c
is followed by a total of 22 cases, aga
spersed. However, in contrast to the f
into categories of any sort, and only
the rest, seven are by famous physic
states have been included as examples
by emotion. There are also four short
from the Hanshi yitong. Therefore, o
are not by Wang Ji, although he felt
own. The appendix contains two the
astragalus root, one by Wang Ji, and
as well as biographies of both Wang J
also a physician. The biography of Wa
rates 47 case histories compiled by
Wang Wei's biography was written b
amples of his father's clinical expertis
Individual Case Structure
Altogether the main body of the Shis han y i 'an contains a total of 1 14 case
histories by Wang Ji, many of which are structured in a similar way. The fol-
lowing example demonstrates many of the features commonly found in this set
of case histories:
developing the theories of "minister fire" ( xiang huo and of yang being in excess,
yin being depleted. He wrote the Gezhi yu lun (Supplementary discussions for
the perfection of understanding through investigation of phenomena), which had great
influence on the thinking of later physicians, Wang Ji included.
29 The Siku quanshu edition has only 46 cases in this fascicle. Three cases which ap-
pear in every other edition I have examined, including the original block-printed edition
from 1531, have been omitted.
30 The rationale behind the division into the particular categories used is unclear; the
organizational strategy appears simply to be the loose grouping together of similar
symptoms or chief complaints.
31 Although compiled a decade earlier and by different disciples, the form and con-
tent of these supplementary cases is remarkably consistent with those in the main body of
the text. The clinical encounter is described in a very similar way, and the same views are
expressed in terms of medical theory and type of treatment.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
A man. Thirty years old. Pale in appearance. Owing to exhaustion he caught a

fever. In the ninth month he was extremely ill with fever, headaches, thirst, vom-
iting, a feeling of heaviness in the chest, anorexia, spontaneous sweating, and
lassitude. He was often hot, and rarely cold. A doctor used medicines to stop [the
fever], but the illness worsened, and he would vomit violently if he drank water.
I examined him. His pulses were all floating (fu ^), big (da ý^), soggy (ru ü§),
and quite taut (xian j}¿). I said, "This is the type of fever where exhaustion harms
the spleen, and heat harms the qi." I told him to use three qian ($8)32 of ginseng
(rertshen À#)> one and a half qian of astragalus root (huangqi î|fï£), one qian
of white atractylodes rhizome (baizhu Q yfu), one qian of ophiopogon root (mai-
mendong five fen (5^)33 of immature bitter orange (zhishi 1RS), seven
fen of hawthorn fruit (shancha lllS), seven fen of angelica sinensis (guishen
MMX seven fen of phellodendron bark (huangbai jlrfÉ), seven fen of anemar-
rhena rhizome (zhimu £Q-fii), three fen of dried ginger ( ganjiang and three
fen of licorice (gancao tflpL). It was decocted, and he took three doses. The ill-
ness receded. He was again harmed by exhaustion and the illness returned. The
ginseng in the previous remedy was increased to four qian; he took it and recov-
ered.34
Most cases are narrated in the first person and begin with either the words "a
man" or "a woman," or occasionally with one of the various words for "a child."
This is sometimes varied by giving the name of the person in question, or their
official title, or occupation. Their age is generally then given, followed by a
brief description of their appearance, mainly their build and/or colouring. Next
some sort of aetiology or explanatory factor is often given, such as being fond
of drink, or as in this case, being exhausted. The symptoms suffered are then
listed, often with some mention of what time of day or year they occur, and
whether they are more severe in the day or at night. Often these symptoms are
described in great detail and can include information about all types of bodily
function, such as frequency of seminal emissions, regularity and consistency of
bowel movements, and so on. The patient is then generally said to have seen a
physician, whose remedies are either ineffectual or cause the illness to worsen.
This prompts the patient to invite Wang Ji to examine him. Wang Ji takes the
pulse and usually on the basis of this reading makes his diagnosis. An exposition
of the illness syndrome is often then given, followed by his proposed treat-
ment.35 Finally, he relates the outcome of the treatment, and whether there were
32 One qian is a tenth of a Chinese ounce or tael (Hang jāg), which in the Ming dy-
nasty was approximately equal to 1.3 imperial ounces. See Mote and Twitchett 1988:
xxi.
33 One fen is a hundredth of a liang jāg.
34 Shishan yi 'an 1 : 1 7-1 8
35 Wang Ji utilizes the information obtained from the clinical encounter to translate
the patients' symptoms into a complex and individual pattern of illness grounded in the
abstract theoretical principles of Chinese medicine, but the terms bianzheng ffîWt (pat-

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
any later recurrences of the illness. In

of remuneration for services rendere
charge for his services, or because
appropriate, or perhaps sufficiently
ries. The latter is probably the most
post, Wang Ji would presumably nee
tice.
Not all case histories rigidly follow the structure described above. In some
cases not all of this information is present, in others the basic structure is fol-
lowed, but it is interspersed with additional information about, for example,
when, where, and how often the patient was seen, the various illnesses suffered,
or Wang Ji's opinions regarding the patient or the treatments offered by other
healers. Some patients are seen several times over a number of months or years,
and suffer from a number of different complaints. In these cases the chronology
of events is more likely to determine the structure of the case, and the overall
effect is more anecdotal than structured. For example, the case of a man suffer-
ing from recurrent swellings is narrated in a chronological fashion, and covers a
duration of several months. The events are described in the order in which they
happened, and include accounts of two separate visits by Wang Ji, two letters
sent to him by the patient, and a number of encounters between the patient and
other physicians who are trying to persuade him to abandon the treatment rec-
ommended by Wang Ji.36 The incidental information contained in these longer
accounts can be used to create a better understanding of the context in which
medicine was practised in the Ming dynasty.
Another way in which the narration of some cases departs from the structure
described above is by incorporating dialogue between the physician and the
patient. This is used in a number of different ways. The first is to elicit informa-
tion from the patient about his or her symptoms, as this example shows:
I asked him, "Are you hot?" He said, "I do not feel it." I said, "Do you cough?"
"Only a few times in the night." I said, "What are your bowel movements like?"
"Recently I have had watery stool, and an abscess has developed by my anus.
The pus has come out but the wound has not yet closed up." I said, "What is the
worst thing?" "At night I don't sleep well and my limbs lack strength."37
In other cases it is the patient who is described as engaging Wang Ji in dia-

logue. This enables Wang Ji to elaborate on various aspects of the illness. For
example, in one case a man is suffering with syphilitic sores (yangmei chuang
), and asks Wang Ji a series of questions about his condition. These in-
tern diagnosis), referring to this process, and zhenghou UM (illness syndrome), refer-
ring to the resulting medical diagnosis, are not explicitly used in the text.
36 Shishanyťan 2: 27-28.
37 Shishanyi'an 2: 9-10.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
eluded enquiries as to why the medicine he had been taking was inappropriate,
what caused his sores, how they were transmitted, and what medicines would be
suitable for his disorder.38 Finally, in a number of cases, the phrase "Someone
asked . . (huo yue ^0) is used.39 Usually the person is questioning either
Wang Ji's diagnosis or his proposed treatment. This then acts as a cue for Wang
Ji to justify his actions in detail, often quoting from the medical classics to back
up his assertions.
The use of dialogue in the case histories is clearly not an attempt to repro-
duce verbatim an actual conversation, but a literary device which is understand-
able on a number of interconnected levels. On one level, it reflects the real con-
flict between the physician and the patient with regard to the more controversial
aspects of diagnosis and treatment. Linked to this is the idea that the reader will
have similar reservations and therefore on another level the author is reacting to
his expected audience by explaining and clarifying his position to the sceptical
reader. Further, given the didactic tone of the text, the author is also demon-
strating to the reader how he, as a skilled physician, overcomes popular objec-
tions to his methods, so that those using his text as a practical guide and fol-
lowing his theoretical stance can similarly meet the criticisms they encounter in
practice.
Finally there are those cases which Wang Ji does not actually see. In two
cases Wang Ji is merely reporting what he has heard,40 and in others the case is
conducted entirely through correspondence or an intermediary.41 Obviously the
structure of such cases necessarily differs from the more common form de-
scribed above.
Wang Ji and His Medical Practice
Case histories present us with an opportunity to examine many aspects of clini-

cal medical practice. One important area is the interrelationship of theory and
practical therapy. Here the Shishan yi'an is a rich source of information about
Wang Ji's theoretical beliefs, their origins, and the extent to which they influ-
enced his clinical practice. In addition, the fine detail of many of the case histo-
ries facilitates an exploration of the logistic aspects of practising medicine, such
as where Wang Ji saw patients, how he examined them, how he reached a diag-
nosis, and what sort of factors were involved in deciding how and whether to
treat a patient.

39 E.g., Shishan yi'an 1: 31-32; 2: 29, 4(M1; 3: 22-24, 25-27.
40 Shishan yi'an 1: 33; 2: 24.
41 Shishanyi'an 2: 18-19, 29-30; 3: 1-3.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Wang Ji's Theoretical Beliefs
Although case histories, by definit

medicine, theory is a very obviously f
The Shishan yi'an , for example, beg
nearly every case history contains a d
ness syndrome, and some cases are eve
commentary. There is no question of p
theory and practice are inextricably lin
Wang Ji sets out his theoretical posit
his introductory essay he takes as his
in the human body yang is in excess a
meaning behind this has been misunde
agreeing that yin often needs to be re
raries he also believed yang too could n
relative, both can be divided into eleme
character. In terms of bodily fluids, qi
Ji emphasizes the division of yang qi
and structive qi (yingqi Hü).43 Protect
circulates around the exterior of the bo
pernicious influences. It is endowed
being replenished. Structive qi is also y
and is formed from the water and grai
facilitate the function of protective q
a type of qi, structive qi is by definiti
is yin. Therefore it can be considered a
to Wang Ji's argument: "Those who ar
yang of structive qi, those who are re
structive qi."44 This theory not only u
cal practice but is also used to unite th
cians who were most influential on hi
42 Shishan yi 'an 1 : 1-6.

43 This division of qi into protective qi
neijing, one of the earliest extant theoret
nasty. Wang Ji was responsible for develo
lingshu StëÎL fascicle 4, section 18:
(Treatise on the production and convergen
the Siku auanshu edition of the Ling shu , vol. 733, dd. 12-14.
44 Shishan yi'an 1:4.
45 Li Gao (1 180-1251), or Li Dongyuan as he is also known, was an-
other one of the so-called "four masters of the Jin and Yuan" along with Danxi. He em-
phasized the need to regulate the spleen and stomach using warming and replenishing

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
ing a coherent rationale for his beliefs: "Danxi regarded replenishing yin as im
portant, and therefore replenished structive qi. Dongyuan [i.e., Li Gao] regarde
replenishing qi as important and also replenished structive qi. Regard structive
qi as both blood and qi."46
This dual nature of structive qi is the basis of Wang Ji's medical beliefs, and
in practice governs his preferred choice of treatment for depletion. This relation
ship between theory and treatment is expressly stated when he writes that gin-
seng (renshen À#) and astragalus root ( huangqi jf replenish qi and there-
fore replenish structive qi, which is in effect also replenishing yin.47 Thus in
cases of yin depletion, Wang Ji argues that ginseng and astragalus root should
be used, because although they replenish qi they also replenish yin and can giv
rise to blood.
A simplified version of Wang Ji's theoretical beliefs would be that qi can be
depleted, that blood and qi disorders are particularly common, and that suitabl
therapies would involve replenishing treatments such as ginseng and astragalus
root. In practice, true to his theoretical beliefs, Wang Ji regards depletion, in it
various manifestations, as being at the root of the majority of disorders suffered
and ginseng is the most popular medicine prescribed, being given in over thre
quarters of all cases. Astragalus root is the fifth most popular medicine, given in
over half of all cases. Although this warming and replenishing approach w
also favoured by other eminent physicians, including Wang Ji's contemporary
Xue Ji, both the theoretical premise and its application in practice were reform-
ist and controversial at the time, especially with regard to the use of ginseng fo
disorders of yin depletion. Therefore, despite his reputation, many disciples, and
prolific writings, Wang Ji met much resistance on a local level from physician
and patients alike. In this context, the Shishan yi'an can be read as an expositio
of his theory of depletion using actual cases to demonstrate its use and efficac
in clinical practice with the intention of silencing critics and converting futur
physicians to his way of thinking.
Wang Ji's theoretical framework, although individual, draws heavily on the
theories of his medical forebears, in particular on the work of Danxi and Li Gao,
and to a lesser extent on the theories and prescriptions found in the Han dynast
classic, the Shanghan lun (Treatise on cold-damage disorders), writte
by Zhang Zhongjing jjJlíŤft. Although Wang Ji quotes heavily from the medi-
cal classics to back up his argument, the quotations are almost always intro
duced simply by the phrase, "The Classic says" (jingyue MB), thus leaving the
specific source of the quotation ambiguous. However, on the occasions when he
does identify the source, it is nearly always from Danxi, Li Gao, or Zhan
methods. He is most famous for his work Pi wei lun Suffira (Treatise on the spleen an
stomach).
46 Shishan yi 'an 1 : 6.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Zhongjing. For example, on at leas

"Blood is hard to form and easy to de
also quoted several times by Wang Ji
priateness of ginseng in treating disor
Now if yin depletion ends up as yang

yuan's [i.e., Li Gao] "Yang engenders an
both sweet and warming. . . . Zhongjing
ness you should use ginseng. . . . Dongy
seng. I have verified this from his writin
In another case, Wang Ji recognises

by Zhang Zhongjing and closely fol
scriptions in treating the case.50
Wang Ji therefore saw himself as be
dition, which stretched back through
also makes it clear that he does not ju
went before him. Mainly he is critica
Danxi by followers such as Wan
(Miscellaneous writings of illustr
mental in popularizing the view th
treated by drugs which specifically ta
replenishing qi, such as ginseng an
Wang Ji. However, Wang Ji does not
views, and quotes Li Gao and Zhang Z
opinions. His criticisms are mostly
interspersed between cases, as this ex
Danxi said, "With qi disorders, if you

the spot, it also does no harm. With bloo
blood is increasingly depleted and dispe
one who has not committed a crime."
blood, and I treated it using ginseng an
ter not to go against the warnings of D
48 Shishan yi 'an 2: 20-23; 3: 20-22.

49 Shishan y i 'an 3: 1-3. The quotation b
seng for blood depletion and qi weakne
wording is slightly different. See Shishan
50 Shishan yi 'an 3 : 3-5.
51 The authors of medical texts would co
and align themselves with the medical tra
a detailed study of medical lineages and
several centuries, with particular referenc
Wansu see Wu Yiyi 1993-94.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
understanding, you cannot be inflexible."52 . . . Dongyuan also said, "If blood

has collapsed ( tuo fl£), increase qi. This is the method of the ancient sages." ... I
have examined the treatment of blood disorders in the classics of previous sages,
and they never exclusively concentrate on treating the blood and not nourishing
qi. When faced with a disorder, you have to recognize what is suitable.53
Thus, although it would be true to say that Wang Ji saw himself as part of a
long and established medical tradition, he was not prepared to align himself with
any single school of thought. And, while he had strong and independent opin-
ions about medical theory, particularly with regard to the use of drugs to re-
plenish qi in treating disorders of the blood, his opinions would normally b
justified by quotations from the classics. He also emphasized the need to take a
flexible approach, and to use whichever treatment was most appropriate in each
individual case.
Wang Ji's Medical Practice
To date, very little has been written about the logistics of actually practising
medicine in imperial China. Case histories represent an ideal opportunity for the
examination of practical issues: where a physician would carry out his practice,
what examinations he would carry out and what criteria he would then utilize to
make his diagnosis, or when and why he would decide not to treat a patient.
Issues such as these are often not the focus in the narrative, but are nevertheless
of use in the construction of a bigger picture of the mechanics of his clinical
medical practice.
An interesting facet of medical practice highlighted in the Shishan yi'an is
its itinerant nature. From the cases it would seem that Wang Ji travelled around
a great deal, and that his patients both visited him and were visited by him. This
is most clearly shown in some of the longer cases where there is a certain
amount of coming and going over the months and years. Often this is simply
expressed, and not elaborated on, in phrases such as "I was invited to go to ex-
amine her" or "I went to see her."54 On other occasions there is the definite im-
pression that Wang Ji just happened to be at that certain place. For example, a
man who is seen by Wang Ji later sends letters on two separate occasions asking
for further advice about his case. Wang Ji writes: "I happened to go there, and
told him to stick to the previous remedy."55 In another case, Wang Ji has a pa-
52 The concept of the need for flexibility in scholars is an ancient one, and can be
found in book one, paragraph eight, of the Lunyu ffàgg (Analects). I have used the Siku
quanshu edition of the Lunyu , vol. 195, p. 538.
53 Shishan yi'an 2: 33-34. See also 3: 27 for another example.
54 Shishan yi'an 2: 26, 31-33.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
tient whom he has been seeing over th

tain place, and the patient is brought
maidservant. After being examined s
when he next happened to go to that
pletely cured.56 This type of commen
and only infrequently passes through
patients went quite out of their way
her return journey by sedan chair had
condition.58 However, Wang Ji also p
ple, he is twice said to have braved te
and travelled by foot from Wuhu in
120 kilometres - in order to visit his
was compiled from the writings of d
be accompanied by them on his visits
commented on in the text itself.
With regard to examination and dia
aminations (, sizhen E3i^) are used by
condition. The components of the
listening and smelling (wen ¡H), as
"Looking," the first of these examina
ries. After stating the sex of the pat
description of the patient's physique a
fat or thin, pale or dark. "Listening
important technique as in only two c
odour.60 Although in only one is ther
to elicit information about the patien
some detail the symptoms suffered,
began, in what order they occurred,
whether they were more serious in th
tion, particularly about the history o
conversation with the patient, or the
clearly a vital component of the diag
of pulse taking, is probably the most
Ji's diagnosis invariably took the pul
this reading be accurate, and Wang J
period of days, or after his proposed
56 Shishan yi 'an 2: 35-37.

57 For further examples of this type of
59 Shishan yi ' an 1 : 30.
60 Shishan yť an 1: 29; 3: 24-25.
61 Shishan yť an 2: 9-10.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Joanna Grant: Medical Practice in the Ming Dynasty 5 7
one occasion, a patient had come a long way by sedan chair, which Wang J
suspected had caused his pulses to be unsettled, so the patient had to come back
early the next morning to have them checked.62
The results of all of these four examinations were then combined to produce
a reasoned statement of the illness syndrome. One case in particular demon
strates how the patient's appearance (xingse Ê), her pulses {mai ļfij), and
symptoms ( zheng Se) all contribute to the final diagnosis and treatment plan.
First of all, the patient has put on weight over the years, so being plump she i
perceived as more prone to disorders of qi depletion. Secondly, her pulses were
all flooding ( hong $£), slippery (hua yjf), and lacking in strength (wuli Mýj)>
which Wang Ji considers to be symptomatic of yin flourishing and attacking
yang. Finally, with regard to her symptoms, the pain is extreme during the day
but quite mild at night. This is interpreted in terms of yang being depleted an
therefore unable to transport, so it congeals, stagnates, and causes pain. Thus,
the patient's appearance, symptoms, and pulse all combine to create a coherent
picture of yang depletion, and Wang Ji concludes that taking both the symptom
and pulse into account, a suitable treatment would be to assist yang.63
However, sometimes the four examinations would yield conflicting infor-
mation which could not be combined into a coherent pattern. In such cases, it
was necessary to prioritize the results of certain examinations over others. For
example, a man dark in appearance was diagnosed as having qi depletion, al
though qi depletion was generally regarded as more common in people with a
plump and pale appearance. Wang Ji explains how, despite the patient's appear-
ance, his pulse and symptoms both point towards qi depletion, and writes
"When the ancients treated illness, there were those who relied on the symp-
toms, those who relied on the pulses, and those who relied on the appearance.
Now, it is right to rely on the symptoms and the pulse, and make [a diagnosis
of] qi depletion."64 In most cases, this one included, it is the pulse reading which
is considered the most revealing of a patient's condition, and therefore the ex-
amination which is most relied upon. For example, in one case the pulse reading
alone clearly reveals to Wang Ji that the patient has become pregnant, despite
her not having menstruated in the previous year.65
62 Shishan yi 'an 3 : 10-11.

63 Shishan yi'ah 2: 35-37. For other examples of a combination of either appearance
and pulse, or symptoms and pulse, contributing to the final diagnosis, see Shishan yi 'a
1:39-40; 3: 9-10.
64 Shishan yi 'an 2: 5-7. For a similar example, see Shishan yi 'an 2: 8-9.
65 Shishan yi'an 2: 38. Some surprise is shown that this woman was able to conceive
without having menstruated for a considerable length of time. This is indicative of th
extent to which menstrual regularity ( tiaojing SUM) was perceived as essential befor
conception could take place.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
There are also those patients whom

the case is dealt with either by corre
Obviously this presents problems wit
tions. In one such case, Wang Ji write
four [examinations] of looking, listen
their duty. With regard to your illnes
of asking, and the remaining three m
clearly. I trust to fate in offering a p
cessful."67
His diagnosis and recommended treatment in such cases is therefore based
solely on the information regarding symptoms which he has been given in the
letter, although sometimes information about the pulse can be forthcoming even
in such cases. For example, the son of a woman who has been ill for some
months and has seen several doctors without success, goes to see Wang Ji, and
as well as relating his mother's symptoms to him, when prompted he also ex-
plains that the other physicians had told him that her pulses were flooding and
rapid.68 That Wang Ji enquires as to the state of her pulses is indicative of their
importance as a diagnostic tool.
When it comes to treatment, drug therapy is Wang Ji's treatment of choice,
with over ninety percent of his patients being prescribed a combination of drugs,
usually medicinal herbs in decoction, to treat their illness. In a typical case,
having conducted his examination, stated the diagnosis and aetiology, and de-
scribed the illness syndrome, Wang Ji will then list the medicinal herbs to be
taken and the quantity required of each, and explain the method of preparation
and how frequently the resulting medicine is to be taken. For example: "I used
ginseng and astragalus root, two qian of each; Chinese angelica root, poria
(filling and ophiopogon root, one qian of each; scutellaria root ( huangqin
and tangerine peel (chenpi seven fen of each; and five fen of liquo-
rice. It was decocted, she took it and recovered."69
In some cases the function of each ingredient is stated, as in this example:
You should use ginseng, white atracty lodes rhizome, and poria to replenish the
spleen, as the ruling drugs; Chinese angelica root, ophiopogon root, and scutel-
66 The practice of prescribing by correspondence without ever seeing the patient was
also not uncommon in eighteenth-century England. See Porter and Porter 1989: 76-78.
More recently, the murderer Dr. Crippen also practised postal prescribing. See Cullen
1993: 136.
67 Shishan yi'an 3: 1-3. See also 2: 29-30, 37-38 for cases where Wang Ji makes a
diagnosis based solely on symptoms related to him either in a letter or by an intermedi-
ary.
68 Shishan yi'an 2: 18-19. There is also another example of a man who wrote a letter
to Wang Ji in which he explained what his pulses were like; see Shishan yi'an 2: 15-16.
69 Shishan yi 'an 1 : 40.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
laria root to clear the lungs and nourish the heart, as the minister drugs; chuan-
xiong (J 1 1^0, tangerine peel, and hawthorn fruit (shancha ill® to disperse the
stagnation and eliminate the dampness, as the assistant drugs.70
A total of over 120 different drugs are used by Wang Ji in the Shis han y i 'an
a fairly staggering number when one considers the effect of geography, climat
the seasons, and local conditions on the range of herbs available to a physician
at any particular time. However, of these less than 40 are used three times or
more, and only about 20 are employed on more than twelve occasions, that is
more than about ten percent of cases. If one examines the drugs used in over
half of all cases, one finds a select core of about five herbs, which constitute th
basis of Wang Ji's therapeutic policy. These are, in order of most use, ginseng
white atractylodes rhizome, Chinese angelica root, liquorice, and astragal
root. Ginseng and astragalus root are sweet and warming, and replenish q
White atractylodes rhizome is also sweet and warming, replenishes qi, an
strengthens the spleen. Chinese angelica root, also sweet and warming, is per-
haps the best known herb for replenishing the blood. Liquorice also acts on th
spleen and replenishes qi, but is often used in its guiding and co-ordinatin
function.71 Given Wang Ji's strong theoretical conviction of the need to replen
ish qi, his continual diagnosis of depletion, and his advocacy of the use of gin
seng and astragalus root, and other sweet and warming drugs, it is no surprise
find these herbs used most often.
Wang Ji seems to favour an individual and flexible approach to treatment
over set prescriptions, and the combination and quantity of drugs he selects i
one case is rarely, if ever, an exact match for any other. This said, a total of
prescriptions are mentioned in the text, although of these 30 are used only onc
another 7 only twice, and often certain modifications are advised to tailor the
medication to the specific requirements of the patient. The two most commonly
used prescriptions, Decoction of Four Ingredients (siwutang and De
coction of Four Gentlemen ( sijunzitang are only used on seven oc-
casions in total, but their ingredients are all among the dozen or so drugs mo
frequently used by Wang Ji.
Apart from treatment using medicines, Wang Ji employs very few other
therapeutic interventions. There are two cases where Wang Ji uses heat treat-
ments on patients. In the first case of a woman who has stagnant heat inside
which he is not able to draw out using herbal decoctions, he makes her sit on h
bricks which have been bound in cloths.72 This treatment would appear to deriv
from the a passage in the Shanghan lun describing a treatment called "scorching
70 Shishanyi 'ani: 5.
71 For more detailed information on the properties of these herbs see Zhongy
dacidian bianji weiyuanhui 1994: 20, 777, 254, 314, 221 respectively.
72 Shis han y i 'an 1:3 7-3 8 .

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
the back" in which hot tiles, wrapped

induce perspiration.73 In the other ca
feet of female patient.74 Moxibustion
of these cases some kind of needling
ever, Wang Ji never utilizes either o
casion the procedure is carried out by
erbating the patient's condition. Wan
puncture as therapeutic techniques
patient is told that his recourse to m
bones, harmed the muscles, and contr
In some cases, Wang Ji examines th
occurs for two main reasons. First, if
tient is close to death, or that the illn
ment. Invariably, this diagnosis is show
Wang Ji may be unshakeable in his c
other reason for declining to treat th
having to take responsibility for the
regarded as unsuitable for treatment
recommends that a more appropriate
ate one's behaviour and remain calm i
sees two women suffering with a sim
your abdomen is distended and han
medicines cannot reduce. You should
desires in order to protect your destin
not inconceivable that a recovery wil
the women in question become pregna
This reluctance to treat certain pati
physician's medical knowledge. Wan
situation is either beyond his control,
that matter, knows anything about
kind of lung disorder which keeps re
Ji tells her: "If the illness is eliminat
omen. If the illness comes back, this i
73 Shanghan lun (Treatise on cold da

text is attributed to Zhang Zhongjing
century.
75 Shishanyi'an 1: 19, 33; 2: 1, 37-38; 3: 20-22.
77 Shishanyi'an 1: 29, 31; 2: 1-2, 9-10.
78 Shishan yi'an 1: 31-32. See also 2: 2-4 for a discussion of the role of self-
cultivation in treating illnesses for which medicines are unsuitable.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
was similarly unable to provide a convincing rationale for the strange cases of
the woman who lacked any discernible pulses and the woman who becam
pregnant without having menstruated since the birth of her last child a year ea
lier. He had to content himself with the knowledge that "theory lacks the im
mense variety to be found in practice."80 Thus it is clear that as a physici
Wang Ji did not regard himself as omniscient, but was aware that he would o
casionally encounter certain conditions that he felt he was not only unable to
treat, but also that he was unable to explain in terms of any recognisable theo
retical framework.
Case histories, then, contain much information which can be used to recon-
struct a picture of both a physician's theoretical framework and the more pract
cal aspects of his work. However, a practising physician would also have some
interaction with, as well as opinion of, the other healers with whom he inevit
bly came into contact, and from the Shishan yi'an emerges a vivid portrayal o
the wide variety of healers, and the range of treatment options they offered, i
Ming dynasty Anhui, as seen through the eyes of an elite physician.
The Physician and His Interaction with

Other Physicians and Healers
The view of medical practice presented in the Shishan yi'an obviously has
biases, but while this text may not be of assistance in constructing a representa
tive picture of the whole variety of healing practices available to the sick at tha
time, it does provide an extremely illuminating insight into the social context o
contemporary medical practice. The single most important factor to be taken
into account is the strong element of competition faced by any physician; ove
two-thirds of all of Wang Ji's patients are described as having seen at least on
other healing practitioner, and in many cases to have availed themselves of th
services of several practitioners. Even Wang Ji's own grandson and his
nephew's wife were initially seen by other physicians before Wang Ji was call
in.81 Under such competitive circumstances it cannot be expected that a phys
cian would be very favourably disposed towards his rivals, and indeed th
comes out clearly in comments made in the case histories. An examination of
the Shishan yi'an reveals much about Wang Ji's somewhat tense relationsh
with other elite healers like himself, and about the healing alternatives which
interacted with the elite medicine practised by Wang Ji, including self-treatmen
the initial therapeutic approach taken by some patients.

81 Shishan yi'an 2: 42; 3: 24-25.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Wang Ji and Elite Medical Practice
Most of Wang Ji's patients see other

these healers are also elite physicians.
he is forced to compete against them
for his reputation and livelihood. As a
direct rivals in the Shishan yi'an is on
tice. However, underlying this rhetori
rity, because although Wang Ji knows
nevertheless being constantly underm
hearts and minds of his patients, and
tempts.
Wang Ji constantly makes critical comments about the treatments other phy-
sicians offer to patients. He often recounts that he was called in after the treat-
ments of three or four previous physicians had proved unsuccessful. He then
proceeds to explain why their various approaches were fundamentally mis-
guided, and to prescribe a more suitable treatment, which is generally a success.
In some cases, these other treatments are not only unsuccessful, but positively
harmful and cause the patient's condition to worsen,82 and in at least one case
Wang Ji regards a patient of his who is about to die as having been fatally
harmed by the inappropriate treatment of another physician.83
The treatments prescribed by other physicians, as recounted by Wang Ji,
generally can be divided into two categories: treatments using herbal prepara-
tions, and treatment by acupuncture or moxibustion. With regard to herbal
medicines, Wang Ji almost always favours the use of sweet and warming medi-
cines - such as ginseng and astragalus root - which assist the spleen and stom-
ach. This opinion is most clearly expressed in the theoretical essay written by
Wang Ji in the appendix to the Shishan yi'an where he attacks the taboo on
these medicines found in Wang Lun' s Mingy i zazhu,u and also in his theoretical
introduction to the Shishan yi 'an where he writes: "All of those in the world
today who say that ginseng and astragalus root replenish yang and do not re-
plenish yin have never tested their use in practice."85 He is therefore very criti-
cal of physicians who employ bitter, cold, or cooling remedies, which he be-
82 There are numerous examples of the patient's condition being worsened by the
medical treatment received from physicians other than Wang Ji. See Shishan yi 'an 1:33-
34, 34-35, 35, 40, 40-41; 2: 1-2, 8, 12-13, 24-25, 25-26, 27-28, 30-31, 40, 41, 41^2;
3: 20-22, 22-24, 24-25.
83 Shishan yi 'an 1:31.
84 See, Wang Ji, "Bian Mingyi zazhu jiyong shen zhulun" ira
[Discursive essay on the taboo against the use of ginseng in the Miscellaneous writings
of illustrious physicians ], Shishan yi'an fulu [appendix]: 1-7.
85 Shishan yi'an 1:5.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
lieves will increase the harm to the stomach.86 In one particular case of a wo
who is suffering from menorrhagia, Wang Ji rails against the attitudes of
temporary physicians:
Now qi is unable to [perform its functions of] transporting or raising which ha

resulted in menorrhagia. The therapy should treat yang. Contemporary physi
cians are blind to this, and only know that if blood is hot then it circulates, if it i
cool then it congeals, and if it is cold then it stops. Therefore they used bitter
cold, and black ash remedies. They certainly do not know that bitter [remedies]
cause purging. If the stomach is cold then there is a downward collapse (Jiangxi
ß$~F ). Therefore the classic says, "Bitter harms qi, cold harms blood." How are
they able to treat this menorrhagia? The spleen and stomach belong to earth, they
have an aversion to dampness, a liking for warmth, and a fear of cold. In princi-
ple you should use sweet and warming [remedies] to nourish the spleen, then
heat will naturally be eliminated, the qi will naturally transport, and the blood
will follow qi, and each will return to their channels.87
Having criticized contemporary medical practice in this fashion, Wang J

goes on to praise "the ancients," and Li Gao in particular, for knowing to t
blood with remedies which nourish qi, such as those he recommends. T
marked contrast between the wisdom of the ancients and the folly of his c
temporaries is also a common feature in Wang Ji's criticisms.
Acupuncture, and moxibustion in particular, are therapies also attacked
Wang Ji. For example, a man who has had moxibustion twice, and who has
had the moxibustion sores needled, is told by Wang Ji:
Now the stomach does not [perform its] receiving [function], and the spleen does
not [perform its] transporting [function]. The muscles and channels increasingly
lose that which nourishes them. Again, you have increased this with moxibustion
and needles scorching the bones and harming the muscles, which has again de
pleted the blood. Danxi says, "Blood belongs to yin. It is hard to create, but easy
to deplete." Given this, if you then rashly undergo acupuncture and moxibustion,
then the blood is depleted and wasted.88
Again, Wang Ji recommends replenishing as a suitable method of treatme

These criticisms of acupuncture and moxibustion initially seem somewhat i
congruous coming as they do from the author of a book on acupunctur
moxibustion, the Zhenjiu wendui (Questions and answers on acu-
puncture and moxibustion). But reference to this volume quickly clarifies this
apparent contradiction: the Zhenjiu wendui is essentially a reassessment of acu-
puncture and moxibustion as is appears in the early classics such as the Huangdi
86 Shishanyi'an 2: 24-25; 3: 22-23.

88 Shishanyi'an 3: 20-22. See also 2: lb, 27-28.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
neijing , and itself contains many cri

and moxibustion in contemporary me
demns the use of acupuncture for tr
puncture to be depleting by nature a
disorders of depletion.
However, Wang Ji's writings woul
from other physicians, and sometime
the need to treat blood disorders wit
on several occasions we see Wang Ji
spairing at the state of contemporary
cides to use ginseng and astragalus roo
ing up blood due to spleen depletion.
"[If there is] coughing [then] the lungs

[disorders of] coughing blood and vom
cious influence of fire. The two things
and astragalus root.' Now, why are you
ness opposes it?"89
While the use of "someone said" i

Wang Ji to go on to justify his use of
he feels the need to include this justif
some extent his treatments went aga
This can also be seen in another case
Wang Ji for fifteen years. As she ha
changes his diagnosis of stagnation an
changes her treatment to one which
though she recovers completely, the
Wang Ji writes:
Later I heard that she had several pain

neglected to tell me about at that time.
and returned blaming it on having ta
root.90 They really do not know that i
89 Shis hart yi ' an 2: 7.

90 Surgical practitioners ( waike wou
the exterior of the body, such as wound
not thought that they performed much in
his work on surgery, the Waike lili , Wan
ternal medicine (i.e., surgery) deals with
be seen on the exterior. Therefore it is
though the manifestation of the illness w
illness was on the interior, so effective tr

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
much stagnation. If she had been able to take the previous medicine for a long
time, not only would the breasts lack painful lumps, but even if there were any,
they would also disappear. It would mainly be because the illness was receding
and she stopped the medicine when the blood and qi were not yet sufficient that
the qi stagnated and the blood congealed and formed these lumps.91
Clearly Wang Ji's theoretical outlook, which emphasized the use of medi-
cines such as ginseng and astragalus root in the treatment of depletion disorders
was at odds with that of his contemporaries.
Wang Ji makes other criticisms of Ming dynasty medical practice, which d
not simply consist of disagreements over appropriate therapeutic technique
resulting from different theoretical approaches, but concern more fundament
issues of contemporary attitudes to practising medicine. First, in the case of the
man who has been suffering from syphilitic sores and has taken a variety of
treatments without success, Wang Ji complains about other physicians for whom
a temporary resolution of the symptoms is more important than actually curing
the disorder:
People today seek quick successes, and all use qingfen (|S$fr).92 The dampness
and phlegm are forced out, and over three to five days the sores are temporarily
better, but the raging heat is still there, and after no more than ten to twenty days
the sores return. Again the previous medicine is taken, again the illness is elimi-
nated, and again the patient is cured, but again the sores erupt, and round it goes,
with no appreciation of the fact that using eliminating medicines increases the
raging heat. Owing to this the limbs and the body either have oozing abscesses or
spasms, and subsequently it becomes a chronic disease. The Analects says, "If
you desire it in a hurry, you will not succeed."93
In another case, Wang Ji is able to make a diagnosis of depletion, because on

examination the patient's pulses vary from day to day, a recognised sign of a
depletion disorder. However, he bemoans the fact that most physicians do not
as herbal decoctions, and external remedies, such as ointments or acupuncture an

moxibustion. See, Siku quanshu, vol. 765, p. 112.
92 Qingfen is a powder of mercury chloride crystals. According to the Benca
gangmu, it is formed by taking mercury (produced by roasting cinnabar), adding whi
alum and table salt, and roasting until the qingfen sublimates to the top. It was said to b
pungent, cold, and inactive, but Li Shizhen notes that its nature is actually warm, fierce,
and active. See Bencao gangmu 1993: vol. 2, fascicle 9, pp. 59-60. It was used in th
treatment of syphilis and other sores. I am grateful to Dr. David Wright for helping me
follow both the technical Chinese and the chemical processes involved in this passage
from the Bencao gangmu.
93 Shishan yi'an 2: 20-23. The final quotation is indeed taken verbatim from th
Analects, book 13, paragraph 17. See the Siku quanshu edition of the Lunyu, vol. 195,
648.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
take the time to make an accurate pu

based on the individual nature of the
duct their examination in an instant,
then open their bag and make up the p
is unreliable and cannot get to the bo
criticism can be contrasted with his p
of whose case histories are also includ
marily because the theoretical outlook
one of Han Mao's case histories, Wan
Han Mao really knows how to adapt h
of the case, implicitly suggesting tha
that time.95
These continual criticisms can be understood as the product of the social
context of medical practice, where there was not a single coherent body of
knowledge but a wide diversity of opinion on almost every aspect of medicine,
and where it is the patient who has control and is in a position to dictate what
medicines he will take, and which physicians he will see. It would seem that, in
common with many other Ming dynasty medical practitioners, Wang Ji com-
manded little authority over his patients.96 In some cases, Wang Ji may treat a
patient over an extended period of several months or even years,97 but there is
always the possibility that at any point the patient will either see other physi-
cians or even change physicians altogether. This is precisely what happened in
the above-mentioned case of the woman who had been treated by Wang Ji over
a fifteen year period then failed to tell him about her breast lumps and went to
see a surgical practitioner, who blamed them on the treatment prescribed by
Wang Ji.98 In another case, of a man who had a swollen and painful leg, the man
changes doctors a total of four times, and even after Wang Ji has told him that
moxibustion will exacerbate his condition, when Wang Ji goes away he changes
doctors again, and again has moxibustion performed.99 Or again, a man is being
treated by Wang Ji for scrotal swellings, but when Wang Ji is away, the man
sees another physician who wants to alter Wang Ji's prescription. In that in-
stance the patient defends Wang Ji's prescription and refuses to alter it, but later
on he gets another swelling which he allows other physicians to treat before
seeing Wang Ji.100 A sense of insecurity and impotence in the face of relentless
94 Shishan y i 'an 2: 19.

96 Charlotte Furth (1994: 247-48) also raises the question of whether physicians in a
Chinese context commanded the same authority as their European counterparts.
97 Shishan yi'an 1: 30; 2: 19.
100 Shishan yi 'an 2: 27-28.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
competition is no doubt partly responsible for the tension seen in the Shishan
yi'an between elite physicians. Wang Ji is fearful of other doctors changing h
recommended treatments, and on one occasion practically has to threaten a pa
tient to induce him to take the medicine until the spring, saying "If you are de
luded by the words of other men and stop the medicine, not only will the feve
not be able to be stopped, but [will become] either consumption or swellings,
and it will be hard to avoid later sorrow."101 However, Wang Ji himself is no
averse to meddling with treatments of other physicians, as this example show
"I said, 'They were mistaken in their medicines. The previous medicines ar
mainly active preparations, how can the stomach tolerate these things?' I told
him to throw them away and change to using ginseng, astragalus root. . . ."10
Patient/practitioner loyalty was clearly not a feature of Ming dynasty medica
practice. Having already established that Wang Ji travelled around a lot, it ma
also be true that a patient would have some difficulty in always locating t
same doctor for treatment. Nevertheless, the picture the Shishan yi'an presen
of the interaction between elite physicians is one of mutual criticism, insecurit
tension, and rivalry.
Other Healers
Elite medical practitioners, however, were not Wang Ji's only rivals. As both
anthropological and historical studies have already shown in the Chinese con-
text, the health-care system in any society embraces both folk and popular cul-
ture, as well as the professional medical sector.103 Although it obviously cannot
be expected that the Shishan yi'an would present a complete or unbiased ac-
count of other healing sectors, nevertheless Wang Ji's medical practice does at
times intersect that of other types of healing practice, even if only in passing,
and it is interesting to see the extent and nature of that interaction.
The most striking description of the practices of a non-elite healing sector
comes in the case of a man with syphilis (yangmei chuang WvWìÈ)m wh° takes
advice from a thaumaturge (fangshi ^Jib):105
101 Shishan yi ' an 3: 25-27.

103 Kleinman 1980; Cullen 1993.
104 Wang Ji discusses the symptoms of this disorder, and they would indeed seem to
correspond to both primary and secondary syphilis. He first describes how "licentious
men and licentious women" (yinfu yinfu disturb the fire in their Greater Yin
channels (Jueyin Wk and how this causes the kidneys to lose control over fire, which
becomes phlegm, and flows to the glans where it gives rise to a "fornicator's sore" (Jian-
chuang USI). If this is not treated then after some time sores appear on the legs which
resemble the myrica rubra (yangmei f|§#g), thus they are termed myrica rubra sores.
These then spread over the whole body. The first part of this description seems to refer to

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
A thaumaturge told him to take the b

newborn child to be placed on bricked
fire. Drying by fire causes the dead ch
and place on the ground to remove the
an empty stomach, mixed with either
qian. It is supposed to be able to replenish
The first thing to note is that the p

and riot a physician. Second, Wang J
practice is merely to comment that, h
will be somewhat fierce and violent,
does not make any comment on the m
baby, or on the fact that the patient
lation to syphilis, in another case w
chanced upon a Daoist follower ( da
cure.108 Although Wang Ji does not
comment about either the practice of
scribed treatment.
Other references in the Shishan yi'a
(fushui Î^FtK),109 which we are told w
mention of fortune-telling. Interestin
his fortune told from his facial cha
writes: "A physiognomy book (fengji
lids ( ganmen H) were green/white th
the chancre of primary syphilis, and the

knowledged connection with sexual activ
105 A number of translations have been
turge, wonder-worker, gentleman poss
quack. It is generally used of others, and
selves. In this context, thaumaturge is per
107 Another Ming physician, Li Shizhen,
treatments. He writes, "The ancients con
and often received preternatural rewards
hearts are set on profit and the satisfac
medicines. Can [medicine], the 'art of be
of thing? And dogs do not eat the bones o
bones of men?" Bencao gangmu 1993, v
translation found in Cooper and Sivin 19
108 Shishan yi 'an 2: 24.
109 This refers to the practice of writing
ashes in water, and taking them as a medi
1 10 Shishan yi 'an 1:1 6-1 7.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
teller foretold that her fate would worsen and she would die."111 Again, Wang
makes no comment as to whether he believes this, or with regard to the role
fortune-telling in predicting the outcome of illness. In this case, however, th
prognostication proves incorrect and Wang Ji is able to save the patient.
Among the cases in the Shishan yi'an by other physicians, there is one con
cerning the treatment of a girl who is depressed because her mother has died
The physician in question believes that since emotion is at the root of her illnes
it can only be cured by emotion. He therefore tells her husband to bribe a fema
spirit medium (niiwu izM) to tell the girl that her mother, in the underworld,
angry with her, blames her for her death, and is making her ill by way of retr
bution. The girl then becomes angry, and is cured.112 Thus anger is being use
to conquer pensiveness according to the five phases, where the liver/anger con
trols the spleen/pensiveness. The spirit medium is thus being utilized by the
physician, who is using his own theoretical understanding of disease manage-
ment, whereas the patient is cured through her conceptual framework of spirit
in the underworld, and the power of the spirit medium to tap into this world
Therefore, although a cure is effected, the patient and the physician have diffe
ent beliefs about the nature of the treatment and why it was effective. In th
situation, the spirit medium too is capitalizing on the faith of the girl in her
powers, while being fully aware that she is acting fraudulently. The physician
while not necessarily believing in the power of the spirit medium, or condonin
her practices, is aware that because of the nature of his patient's problem and
owing to her belief in spirit mediums, the illness is more likely to be cured b
manipulating that conceptual framework, although he uses his own medic
framework to rationalize the treatment process. So here we find an elite phys
cian in league with a practitioner from a non-elite sphere of healing in the inte
ests of the patient's welfare. This is the only example in the Shishan yi'an of
female healer of any sort, and as mentioned above, this case is not even b
Wang Ji. The absence of female healers from the text is somewhat unexpected
given that another Ming writer, Lti Kun Si$, wrote that women were mo
likely to go to a female healer as their first recourse for their own health prob
lems and those of their children.113 This viewpoint is also borne out by the fac
that Wang Ji sees nearly two men to every women, so although some women

112 Shishan yi'an 3: 17-18. Wang Ji does not identify the physician in this cas
However, the case is also quoted in a slightly different form by the late Ming physic
Zhang Jiebin in his Zhangshi leijing (Mr. Zhang's classics arranged
by subject). He attributes the case to a Han Shiliang. I have followed the translation in
Unschuld 1985: 331.
113 Lü Kun Shizheng lu Htíkfêk (Writings on practical government): 2: 51a,
quoted in Angela Ki Che Leung 1987: 153. More evidence for this preference of women
for female healers is also found in the Ming dynasty novel Jin ping mei . See Cullen
1993: 126-32. For other information on female healers, see, Cass 1986.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
may be cured by the female healer

given that patients seemed to consult
quite strange that there is no other me
There are also several occasions in
themselves or are treated by their fa
cessful. For example, Wang Ji tells th
coming out from his penis, and pulls
using metal tweezers. He is then cure
problem.114 On other occasions their
the man who was twice cured of a uri
tracted a cold-damage disorder ( sh
him that sex acted as a curative in his
dispersed the heat.115 Another man, w
honey-roasted medicine to his testicl
sulted Wang Ji when he felt cold and
comment on the efficacy of this trea
their attempts at treating themselve
prescription ( qingshuyiqitang
that although her treatment was suita
illness. Qingfen is taken by a man wi
that as its nature is fierce it can only
have a means of accessing treatments
attempt a treatment themselves, only
tive. It is perhaps no coincidence that
course to self-treatment occur with il
patients suffering from genital comp
medical attention for reasons of pers
on this practice of self-treatment oth
treatment was suitable in that particul
Families are also involved in the illn
from acting as intermediaries in neg
amine the patient, offer diagnoses, a
case of a man with fever "a family m
'The pulses are exhausted!' He was of
and wanted to give him fuzitang M-fW
to come and treat him."119 Wang Ji
1 14 Shishan yi 'an 1:33.

1 1 5 Shishan yi 'an 3 : 12-14.
1 16 Shishan yi 'an 3 : 27-29.
117 Shishan y Van 1: 19.
118 See footnote 92.
1 19 Shishan yi 'an 1 : 23-24.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
but hidden, and why he does not feel the proposed treatment would be suit
in this case. However he does not criticize the relatives' involvement in the case.
Another man has been treated several times by Wang Ji, but as yet without suc-
cess. Wang Ji then writes, "His whole family were alarmed, and suspected that
these were yin symptoms occurring post-coitally, and intended to give him
fuzilizhongtang Again, Wang Ji disagrees with their diagnosis
and proposed treatment, and explains why, but does not criticize them for
wanting to interfere in his series of treatments. The man in question is a 46-year-
old adult, so it is interesting that his family seem to have little reticence in dis-
cussing his sexual activities with the doctor, and blaming them for his illness. In
both these cases, however, the families consult the physician before imple-
menting their treatments.
From the above, it would seem that individuals do not have just one expla-
nation for their illnesses. They are capable of interpreting their illness in terms
of elite medicine, which includes concepts of yin and yang, five phase theory,
etc. But at the same time they also have beliefs and understandings from a num-
ber of other sectors which relate to beliefs that are personal and religious, as
well as medical, and include concepts they absorb from their families, religious
groups, spirit mediums, thaumaturges, fortune-tellers, and so on.121 These be-
liefs are not mutually exclusive, but coexistent, and can be employed in the
relevant clinical context. The patient, or in some cases his family, chooses
which of the explanatory models is most useful to him at any given time, and
determines the course of action to be taken with regard to the which healers he
consults and whether he elects to follow the advice they give.122
As we have seen, Wang Ji's elite medical practice interacts at various levels
with these other healing spheres as well as with other practitioners of elite medi-
cine. He is much less critical of medical interventions by either patients and
their families or other healers than he is of the actions of rival practitioners be-
longing to his own sphere of healing. With regard to patients and their families,
this may be because he values their custom, and is therefore wary of being
openly critical, but one might have thought that a physician would want to de-
fend his own set of beliefs and values against those of competing systems of
thought. One explanation for this is that he sees other elite physicians as his di-
rect competitors with whom he is engaged in a battle for both intellectual and
clinical supremacy, whereas other healers he considers as to some extent offer-
ing services complementary to, not in competition with, his own.
120 Shishan yi ' an 3 : 3-5.

121 Additional evidence for the ability of laymen to understand complex medical
concepts can be found in the Jin ping mei. See Cullen 1993: 120.
122 For a discussion of the wide variety of explanatory models of illness employed by
individuals in modern day Taiwan, see Kleinman 1980.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
The Patient/Physician D
As well as interacting with other hea

tionship with his patients. Several asp
discussed, namely whether the patien
goes to the patient, the conducting o
which a physician would decline to tr
patients either treating themselves o
other medical practitioners, and the
dence to be found in the Shishan yi'a
of Wang Ji's clientele, the actual dyn
and the part played by intermediaries
Wang Ji's Clientele
Social class can be an important fact

cian or healer, quality and duration of
namic are all issues which can be affec
Wang Ji's case histories begin eith
woman" ( - #§), which is not a goo
However, there are exceptions to this
come mainly from the patient's occu
trict magistrates, an attendant censor,
vice magistrate of Yi (!£) district (in
two assistant instructors from Confu
likely to have official titles, but in o
tients as a Child Nurturess, a title of
of civil officials and military officers
the official capacity of these people m
than his, and he wants to be seen to
cannot deduce that all of his patients
likely that if their occupation is not
prestige to be gained by mentioning i
123 Charlotte Furth writes of her anal

nasty, "These doctors were more likely t
was grave, the sick person low in status,
as a social pattern in these cases that wom
more often than men were, and that wo
the doctors were called to the bedside" (F
124 Shishan yi'an 1: 14; 2: 5- 7; 1: 24-
have used Hücker 1985.
125 Shishan yi'an 3: 1 1-12.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
his. There is, however, one occasion on which the patient is accredited a
longing to a fairly low social class, simply that of a woman from the village
so not all of his patients came from the elite classes.
There is also other information contained in the case histories which can
provide some clues as to the patients' social class. For example, we know that
Wang Ji treats various members of his family, such as his son-in-law, his grand-
son, and his nephew's wife, who may be of a similar status as himself.127 Also
he makes certain comments in his discussions of the cases which act as markers
of status. For example, a woman is brought to see Wang Ji in a sedan chair by
her mother and maidservant, and a man also comes to Wang Ji by sedan
chair.128 Obviously one would have to be of a certain social standing to have
servants and travel by sedan chair. In another case, he warns the patient against
engaging in drinking and sex after concluding business deals, thus revealing him
to be some kind of merchant or business man.129 Another indicator of class may
well be that the majority of patients see more than one physician, and many see
several. Presumably their services are not free, so the patients or their families
must be sufficiently well off to enjoy the opinions of a number of healers. One
other factor to be taken into consideration is the knowledge of medicine pos-
sessed by the patient. Many patients are relatively well versed in the classics,
and discuss their treatments with Wang Ji. Obviously then, these patients must
belong to the literate classes and must have had some kind of classical educa-
tion.
In sum, Wang Ji saw patients from a range of social and economic back-
grounds, but in the majority of cases patients were literate, although not neces-
sarily titled, who could not only afford his services but those of other physicians
too, and may have had the means to travel by sedan chair and employ servants.
The Patient/Physician Dynamic
It has already been established that to a large extent it is the patients who
make the choices with regard to their medical needs, and the physician is oper-
ating in a somewhat unstable environment in which he faces stiff competition
from other healing spheres as well as rival elite practitioners. This is also clearly
demonstrated in the cases in which we see clear evidence of the pa-
tient/physician dynamic, as opposed to those which simply run through sex,
appearance, symptoms, diagnosis, treatment, and outcome. Indeed, in most such
cases, the only visible interaction between patient and physician concerns con-
126 Shishanyi'an 2: 8.
127 Shishanyi'an 1: 30; 2: 42; 3: 24-25.
128 Shishanyi'an 2: 35-37; 3: 10-1 1.
129 Shishan yi 'an 2: 1 .

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
flict over diagnosis and appropriate t

most cases patients also seem to have
cine, which enables them to argue wit
As might be expected from his inte
of these arguments concern Wang Ji
sion to treat with ginseng and astragal
I examined him: the left pulse was floati

was floating, taut and languid. This is
easily hungry and like eating, my noct
quent, it seems like yin depletion. If y
seng and astragalus root, I fear it will in
And again:
I said, "This is qi depletion." He asked

times coughing up black phlegm, are
said, 'In dark people qi is replete.' Now
you say it is qi depletion?"132
And again:
I said, "This is spleen depletion and insufficiency." He said, "I have already
taken an ointment of ginseng and white atractylodes rhizome. My chest also feels
full and oppressed. I fear it is not suitable to use ginseng and astragalus root [to
treat] this illness."133
However despite their fears, in most cases Wang Ji seems to manage to con-
vert patients to his way of thinking, persuade them to take ginseng and astraga-
lus root, and effect a recovery. Thus, although they initially disagree, Wang Ji's
counter-arguments are sufficiently persuasive to make them change their minds,
suggesting that a physician was not entirely without authority. Again we see that
the use of ginseng and astragalus root as a treatment was somewhat controver-
sial at that time, and that even patients were aware of this and therefore reluctant
to take them.
It may be that cases such as these were only included because Wang Ji
wanted to show that his choice of diagnosis and treatment were ultimately
proved justified, and that such a high level of knowledge was not common
among patients. However, this would still indicate that some patients did not
130 See also Shishan yi'an 2: 20-23; 3: 25-27 for examples not related to arguments
over the nature of depletion and treatment using ginseng and astragalus root.
133 Shishanyi'an 2: 17-18. See also 1: 39; 2: 5-7, 13-14, for similar examples.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
meekly comply with the physicians recommendations, but were prepared t

argue back if the physician's diagnosis did not correspond to their own under-
standing of why they were ill. One could also suppose that this dialogue wa
simply put in the mouths of the patients, again to enable Wang Ji to expand o
the theoretical basis of his treatments, but as the cases are intended to be believ-
able, a scenario in which the patient questions his diagnosis cannot have been
entirely implausible.
Another facet of this dynamic between the physician and the patient is the
imparting of moral advice to the patient regarding the kind of behaviour re-
quired if a recovery is to be achieved, accompanied by dire warnings of th
dangers to the patient's health if this advice is not followed. Such moral recom
mendations usually require the patients to restrain their desires, moderate their
diet, and abstain from sexual intercourse.134 It is made clear that such behaviour
is more fundamental than any medicines they are given, as this self-cultivatio
treats the root of the problem, whereas medicines only treat the branch.135 Al-
though the patient obviously has the choice to ignore such warnings, Wang Ji is
invariably proved right, as those that comply live and those who rebel cannot be
saved.136 Thus the physician is portrayed as having some authority in advising
the patient about appropriate behaviour given that the patient ignores this advic
at his peril.
Since some patients, however, never interacted directly with the physician,
but conducted their treatment either by correspondence or through an intermed
ary, the patient/physician dynamic in these instances existed only on paper, or in
the form of verbal information passed between the two parties, and so was con-
siderably more distant. However, it did not seem to be unusual to go through
such channels; the Shishan yi'an contains nine examples of replies to letter
mentions four occasions when patients wrote to Wang Ji explaining their
symptoms, includes two cases in which the entire case was conducted through
an intermediary, namely the husband or son of a female patient, and other cases
where, because of the young age of the patient, the dynamic existed between th
parents and the physician, not the patient and physician.137 This form of the dy
namic obviously contained much less opportunity for interaction, discussion, o
disagreement, and as Wang Ji himself noted was much less reliable as there wa
no opportunity to carry out the four examinations.138 Nevertheless, he was stil
prepared to offer diagnoses and treatments on the basis of the information re
m Shishan yi'an 1: 31-32, 32, 32-33; 2: 1, 11-12, 20-23; 3: 1-3.

136 Shishan yi'an 1: 31, 32, 32-33.
137 Shishan yi'an 1: 6-13; 3: 1-3; 1: 13-14; 2: 15-16, 27-28, 29-30; 2: 18-19, 37
38; 3: 22-24.
138 Shishan yi 'an 3 : 1 -3 .

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
garding symptoms, and occasionally th

such intermediate channels.
In many ways the patient/physician dynamic is portrayed as an area of in-
tense conflict, and good debating skills were essential if the physician was to
convince the literate patient, conversant in medical theory, of the accuracy of his
diagnosis, suitability of the treatment, and the need for moderation of the pa-
tient's desires. The patient was free to choose to follow the advice given, or to
seek one or more second opinions, which they frequently did. This must have
increased the pressure on a physician who was in a position of having to con-
tinually justify his actions both to rival physicians as well as to sceptical pa-
tients. However, that Wang Ji was often successful in this task means that to
some extent he can be seen as an authoritative figure, although on other occa-
sions this authority was clearly undermined, either by other physicians and their
competing theories or by the essentially fickle nature of his patients, which
meant that neither their loyalty nor their compliance could be relied upon.
Conclusion
Case histories, then, are a valuable source material for researching medical his-
tory, and offer a more dynamic and illuminating picture of both theory and
clinical medical practice than can often be found in theoretical texts alone. On
one hand, through Wang Ji's experiences it is possible to make some general
observations about the practice of medicine in the Ming dynasty. It seems clear
that there was a wide diversity of healing practices and practitioners available to
the patient, which ranged from elite practitioners of traditional Chinese medi-
cine to thaumaturges, religious healers, and spirit mediums, and included self-
treatment and intervention by the family. There does not appear to have been a
prevailing medical orthodoxy, and even within the ranks of the elite practitio-
ners conflict and controversy raged over appropriate theoretical approaches,
diagnostic conclusions, and suitable therapeutic interventions. Certainly, tradi-
tional Chinese medicine could not be described as a single, systematized, and
consistent body of knowledge, even though the basic theoretical principles and
historical tradition of the discipline, stretching back to the classics such as the
Huangdi neijing , were recognized by the practitioners of the art. The palpable
lack of patient loyalty to a single physician, evinced by their readiness to change
doctors many times within the course of an illness and to experiment with a va-
riety of healing alternatives, would suggest a distinct unwillingness to trust in
any one healing system, and would possibly attest to a fairly low social standing
for physicians, if one takes their failure to command any kind of authority over
their patients as an indicator of social status.
On the other, the Shishanyi'an allows us a rare glimpse of various aspects of
Ming dynasty medical practice as seen from the point of view of an individual

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
practitioner. First, it has made it possible to explore Wang Ji's often vehemen
theoretical beliefs, and see their transformation into a working strategy of clin
cal practice, and second it has provided an unparalleled opportunity to examine
the various dynamics of his clinical practice itself. This has included the actual
logistics of practising medicine, from its itinerant nature to the practicalities of
examination, diagnosis, and treatment, as well as the chance to gain a bette
understanding of the environment in which Wang Ji practised, encompassing hi
interactions on a number of levels with elite physicians, other healers, and of
course, the patients themselves.
The world he describes differs radically from our own understanding o
medical practice, shaped by our twentieth-century experiences. I have exposed
picture of Ming dynasty medical practice which, although possibly not repre-
sentative, reflects the experiences, frustrations, and opinions of a single physi
cian working in Anhui province in the early sixteenth century. The image he
presents to us through his case histories is one of a valiant struggle to emulate
his sage forebears and practice medicine to the best of his ability, despite bein
faced with relentless competition from his elite rivals, a lack of loyalty from h
patients, and continual criticism from both.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Bibliography
Primary Sources
Bencao gangmu @ (Systematic materia medica). Li Shizhen Original

edition 1596. This edition: Beijing: Zhongguo shudian, 1993. Four vols.
Hanshiyitong Ü jS;!!® (Mr. Han's comprehensive survey of medicine). Han Mao
Original edition 1522. This edition: Liuliqi yishu ASs^lllr, Qing Xiu Santang
kanben, 1794. Volume 5.
Huangdi neijing l ingshirļi7^ If 18 fil (Inner canon of the Yellow Lord - Miraculous
pivot). Anonymous. First century B.c. I have used the Siku quanshu edition, edited
by Wang Bing ī<& in 762. Vol. 733, pp. 317-428.
Lunyu Üf§§(The Analects). Confucius, Kong Zi Jlrř- Written pre-Han. This edition: He
Yan fpJJIs Xing Bing ifßS, and Lu Deming eds. Lunyu zhushu
(Notes and commentaries on the Analects), in Siku quanshu, vol. 195, pp. 534-712.
Mingyi zazhu (Miscellaneous writings of illustrious physicians). Wang Lun
ĪM> annotated by Xue Ji Originally published in 1549, but written in 1502. It
is usually published within the Xue Ji yi 'an (Mr. Xue's medical case histo-
ries). This edition: Xue Ji yi'an Mt^iĚ^juan 20-25, in Siku quanshu, vol. 763,
pp. 442-599.
Shanghan lun fUļīūj (Treatise on cold damage disorders). Zhang Zhongjing
Written ca. third century A.D. This edition: Beijing: Zhongguo shudian, 1993.
Shishan yi'an ÇlJLim? (Stone-mountain medical case histories). Wang Ji com-
piled by Chen Jue Originally published in 1531. I have consulted the 1531
edition, prefaced by Cheng Zeng; the 1633 edition revised by Wang Wei QitÉÉ which
includes a later preface by Chen Jue dated 1541; the Japanese edition from 1696; the
Siku quanshu edition; and the editions found in the Wang Shishan yishu bazhong.
Unless otherwise stated, all references are to the Siku quanshu edition, vol. 765, pp.
325-409.
Shizheng lu (Writings on practical government). Lü Kun Stt- Originally pub-
lished in 1598 under the title Lüshi shizheng lu (Mr. Lti's writings on
practical government). Abridged and circulated in the Qing dynasty under the title
Shizheng lu. This edition: Hangzhou: Zhejiang shuju, 1872.
Siku quanshu (Complete books of the four treasuries). Originally pub. in 1782.
This edition (photographic reprint): Shanghai guji chubanshe, 1987.
Waike lili (Surgical principles and examples). Wang Ji fcEféft. Preface dated
1531. This edition from Wang Shishan yishu bazhong.
Wang Shishan yishu bazhong äiSÜ-lif lir AÍ41 (Eight medical books of Stone-mountain
Wang). Published between 1522 and 1633. Qimen pushu Wangshi sitanghui keben.
Yiji kao ÜH#(Studies of medical books). Tamba no Mototane (D tcJIL- Com-
pleted in 1819. Reprint, Shanghai: Shanghai Zhongxi yiyao yanjiushe, 1936.
Zhenjiu wendui ýH5£fnJ fí (Questions and answers on acupuncture and moxibustion).
Wang Ji fcEtS- Author's preface dated 1530. This text is included in the collected

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
works of Wang Ji, Wang Shis han y is hu bazhong, and can also be found in Siku
quanshu, vol. 765, pp. 41-110.
Secondary Sources
Cass, Victoria. 1986. "Female healers in the Ming, and the lodge of ritual and cere
mony." Journal of the American Oriental Society 106: 233-40.
Cooper, William and Nathan Sivin. 1973. "Man as a medicine: pharmacological and
ritual aspects of traditional therapy using drugs derived from the human body," in
Nakayama and Sivin (eds.), 1973: 203-72.
Cullen, Christopher. 1993. "Patients and healers in late imperial China: evidence from
the Jin ping mei ." History of Science 31,2: 99-150.
Paper presented at the Lu Gwei-djen memorial work

Medicine, held at the Needham Research Institute, Cam
Farquhar, Judith. 1994. Knowing Practice: The Clinical
Oxford: Westview Press.
Furth, Charlotte. 1994. "Ming-Qing medicine and the construction of gender." Jindai
Zhongguo funiishi yanjiu W5S 2: 229-50.
paper.
Hücker, Charles O. 1985. A Dictionary of Official
CA: Stanford Univ. Press.
Kleinman, Arthur. 1980. Patients and Healers in the Context of Culture. Berkeley: Univ.
of California Press.
Leung, Angela Ki Che. 1987. "Organized medicine in Ming-Qing China." Late Imperial
China 8, 1: 134-65.
Mote, Frederick W. and Denis Twitchett (eds.). 1988. Cambridge History of China. Vol-
ume 7, The Ming Dynasty, 1368-1644, part 1. Cambridge: Cambridge Univ. Press.
Nakayama, Shigeru and Nathan Sivin (eds.). 1973. Chinese Science: Explorations of an
Ancient Tradition. Cambridge, MA: MIT Press.
Needham, Joseph, et al. 1954- . Science and Civilisation in China. 7 vols. Cambridge:
Cambridge Univ. Press.
Porkert, Manfred. 1974. The Theoretical Foundations of Chinese Medicine: Systems o)
Correspondence. Cambridge, MA: MIT Press.
Porter, Dorothy and Roy Porter. 1989. Patient's Progress: Doctors and Doctoring in
Eighteenth-Century England. Oxford: Polity in association with Blackwell.
Shanghai Zhongyi xueyuan Zhongyi wenxian yanjiusuo
1994. Lidai mingyi qi'anji (Collection of strange cases
from famous physicians in past dynasties). Shanghai: Shanglian sanlian shudian.
Shi Qi SfgfS and Xiao Mincai MStfí (eds.). 1994. Zhongyi bing'anxue
(Case histories in traditional Chinese medicine). Shanghai: Zhongguo dabaike
quanshu chubanshe.
Sivin, Nathan. 1987. Traditional Medicine in Contemporary China. Ann Arbor, MI:
Center for Chinese Studies, Univ. of Michigan.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC
Unschuld, Paul. 1985. Medicine in China : A

fornia Press.
Wu Yiyi. 1993-94. "A medical line of man
Wansu and his disciples from the Jin to th
Yao Ruoqin and Xu Hengzhi (comps.). 1971, facsimile of the 1933 edi-
tion. Song Yuan Ming Qing mingyi lei 'an (Medical cases, ar-
ranged by topic, by famous physicians of the Song, Yuan, Ming and Qing dynasti
Xuanfeng chubanshe. 2 vols.
Zhongguo Zhongyi yanjiuyuan tushuguan (ed.). 1991. Quan -
guo Zhongyi tushu lianhe mulu (Union catalogue of Chi-
nese medical works in Chinese libraries). Beijing: Zhongyi guji chubanshe.
Zhongyi dacidian bianji weiyuanhui fļ3 H ^ SUI#- 1994. Jianming
yi cidian (Simplified dictionary of Chinese medicine). Beijing: Ren-
min weisheng chubanshe.

130.216.158.78 on Mon, 02 Jan 2023 09:50:59 UTC

This Content Downloaded From 130.216.158.78 On Mon, 02 Jan 2023 09:50:59 UTC

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

This Content Downloaded From 130.216.158.78 On Mon, 02 Jan 2023 09:50:59 UTC

Uploaded by

Copyright:

Available Formats

Medical Practice in the Ming Dynasty—A Practitioner's View: Evidence from Wang Ji's

Stable URL: https://www.jstor.org/stable/43290458

This content downloaded from

Medical Practice in the Ming Dynasty

perhaps the most famous work of the Ming physician Wang Ji

This content downloaded from

both traditional Chinese medicine and

The Nature of the Shishan yi'an

The Author of the Text

This content downloaded from

contact between physicians, both in terms of direct contact resulting from im

6 Shishanyťan fulu [appendix]: 21-47.

This content downloaded from

In Wang Ji we see reflected many

The Case History Genre

Physicians' case histories (yi'an Ü5PD

7 For a concise and systematic accoun

This content downloaded from

The Purpose of Writing Case Histories

This content downloaded from

specifically wanted to set his clinical

8 This suggestion was raised in a debate stimulated by a paper by Christopher Cullen

This content downloaded from

12 Suggestion made by Cullen 1995.

This content downloaded from

association. In the last fascicle, Wang J

16 Shishan yťan 3: 18-20. I have been a

This content downloaded from

21 Wu Yiyi 1993-94: 63.

This content downloaded from

nize the value of both his theory and

The Shishan yi 'an as Source Material

There are a number of important dimensions to this source material which

This content downloaded from

The Structure of the Shishan yVan

26 When discussing medical practice, it is important to remember that medicine was

This content downloaded from

patients. The main body of the chapt

Individual Case Structure

This content downloaded from

A man. Thirty years old. Pale in appearance. Owing to exhaustion he caught a

This content downloaded from

any later recurrences of the illness. In

In other cases it is the patient who is described as engaging Wang Ji in dia-

This content downloaded from

Wang Ji and His Medical Practice

Case histories present us with an opportunity to examine many aspects of clini-

38 Shishan yi'an 2: 20-23.

This content downloaded from

Wang Ji's Theoretical Beliefs

Although case histories, by definit

42 Shishan yi 'an 1 : 1-6.

This content downloaded from

This content downloaded from

Zhongjing. For example, on at leas

Now if yin depletion ends up as yang

In another case, Wang Ji recognises

Danxi said, "With qi disorders, if you

48 Shishan yi 'an 2: 20-23; 3: 20-22.

This content downloaded from

understanding, you cannot be inflexible."52 . . . Dongyuan also said, "If blood

Wang Ji's Medical Practice

This content downloaded from