This interesting monograph traces the emergence of a new empiricist stance in Chinese medical texts in the period from the late ninth century to the twelfth (late Tang and Song dynasties). Chen examines a variety of sources, in particular formularies: collections of medicinal formulas (fangshu) and works on materia medica (bencao). In these texts, written by public officers and physicians, Chen finds a new way of evaluating knowledge based on an author's experience.
In China, the writing of medicinal formulas dated back to the Han dynasty (202 BCE–220 CE). Chen argues that the way to assess and claim the validity of formulas changed significantly over the centuries. Originally, the main method of legitimizing remedies was attributing them to a legendary healer. This shifted to qualifying a formula's healing efficacy by marking it with the character yan (effective, efficacious). Some formularies started to be characterized, even in their titles, as collecting “yanfang” (effective formulas)—a development that can be noticed first in the Era of Division (220–589). Before the ninth century, this was limited to a very brief statement of the remedies’ efficacy, with no mention of actual empirical testing. After the ninth century, in contrast, formularies started to include detailed narrative accounts of the successful trial and application of remedies. Authors of formularies and bencao texts introduced particulars about the “explanatory historical context” (benshi) or the “facts” (shishi) of formulas and medicinal items, sometimes adding circumstantial case narratives as corroborative evidence. Case reports thus began to be appended to formulas—a very significant development, considering that case records, unlike formulas, did not yet exist at that stage as a distinct form of medical writing.
This empiricist turn happened in a period, the Northern Song (960–1127), when the state newly and vigorously engaged in medicine and public health by creating medical academies and sponsoring the writing and publication of medical knowledge. In this period, it was not unusual for state officials to author medical texts—a trend facilitated by the fact that, unlike in late medieval Europe, no formal licensing or training were required for medical practice. Highlighting the contribution of state officials to Song medical writing, Chen argues that the emergence of what she calls “the empirical strategy” in medical texts was related to scholar-officials’ practice of reporting their personal observations on regional phenomena in the provinces where they resided or traveled. This practice found textual expression in new genres focused on observing and investigating natural and social phenomena: genres such as travelogues, “notebooks” (biji, lit. brush jottings), “inventories of things” (pulu) detailing the author's connoisseurship of specific classes of objects, such as flowers, aromatics, coins, stones, etc., as well as medicinal simples and compound drugs. Both scholar-officials and physicians adopted these new genres to record and transmit medicinal formulas that appeared to be based on experience.
Among the texts that Chen examines in detail are scholar-official Shen Kuo's (1031−1095) Good formulas (Liangfang) and physician Xu Shuwei's (1080–1154) The Widely Benefiting Formulary with Explanatory Historical Contexts (Puji benshifang). Chen offers new and valuable insight on these two important authors, already known in anglophone medical historiography thanks to Ya Zuo's work on Shen Kuo (Shen Gua's Empiricism, 2018) and Asaf Goldschmidt's on Xu Shuwei (Medical Practice in Twelfth-Century China: A Translation of Xu Shuwei's Ninety Discussions [Cases] on Cold Damage Disorders, 2019). The bulk of Ninety Discussions on Cold Damage Disorders contains case narratives attributed to Xu Shuwei. Consequently, some scholars have considered this text as a forerunner of the genre of medical case statements (yi'an), which would develop much later, in the sixteenth century. The authorship of this book is dubious, however, so Chen has chosen to analyze another work whose attribution to Xu Shuwei is undisputed, The Widely Benefiting Formulary with Explanatory Historical Contexts. In this text, Xu listed 362 remedies and 123 medical cases, drawn from his practice and from other sources. Interestingly, Xu wrote that he drew inspiration for the special feature of his formulary—namely, the “historical context” of formulas as evidence of their efficacy—from works of literary criticism that provided the “historical context” of poems. Xu cited explicitly Meng Qi's Poems with Explanatory Historical Contexts (886) which, he said, contained the “facts at that time” (dangshi shishi). Xu seems to have perceived a parallel between the scenario in which a poem was composed and the one in which a medicinal formula was devised or applied. Based on this evidence, Chen argues that the new empiricist attitude in the field of medicine borrowed expressive forms from literary texts. Innovation in medical writing seems to have benefited, in this case, from the intertextual dialogue of medicine with literary creativity.
Most interestingly, Chen's work presents further evidence of the link between the recipe and the case that has been observed in European medical history. In both Europe and China, the case narrative as a new medical genre seems to have stemmed from the long-standing practice of collecting medicinal recipes. More generally, Chen's study confirms that the emergence and transformations of epistemic genres—genres devoted, as in medicine, to recording and transmitting valid knowledge—may provide a useful framework for comparative history. Chen offers, in this respect, valuable evidence and stimulating reflections on the comparative history of medical empiricism in premodern China and Europe.
There is, I would argue, a point on which her view of European medical empiricism seems mistaken, however. Chen notes that Song authors like Shen Kuo or Xu Shuwei did not explicitly distinguish between first- and second-hand experience. Apparently, they saw no fundamental difference between validating a formula through their own personal experience or that of reliable informants. Chen seems to think that this was also the case in premodern Europe, where, she says, scholars have found “a perplexing absence of distinct terminology indicating firsthand observation” (p. 41). From the Hippocratics to the fifteenth century, she states, “no specialized language existed in Europe to indicate direct observational practices.” This is certainly not accurate. Already in Hellenistic medicine, in the works of the so-called “empiricist” medical sect, we find a very clear distinction between autopsia (what we observe with our own eyes) and historia (what other observers reported). The great naturalist Dioscorides (first century CE) used the term in the dedicatory letter of his fundamental work on materia medica, to distinguish his own work, based on autopsia, from that of less reliable authors.
Overall, however, this misconception does not detract from Chen's meritorious effort to offer relevant elements for a comparative history of premodern Chinese and European medical empiricism. It would be extremely interesting to compare over time the constellation of Chinese terms related to the empirical validation of medical knowledge, such as “explanatory historical context” (benshi) and “facts” (shishi), with the corresponding cluster of terms in the languages of Greco-Roman (and Arabic) medical cultures. Chen's valuable contribution provides new documentation and opens up new perspectives for this field of research.
