CHAPTER 1

Beginning to Read

Some Methods and Background

Consider how behavior is altered by medical concepts. Those who have a biomedical understanding of the body may open doors with their feet, sneeze into their elbows, and wash hands after greeting a friend. Their daily rituals—using the bathroom, preparing and consuming food, wearing clothes, and interactions with others—are all conditioned by the knowledge that invisible things move from one body to another and cause illness. So, how did those who believe in avenging ghosts as a cause of illness behave? If you know that changes in the flow of vital breath cause illness, what do you do when the temperature drops, or you smell something foul? How do you interact with others knowing that violent swings of emotion can be fatal? How do you read if you know that it can destroy health? Fiction represented these actual practices, but also critiqued, recommended, or explained them. In doing so, fiction reveals its intrinsic interconnectedness with the debates and concerns of its time. But it is also an agent of its time, a vector of transmission that entertains and affects its readers, conditions and instructs them. By capturing these robust practices, fiction is one of the very few kinds of sources that aid the historian of daily life. Yet fiction is fiction, and its fantastical, critical, or hyperbolic representation of healing practices reveal much about readers who would blithely employ or imitate them as if they were reading a medical manual. To rely on fiction as historical source material requires comparison with other kinds of texts to evaluate how authentic, logical, or unique are descriptions found in fiction. Readers’ commentary on fictional and medical texts, published notebooks (biji), accounts in newspapers and gazetteers, medical practitioners’ handwritten manuscripts, historical encyclopedia, guides to daily life, biographies, and medical case histories help to evaluate how fiction was used and, at the same time, provide examples of popular medical knowledge.

Chinese medicine really is a classical scheme of knowing. In addition to the circulation and balance in the body, and between the body and the universe, of blood, essence, and qi, Chinese medicine is based on a theory of systematic correspondences. The health of the state functions like the health of the body (a metaphor that has pervaded medical discourse in China since Huang Di’s Inner Classics of the first or second century BCE). Harmony can be disturbed by excessive desire or gluttony; by external conditions, such as a change in temperature or environment; or by the invasion of evil influences or spirits. Harmony is achieved though the maintenance of the flow of blood, essence, and qi through the body—and, in the case of qi, through immediate and extended environments.

In a syncretic worldview, all appearances belong to two opposite yet complementary poles, yin and yang, which are constantly changing into and out of each other. Early thinkers in the yinyang school considered all phenomena to be interconnected and constantly transforming—day into night into day, high tide to low to high, and so on. A similar school of thought saw the world’s dynamics as based on the interactions of five phases (wuxing) or five categories of all things material and immaterial. Wood, water, fire, earth, and metal represented more than the physical elements—they were also phases, each with their own set of characteristics, and related to each other in a cycle of conquest and generation. Applied to the human body, five-phases theory explained the dynamic relationships and affinities of five basic bodily systems, loosely associated with liver, heart, spleen, lung, and kidneys. The liver stored the blood; the heart regulated the movement of the blood and governed consciousness; the spleen stored and regulated energy from food; the lung regulated the qi of breath and also kept internal and external energy in their proper channels; and the kidneys governed reproductive function and the stores of primordial qi, the original source of life.¹ The yinyang and five-phases schools were synthesized during the first or second century BCE and came to characterize Chinese medicine. The body, with its organs and processes, functioned like the natural and social environments surrounding it (fig. 1.1).

Figure 1.1. Diagram of yin and yang and the five phases. From Xu Dachun, Yiguan bian. Courtesy of Waseda University.

Everyone has a body, and everyone gets sick, but these things are culturally conditioned and construed. Some scholars of Chinese medicine routinely capitalize words such as “Blood” or “Liver” to remind readers that these universals have significant differences in their respective medical paradigms.² Modern blood is not the same as premodern blood, and blood in early modern Europe is not the same as blood in early modern China. This is true also of diseases. While modern biomedicine posits that disease spreads by invisible pathogens, and that the syphilis contracted in Lisbon in the sixteenth century was the same disease contracted in Canton, we cannot ignore the cultural beliefs about a disease—how it was contracted, how it spread, how to treat it, and what it meant—in a given time or place. For convenience, familiar European terms for maladies are often used here. For example, for diseases that affect the genital region or are somehow associated with sex, “venereal disease,” which has fallen out of favor among modern doctors, is used precisely because it is old and imprecise. It retains the meaning “related to sex,” and for this reason is useful both to discuss meaningful disease categories, and to remind the reader that the topic under discussion is not specifically biomedical syphilis or any other disease that might be diagnosed in the modern West. The fusty, premodern term “consumption” does not correlate directly to biomedical “tuberculosis,” and its symptom set—coughing blood, weight loss, and weakness—is similar to depletion and taxation disorders in premodern China. Moreover, since it is often the result of excessive emotion or passion, with the implications of heat and the consumption of bodily resources, the translated term captures some of the illness mechanism, although not every implication of that classical malady in Europe coincides with instances in China. Such terms are not used for detailed analysis of these differences (i.e., the disease Marguerite Gautier suffers from is not exactly that of Lin Daiyu).

The use of imprecise terms is also warranted because vernacular medicine has different nosological systems than elite medicine, with which it overlaps. For instance, elite Chinese medicine most commonly identified nocturnal emission as caused by a deficient condition of the heart, a deficient condition of the kidney, an invasion of pathogenic humidity or heat, or an evanescence of vital essence. Vernacular medicine would also include among the causes of nocturnal emission excessive melancholy damaging the heart or bewitchment by fox spirits.³ Vernacular knowledge sometimes coincided with or encompassed elite knowledge, but at times, the two remained distinct. For instance, the belief that bugs (chong) and demons (gui) played a decisive role in the generation of disease was an accepted conceptual basis of elite health care prior to the medicine of systematic correspondences that rose to prominence in the second century BCE. After that period, bugs were largely neglected by the sorts of elite medical texts collected in the Complete Library of the Four Treasuries (Siku quanshu) as possible pathological agents until modern Western bacteriology entered China in the late nineteenth century.⁴ The important role played by bugs and demons in the creation and transmission of disease was, however, a fact continuously repeated in much of the materia medica literature, formularies, recipes, manuscripts, and practical medical texts produced in the past two millennia.⁵ Medical authors who recorded a variety of treatments for their own practice also recorded a much more robust world of belief than those found in traditional treatises. Formularies and fiction, popular texts starting at the end of the sixteenth century, point to a world of belief that had previously existed outside of printed margins. Elite medicine, the practice of which was usually confined to pulse palpitation and the prescription of medicine based on systematic correlations, was “elite” by virtue of its dominant position in printed texts for centuries. The robust, heterogeneous world of vernacular healing—including bugs and ghosts, and apotropaic and other kinds of medicine—are well represented in the fiction, encyclopedias, and practical medical texts of the Ming and Qing, and reflect the diversity and diffusion of healing practice.

LITERARY TEXTS AND ENTERTAINMENT LITERATURE

One way of knowing the world was through poetry. Poetry, in particular rhapsodies (fu), became critical to the post-Ming development of natural history and medicine. The genre of rhapsodies lent itself to works of natural history because it was always heavily descriptive (rather than lyrical) and became more so over time. But poetry was generally part of the natural history of things, and poems were regularly included in texts describing the known world. Scholars used poems, particularly famous or ancient ones, as evidence. Informational texts of every variety, including practical medical texts, use the phrase “there is a poem as proof” (you shi wei zheng).⁶ The authority of poems was predicated on a respect for the genre, which took emotional truth if not historical fact as its basis. Poetry also carried the hefty weight of esteemed literary tradition, and for that reason as well may have been perceived as a record of empirical evidence regarding the natural world. Another way of knowing was through telling stories. In all kinds of guidebooks we see authors citing a story as precedent, or even a conversation with someone else as evidence for a claim. For many, the only way to learn something new in the premodern period was from texts or word of mouth. Few conducted their own investigations, as did Li Shizhen (1518–1593), the author-compiler of the Systematic Materia Medica. Many essays record accounts of others and cite them as they would a poem. Poetry and stories also reinforced linguistic correlation—the sense that things in the real world that share names or that are related somehow through language have an actual corresponding relationship.⁷ These linguistic correlations undergird many medical interactions. Knowing in premodern China involved a literary logic, and texts that sought to communicate knowledge, particularly novels, recipe books, and medical compendia, employed this logic extensively.

Today, the hegemony of biomedicine is so complete that anything else is, to many, “alternative.” The scientific method is so enshrined as the only real way of knowing that poetry and stories seem poor resources compared to empirical observation, proof, method, and data. Moderns tend to judge therapies based on their effectiveness, not on their accordance with the logic of the universe as it has been known for millennia. It is difficult to imagine the world before biomedicine and scientific inquiry. Ghosts were a fact of life in premodern China. The heart produced thought. Wind flowed into meridians and produced six different pulses in each wrist. Historians of science, religion, myth, and social life all cite texts such as the Systematic Materia Medica to show how common certain beliefs were. But those diverse studies tend to obfuscate the fact that some of the most popular medical texts in China included everything all at once, without any disciplinary or generic distinctions. While the term “medical text” can mean anything from works on a particular group of disorders to instructional texts on palpating pulses to recipe books to apotropaic manuals, few medical texts represent the gamut of medical belief. Those that do represent a broad range of beliefs tend to be practical rather than theoretical. But practical medical texts are not syncretic; they are a collection of effective remedies, or simply a record of reading and life experience. In this regard practical medical texts rivaled novels in representing the complexity of the world.

Chinese novels and practical medical texts were not syncretic and did not make fast distinctions between strata of practice. Elite medicine commingled with popular healing practice in these texts. In novels and materia medica for instance, ghost-influx disorder could be treated with herbs, as could soul loss. Venereal diseases could be blamed on miasma as well as heredity. Pregnancy was aided by pharmaceutical drugs, eating placenta, prayer, sacrifice, and drinking the ashes of written talismans mixed with wine.

SOME USES OF XIAOSHUO

Historically, the literary genre xiaoshuo commonly translated as “novel,” shifted within and between traditional bibliographies and literary taxonomies. Literally meaning “small talk” or “trivial discourse,” in its earliest uses (Han dynasty, 206 BCE—220 CE) xiaoshuo meant something along the lines of “miscellany.” Only as late as the late sixteenth century did xiaoshuo come into common use as a term for full-length prose fiction. Xiaoshuo still includes a variety of genres of different lengths and levels of language that are distinguished from each other by modifying terms.⁸ However, the lack of a precise generic term for the premodern Chinese novel does not mean that the genre was poorly understood. Generally speaking, in China, the novel grew out of the historical tradition, which itself included not only battles and dynastic conquests but also exemplary people and “accounts of the strange” (zhiguai). In fact, works of vernacular fiction were sometimes called, and served as, “unofficial histories” (waishi).

These premodern novels include a great degree of classical-language poetry that coexists with the surrounding vernacular narrative.⁹ This likely shows the influence of traditional Chinese dramatic art, which also fuses vernacular narrative and classical lyric. The novel and serious drama in China had a great degree of mutual influence; sharing the same narrative structures and motifs, as well as the same readers, publishers, and, often, authors. Poetry in novels, like arias in operas, stopped narrative time and focused on a certain character, point, scene, or experience.¹⁰ This lyrical interlude provided background information or foreshadowed coming events. In part, the poetry in Chinese novels creates an interaction and tension between high and low diction, literati and popular culture. In this regard, poetry marks the novel in China, even more than drama, as a hybrid genre. The great works of vernacular fiction self-consciously exploit this intrinsic hybridity by playing with generic and linguistic differences to achieve ironic disjunctions or harmonious visions.¹¹

The novel in China grew out of particular historical conditions in the sixteenth and seventeenth centuries. Contributing to the appearance of the novel in China and represented in them were increased urbanization and population shifts to urban centers of the Yangzi River Delta region, increased printing and literacy, the shift to an economy based on silver bullion, overseas colonization and trade, and incipient industrialization. Xiaoshuo displays a shift in class affinity away from the old elite and the pretensions of classical literature toward a broader, more generously encompassing literature. The new literary form presented subject matter that appealed to a wide audience, namely depictions of the quotidian, mundane settings, and middlebrow characters. It also suggested a resistance to or subversive stance toward those political and cultural forces that had previously kept these strata of life from being represented. The representation of things in the Chinese novel, particularly in those more domestic works, both reflects a literati fascination with material culture in the “poetry of useful things” and presents the reader with a recognizable world of sights, smells, and sounds. Many of the novels from the eighteenth century in particular serve historians of China with their repositories of meticulously documented stuff of daily life.

Most of the novels discussed in this study were written by literati for literati to entertain their friends, relatives, and, in some cases, wives.¹² Most were not intended for publication—not so much because they would not be profitable, as indeed they were, but primarily because the writing of fiction was not a highly respected endeavor. Reading novels was something to be done in private, and writing them was a game by which the author might showcase his education and cleverness to his peers, for fun. It was not until the nineteenth century that many of the great classic novels were even attributed to particular authors—and that some writers became comfortable enough with the genre’s popularity to claim authorship of their own works.¹³

The novels considered to be “masterworks,” written by and for the most educated members of Chinese society, display an overwhelming degree of intertextuality. In referencing, borrowing from, and incorporating all manner of texts, the Chinese novel is virtually unparalleled in its complexity. Novels are hybrid texts, and xiaoshuo even more so, with their incessant borrowing from all genres. Additionally, most literati novels were published with commentary, multiple prefaces, and other paratexts that make some links to preexisting texts explicit. They also map out the logic and structure of the work. The hybrid, polygeneric nature of xiaoshuo and the many other texts in these texts shows that literati authors of fiction and their presumed readers read everything. But many kinds of readers consumed novels, and they did so using a great range of approaches. Literati novels are usually defined in contradistinction to “popular” novels, but literati novels became popular—they were read by lots of people who were not “men of letters,” and who read differently from one another. It is important to remember that the literati, while representing a small (roughly 2 to 5) percentage of the population, were a diverse group—in origin, employment, education, connections, and so on—as reflected in the quality of writings they produced. In the late Ming, literati faced a number of crises that further blurred the boundaries separating their group from the likes of increasingly wealthy and literate merchants. These “other” readers were the ones who used novels as compendia of elite knowledge and culture, and it was also these “other” readers who constituted a large cohort of medical practitioners.¹⁴

Basically defined, “literati” (wenren or shi) in Ming and Qing China were those of the “gentry” who were educated and who maintained their status as cultural elites primarily through classical scholarship, knowledge of lineage ritual, and literary publication.¹⁵ But the literati were not an undifferentiated group. Who was and who was not a literatus was not always clear, especially at a time of such great underemployment and increasing literacy rates, and many wanted to make an argument for themselves. In general, the increased publication and readership of these polygeneric texts contributed to the formation of a common discourse. Novels helped to create a popular vision of Confucian identity through language that is mixed with or complemented by values and wisdom drawn from many sources. Novels lent themselves to synchronicity—to a blending of philosophical stances, and easy movement between popular, official, and inherited registers of knowledge. Novels talked about daily life in a way that was both imperative and indicative; they provided a stable structure of values with which the reader could make sense of the world, and in this sense also participated in the construction of reality.

Most consumers read xiaoshuo in commentated editions, with printed and sometimes handwritten commentary by previous readers in the margins, between lines, or at the ends of chapters. Standard, sanctioned classical texts were read in commentary editions almost exclusively for centuries, but now readers (and sometimes authors) supplied their own commentary to novels. Commentary and novel paratexts literally and figuratively taught the reader how to read that particular novel. They also claimed to be teaching how to read novels in general. As such, xiaoshuo became a literary site for creative reading and interpretation that revealed trends in scholarship, literati life, and even medicine. Some commentaries, such as Zhang Xinzhi’s 1881 commentary on Cao Xueqin’s famous novel Story of the Stone (Shitou ji, 1791–92; also known as Dream of the Red Chamber [Honglou meng]), insist that the numerology, yinyang cosmology, and medicine of systematic correspondence is the key to understanding the entire work; others make more modest claims that a prescription is useful or that the author was engaging in physician bashing.¹⁶ Fiction represented and commented on life, and fiction commentary evaluated the authenticity and meaning of fictional representation. Commentators legitimized writing and reading novels as the work of fellow scholars, connected the work at hand to those of the past, and also corrected what was written.

Some of the most important medical texts of this late imperial period, such as the Systematic Materia Medica, were primarily commentary meant to collect and evaluate what had been previously written on a topic. Compendia of pharmaceuticals, prescriptions, and medical handbooks shared a similar discursive space, as did xiaoshuo, in that neither kind of text was a part of the elite forms of medical or literary practice, yet both enhanced their own popularity and utility by incorporating knowledge from diverse realms. Medical cases adopted many narrative strategies from fiction, and fiction incorporated all kinds of medical knowledge.¹⁷ Readers treated medical texts in much the same way they treated novels (or rather, both were increasingly treated like the classics). They added commentary, explained intertexts, and compiled, quoted, and even followed up medical case histories and materia medica with sequels.¹⁸ Literati had been engaging in these reading practices for centuries, and now they were subjecting fiction and medicine to the same kind of scrutiny. The addition of these texts to the canon of those deserving commentary signaled a shift in intellectual history, and was reflective of a desire to consider vernacular texts and practical knowledge as capable of sustaining that kind of inquiry.

SOURCES OF VERNACULAR KNOWLEDGE: ENCYCLOPEDIAS, ALMANACS, NEWSPAPERS, AND FICTION

By many accounts, the most popular published books in the late Ming dynasty (1506–1644) were medical works, encyclopedias, and fiction.¹⁹ These books were newly popular and appealed to a similar readership. Guides to passing the social service exams and other texts related to the Confucian classics were still among the most printed texts, but they commanded a much smaller share of the market than in the early Ming (1368–1505) and earlier.²⁰ That all three genres were becoming exponentially more popular in the Ming—more popular than the classics, philology, biographies, and other genres—was not a coincidence, nor was that fact that they often shared editors and printing houses.²¹ Practical medical texts, fiction, xiaoshuo, and daily-use encyclopedias, aside from all being classed as “philosophy” (zi), had much in common.²² Publishers were not only editing and printing a variety of useful and entertainment literature; they were also creating it.²³ Members of publishing families and editors wrote medical works and novels, which explains some of the similarities in form and content among genres.²⁴

Since the Song dynasty (960–1279), official bibliographic works referenced an independent category of texts generally translated as “encyclopedias” (lit., “books topically arranged”). The leishu category encompassed a variety of books, including collections of examination literature, instructions for carrying out family rituals, biographical dictionaries, primers on reading classical literature, handbooks on letter writing, pharmacopoeias, geographical surveys, administrative and procedural manuals, and dictionaries of quotations. In the Ming, leishu for the first time referred to works that were truly encyclopedic in their scope that functioned as guidebooks to daily life (riyong leishu). Although these had begun in the Yuan (1271–1368) with works such as the Essentials of Domestic Living (Jujia biyong shilei quanji), in the Ming daily-use encyclopedias flourished, with new compilations, reprintings, and new editions. A large portion of the extant editions of late-Ming encyclopedias for daily use originated in Jianyang County in Fujian, one of the late-Ming print centers, long known for its production of books of low quality in enormous quantity, with correspondingly modest prices.²⁵

These guides to daily life concerned themselves to a considerable degree with medicine. While the word “medicine” (yi) does not appear at all in the table of contents of the Essentials of Domestic Living, the section on “guarding life” (weisheng) contains well over 200 do-it-yourself prescriptions for treating maladies, including everything from hot soup burns (tanghuo shaodang) to consumptive disorders (laozhai). Sections in this encyclopedia, such as “protecting the body” (jinshen), also contain many prescriptions, as well as guidelines concerning damage from emotions, and prescribed amounts of sexual intercourse, food, and drink. Ming encyclopedias commonly featured chapters on medicine (yixue or yilin), nourishing life (yangsheng), and expelling disease (fabing or qubing). In popular encyclopedias of the late Ming, such as Ye Jia’s Newly Cut Complete Book of Myriad Treasures (Xinke yejia xincai wanbao quanshu, 1599), and Santai’s Orthodox Instructions for Myriad Uses for the Convenient Perusal of All People under Heaven (Xinke tianxia simin bianlan santai wanyong zhengzong, 1614), chapters are devoted to medicine, as is an entire chapter on smallpox (douzhen). Chapters on pregnancy, birth, and children (taichan, zhongzi, huyou, or quanying) take medical issues as the primary focus, providing prescriptions, advice, and guidance on palpating the pulses (maijue). Chapters on livestock and husbandry (niuma or majing) are also largely concerned with medical matters. Chapters on “teachers and scholars” (shiru) feature subsections titled “Tried and True Prescriptions” (Jingyan liangfang), as do chapters relating to sex, such as “Young Men” (Zidi) or “Romance” (Fengyue), which provide aphrodisiac prescriptions, including “good prescriptions for sexual desire” (seyu liangfang), “medicine for thoughts of love” (chunyi yao), and tips for enhancing virility. Fair to say, these encyclopedias and others popular in the late Ming and Qing dynasties were substantially concerned with the practice of medicine and the transmission of medical knowledge high and low.

Traditional Chinese almanacs, too (tongsheng, tongshu, lishu, lipu, or rishu), included considerable medical guidance and medical prescriptions. Virtually every household in premodern China used almanacs, and instances in which they were consulted abound in fiction.²⁶ Almanacs listed all types of human activities and gave guidance about selecting the most suitable days on which to perform them. They advised on matters of travel, marriage, buying and selling, opening a business, weaning a baby, pacifying the kitchen god, starting construction, burying a corpse, preparing wine, and all manner of quotidian activities. The most fundamental relationship between almanacs and medicine had to do with interpreting certain physical and emotional changes as omens or signs. Almanacs then gave guidance about how to interpret the meanings of quick-eye movements, ringing in the ear, heat in the face, trembling in the flesh, anxiety, sneezing, and so on. The meaning of each bodily or emotional change was different, depending on the hour of the day. For instance, if the twitching eyelid change occurs at noon, if it is the left eye, that person will soon enjoy good food and wine. If it is the right eye that has a twitching eyelid, that person will soon have a terrible experience.²⁷ The section on “dispelling illness” (fabing or qubing) commonly found in daily-use encyclopedias was very much like an almanac in this regard. Fabing, which literally means “statutory diseases,” were diseases caused by demons or ghosts, and were tied to the calendar. For each day one of the month a different demon was responsible for causing a different disease, and each of those diseases was treated by a different means. Like encyclopedias, almanacs included a great many talismans to treat particular illnesses, to be copied out, burned, and the ashes taken with some wine. Encyclopedias and almanacs drew on similar sources—perhaps each other—in reproducing these talismans. Almanacs also often had a section titled “Finding Doctors and Curing Illness” (Qiuyi zhibing) that gave guidance on when to consult with doctors and what means of diagnosis should or should not be employed at certain times. Almanacs also, like encyclopedias, provided a number of parallel couplets to copy and put on the wall or doorframe to prevent malevolent influences from entering, or to entice curative ones to come in.

By the early Qing, many almanacs devoted sections to “medicine” (yixue) or “guarding life” (weisheng). Some almanacs that date from at least the early nineteenth century contain a long section titled “Methods for Producing Children” (Zhongzi fangfa), which provided explicit information for women and men concerning menstruation, times for and frequency of sexual intercourse, preparations for pregnancy, and so forth. These included prescriptions for regulating menstruation, strengthening vital essence (jing), and supporting pregnancy. Although the majority of almanacs’ content indicates that much of life is preordained, it also made it clear that human action could still influence events. For instance, if a husband and wife wanted a healthy male child, they should be rested before having intercourse, choose a quiet time on a yang day and at a yang hour, and avoid eating dog meat. After intercourse, the woman should lie on her left (yang) side. These sections also tended to have a highly moralistic tone, repeating the same sentiments as famous doctors such as Zhu Zhenheng (aka Zhu Danxi, 1281–1358), who emphasized moderation and self-restraint. The Complete Almanac (Daquan tongshu) for 1819, for instance, informed husbands that they must curb their selfish desires if their wives were to have healthy children. They should not force themselves upon their spouses, have intercourse too frequently, or engage in sexual activity while drunk.²⁸ Extant medical manuscripts include sections hand-copied from encyclopedias and almanacs showing that medical practitioners found this information useful. Some authors even thought their medical manuscripts worthy of inclusion, as shown by the title “Broad Records in a Jade Casket with Contents Worthy to be Selected for an Almanac” (Xuanze tongshu guang yuxia ji, Daoguang [1821–1850] period).²⁹

Late Qing and early Republican-era medical manuscripts also include medical prescriptions copied from newspapers.³⁰ Some people intending to pass on medical recipes as an act of merit or gratitude took out ads and published them in newspapers. Such publicized recipes often aimed at remedying acute diseases, such as sore throat, “leg-hoisting sand disease” (diaojiaosha), injuries from dogs and poisonous snake bites, intrusion into the abdomen by centipedes, scalding, and accidental swallowing of metal needles. Many of these were clearly intended to garner merit, since they are prescriptions that treat life-threatening maladies. One 1874 manuscript lists prescriptions the author intended to publish in newspapers. Other medical manuscripts from that period copied prescriptions from the newspapers Shangbao, Xibao, Shenbao, Jingbao, and Shibao, and these are copied next to excerpts from (mostly contemporary) printed medical texts.³¹ The practice of publishing prescriptions in newspapers continued at least through the 1930s, and medical manuscripts from that period often drew heavily on them.³² In the last decades of the nineteenth century, it was common to find newspaper articles and advertisements recommending simple medicines, but over time, these gave way to ready-made prescriptions, commonly recommended for supplementing depletions.³³ In the twentieth century, prescriptions in newspapers that included Chinese and Western ingredients became increasingly common, and medical manuscripts informed by newspapers reflected this change as well.³⁴

Practical, vernacular medical texts, in their broad range of collected knowledge, resembled encyclopedias and novels, from which they gathered information. In the late Ming, novels began to display a dizzying degree of intertextuality, which coincided with their increase in popularity.³⁵ Plum in the Golden Vase (Jinping mei, 1618 or shortly after), for instance, was not just encyclopedic in its range of contents but was an encyclopedia.³⁶ In its copied source texts, Plum in the Golden Vase collects and assimilates virtually the entire spectrum of Ming dynasty literature.³⁷ Almost all the major categories of materials that make up contemporary miscellanies and guides to daily life find their way into this work.³⁸ Why the author chose to incorporate this kind of practical knowledge into his novel is not entirely clear. From a literary standpoint, it complicates the narrative discourse and adds a great deal of robustness to the varieties of vernacular language in the novel. The novel was also a venue for displaying mastery of many topics, but there is evidence that Plum in the Golden Vase’s author copied source texts word for word, as if he were assembling a personal encyclopedia, like those who made manuscripts for their own use.³⁹ The whole spectrum of medical knowledge is presented, albeit with considerable bias. The motive for working material into the novel is often ironic. At times, it seems authors were either commenting on the original source or having a character misread a passage to humorous effect.⁴⁰ Such novels became troves of information that were given the weight of popular response, legitimized through the story context, and disseminated to the point that they became common knowledge.

Medical, fictional, and encyclopedic books newly popular in the late Ming shared a readership. Relatively cheap editions of each were widely available for purchase.⁴¹ An episode in the seventeenth-century novel Marriage Destinies to Awaken the World (Xingshi yinyuan zhuan, 1661) suggests a potential owner and use of these various texts. Chao Yuan, a dissolute young man who frequents brothels and marries a prostitute, calls for the lusty quack Dr. Yang to treat him when he falls ill.⁴² The doctor calls for a book to prop Chao’s arm so that he can palpate his pulses. The maid has a terrible time locating a book, and finally comes up with the sex manual Secret Games for Spring Nights, Illustrated (Chunxiao mixi tu), which she found next to his pillow. The doctor thinks this will make Chao’s pulse race, so he calls for another book, and the maid brings him the erotic novel The Lord of Perfect Satisfaction (Ruyijun zhuan), which the doctor also rejects. Finally they locate a sufficient book for propping an arm: the daily-use encyclopedia Seeking No Help from Others for Myriad Things (Wanshi buqiuren).⁴³ Chao, for all that his collection insinuates, at least is a reader interested in the practical knowledge found in guidebooks, encyclopedias, and novels.

Fiction, practical medical texts, and encyclopedias were all written in the vernacular or a simple classical language.⁴⁴ All three kinds of texts were also “vernacular” in that they were generally not included in officially sponsored collections. For instance, the 1772 imperial edict concerning the criteria of inclusion for books in the Qianlong Emperor’s (r. 1736–1796) “Complete Library of the Four Treasuries” (Siku quanshu) clearly states that books like daily-use encyclopedias would not make the cut. This virtually defined daily-use encyclopedias as having no cultural value for the scholarly elite and categorized them as popular compendia of vernacular knowledge.⁴⁵

Since the Yuan dynasty at least, large numbers of scholars who failed in the imperial civil examinations subsequently turned to medicine as an alternative career choice.⁴⁶ Many printed books served as introductions to the field. Readers often copied selections of these, along with other printed materials, into manuscripts for regular use. These medical manuscripts may have been created because their copyists could not afford printed texts or because copying was such a time-tested way of acquiring knowledge. Copyists would add their own knowledge by commenting on the source text and copying other texts side by side. These medical manuscripts are, in essence, personally created medical encyclopedias for daily use. While the manuscripts were mostly unpublished, the majority of their contents are copied from printed sources, and as such they constitute records of reading practice—a kind of commentary based on what was selected from practical texts, and what was left out.

Almost all medical manuscripts contain recipes, and some are focused on them.⁴⁷ Collections of recipes, like pharmaceutical texts, imply a much broader conception of medicine than do the medical classics or other treatises. Since the manuscripts focus on practical knowledge, when they draw on official medical texts, they select the most useful chapters. The official medical text most commonly excerpted by the medical manuscripts is the Imperially Compiled Golden Mirror of Medical Learning (Yuzuan Yizong jinjian), but the sections copied are invariably those on acupuncture, pox, women’s ailments, pediatrics, and external medicine, the aspects of medicine most commonly addressed in practical texts.⁴⁸ The manuscripts very rarely draw on works that elucidate or debate medical theory, and look more often to formularies, materia medica, almanacs, encyclopedias, religious texts, medical cases, and reports of local practitioners. As such, these medical manuscripts give real insight into what kinds of information were thought to be important for practitioners of medicine, and what they believed. Reading through their contents, we get a view of therapeutic practice that is broadly encompassing, a vernacular tradition that is focused on expediency and unconcerned with the often contrasting or competing beliefs undergirding coexisting treatments.

TRADITIONS OF MEDICINE IN FICTION

Medicine and healing as depicted in vernacular fiction reveals the tension between the needs of readers and the dictates of fiction: sometimes graphically real, at other times hyperbolic and cliché.⁴⁹ In many cases, the use of medicine in novels reveals a distinction between middlebrow literati novels and lower-brow “popular” fiction. Authors of literati fiction allotted more space to describing diseases and doctors than did those who wrote popular fiction. Popular fiction is usually centered on action, which probably explains its general lack of detailed descriptions of or meditations on disease. This pattern is so distinct that “there is a direct correlation between the educational level of the author and the attention given to medical matters.”⁵⁰ But only a few literati authors direct particular, extended, and explicit attention to medicine. Among them are Li Yu (1610–1680), who gave special consideration to sexual function and dysfunction in stories and novels; Li Ruzhen, who included over twenty-five prescriptions in his novel Flowers in the Mirror; and Xia Jingqu (1705–1787), who described medical expertise as one of the characteristics of the ideal Confucian gentleman in his eighteenth-century novel Humble Words of an Old Rustic (Yesou puyan, first published 1881, but written over a century earlier).

In all kinds of fiction, high or low, disease was a common element, but it was not usually discussed at length or depicted in detail. Fiction before Plum in the Golden Vase was not very interested in describing the minutiae of daily life, generally, and therefore sickness in early fiction was mostly a device to kill off a character, rather than a literary device that revealed something about that character. Interestingly, there is very little representation of epidemic disease in traditional fiction, even in popular works.⁵¹ Perhaps epidemics did not lend themselves to metaphor well, or authors shied away from such a gruesome topic, despite the fact that many lived through major epidemics in the late Ming and Qing. In all kinds of fiction, though, people tended to fall ill while traveling. These man-out-of-place illnesses are typically attributed to unpleasant weather conditions, accidents, or passing into a different geographic area. This leads the patient to stay at an inn or temple to recuperate, where he is helped (or robbed) by a stranger, monk, or Daoist.⁵²

Literati fiction also treats the theme of possession more commonly than does popular fiction. This is particularly common in novels where retribution (bao) is the structuring morality, and the victim of possession is being haunted by a person they have wronged or killed. Although in medical texts there are many treatments for “ghost infection” (guizhu) and “ghost stroke” (guiji), in fiction there is rarely a cure for possession, and the victim usually dies in a fit of madness.⁵³ Madness unto death can also happen when a victim, usually a young woman, is possessed by a fox or monkey spirit, or is seduced by one on repeated occasions. In this case, the sprit has to be exorcised to save the weakened victim from continued depletion. Professional exorcists are usually not as successful at exorcising these demons as are examination graduates and lovers. Long novels from the seventeenth and eighteenth centuries in particular liked to treat the theme of possession,⁵⁴ presumably because it fit so well with a literati obsession with bodily depletion, loss of essence or semen (jing), desire, sentiment (qing), longing, and retribution.⁵⁵

Loss of semen and vaginal secretions gets a great deal of attention in these literati novels, which recast recreational sex and masturbation as dangerously depleting activities.⁵⁶ In fiction, aphrodisiacs, which are among the most commonly discussed drugs in medical formularies, were markers of foolish men about to die an excruciating death.⁵⁷ Adepts at using intercourse to rob the vital energy of others were likely to be defeated in this same manner by a more skillful practitioner of that art.⁵⁸ The victors are usually roving monks, Daoists, or nuns, and the narrative usually instructs readers (sometimes by addressing them directly) to avoid such people. Medical texts of the Ming period argued strongly against the possibility of prolonging life by nourishing the vital essence—the practice of having intercourse but not ejaculating so as to reabsorb that essence into the body—but they rarely fail to address the topic, which suggests that these notions were persistently on the minds of the literate. Neither medical nor literary texts questioned the power or danger inherent in the sex act. The theme of depletion was popular in part because it helped to define and distinguish qing, sentiment, passion, and desire—all distinct literati endeavors—from mere lust, to which the other, lesser, classes were also subject. But the concern with loss and depletion was also tied up with the literati fascination with obsession—their interest in and wariness of losing oneself in the pleasures and details of an act.⁵⁹

A related malady important to literati fiction, lovesickness, is usually described without much reference to medical theory. Commonly women, but sometimes men, fall ill after being separated from someone for whom they may or may not have declared their love. When described, the symptoms are weakness, listlessness, and loss of appetite, sometimes accompanied by coughing and weight loss. Doctors may be called in, but only being or expecting to be reunited brings recovery, which is usually quick, particularly via sex or marriage. If however, the union is frustrated, one or both lovers die. This lovesickness theme is frequent and not limited to fiction. Yuan and Ming drama present many such lovesick cases. Lovesickness is the more refined parallel to seminal loss; the former is caused by unrestrained emotion, the latter by unrestrained carnal lust. Authors of literati fiction represented both but differentiated between sympathetic lovesickness and base depletion due to lust. They also drew upon a notion found in medical texts and popular fiction—namely, that one emotion can be used to cure another.⁶⁰

As for those who would attempt to effect cures, doctors in popular fiction are usually called in to treat characters that have been poisoned; they rarely treat illnesses.⁶¹ Most long works of domestic fiction, by virtue of being detailed accounts of daily life, include a doctor in their cast of characters, though these usually play a minor role. Fiction high and low featured three or four quacks for every talented doctor, which presumably reflected prevailing attitudes toward and suspicions about that profession. In the Ming and Qing, there was a tendency to valorize “lower-class” characters from iffy professions who upheld Confucian values as a way to shame their social betters who did not uphold standards of loyalty, honor, or humaneness. These included professional storytellers and courtesans as well as doctors. Portrayals of charlatans also established effective medical knowledge as something both rare and virtuous.

As for drugs, poisonous and beneficial, one of the more common medicinals discussed in fiction is human flesh. Dangerous monks try to kill pregnant women or otherwise obtain the fetus for use in some kind of magical medicine. Demons and villains particularly desire to eat the flesh of devout or virile characters for its medical properties. If trying to eat human flesh characterized villains, trying to get a sick relative to eat one’s own flesh, usually in a medicinal soup and without their knowledge, marked a great filial sacrifice of a noble Confucian. This was potent human medicine indeed, and it rarely failed to cure the patient.⁶²

In both popular and literati fiction, good medicine works immediately, its potency often indicated by its rarity or repugnancy. Authors rarely mention therapies other than medicinal prescriptions or apotropaic medicine. When authors discuss therapies such as massage, acupuncture, and moxibustion, they designate them as the practices of unlearned medical hacks. Writers may have excluded them from fiction because they are therapies, and the demands of plot require a cure. Therapies are also likely absent because illness in fiction is usually not chronic, only poorly treated. There is a general belief that an “upright person” (zheng ren) is immune to demons and less likely to fall ill than others; the corollary is the foolish person ruining his health and inviting disaster with immoderate living or otherwise tempting fate. Novelists rarely mention healing through prayer, although many families made copies of sutras for free distribution to accrue merit that might be used to fight off illness. In both popular and literati fiction one of the most desirable kinds of medicine is fictional—a miraculous pill of unknown composition.

LITERARY LOGIC AND REGISTERS OF MEDICINE

When medical texts told stories it was to prove a point. In practical medical texts, anecdotes were facts that served as evidence, even in the absence of a logical explanation. The mechanism is different than that of the poetry employed throughout the Systematic Materia Medica, for instance, which relies either on the authority of the well-known poet or poem, or on the sort of daily-use logic that is found in practical poems. In the Materia Medica, poems were usually included in the “explanation of names” (shiming) or “collected notes” (jijie) section of each drug’s description that explained which names a drug was known by and why, and what its properties were. To cite just one of many references to poetry, Li Shizhen discusses the properties of xiebai, the stem of green onion:

Poet Du Fu wrote a poem about the long-stamen onion:

“In the color of green hay

With a round head like hairpin of jade

Warm as it is

It works to warm the cold in chest.”

What the poem says is in conformity with the record in the classics. So what Su Song said in his Tujing Bencao [about xiebai being] ‘cold and tonifying’ is not correct.”⁶³

For Li Shizhen at least, poetry was an authoritative source for knowing the natural world and the properties of objects in it. Stories were usually included in the “indications” (zhuzhi), “explications” (faming), or “prescriptions” (fufang) section of a given drug entry. If poems verified a drug’s properties, stories provided a literary logic or pattern of precedents to convince readers that the medicine was effective.

Claims made in the Systematic Materia Medica were legitimized by citing geographic provenance (knowledge originating in a city), experience (tried and true, personally witnessed), or text (famous poet, weighty text), but vernacular medicine in a fictional framework persuaded through narrative logic or familiarity taken for truth. Vernacular medicine encompasses many traditions, one of which is usually characterized by historians of medicine as “magic.” In the Systematic Materia Medica many drugs are deemed effective because of precedent, no matter how far-fetched the story of the precedent may seem to modern readers. Such stories often present an argument for the drug’s literal action based on the logic of metaphor. That fish are averse to vinegar makes vinegar the perfect cure for hallucinations brought on by having eaten too much fish, for instance.⁶⁴ If there was no such logic based on homonyms or etymology, the medical author had no recourse but to cite a story with a familiar structure (many ineffective prescriptions followed by a miraculous one) as evidence for his claims.

Since delineations between apotropaic and elite medicine were age-old, we might expect them to employ different systems of logic, as there were many different ways of thinking about the body and its relation to the cosmos. Yet, as doctors in the Ming and Qing increasingly adopted vernacular practices and folded them into the more orthodox traditions, we see that these systems of logic could coexist if not exactly overlap.⁶⁵ This was certainly the case in fiction. Authors of fiction may have found certain apotropaic practices lent themselves to literary use more readily than those of elite medicine, but these were practices observed in real life too. The 1736 Zhejiang provincial gazetteer discusses at least twenty-six cases of magical medicine in its “Filial Devotion and Friendliness” (Xiaoyou) section. In most of these, an adult male seeks to cure a sick parent by medicine and prayer, offering up his own life if all else fails. The magical healing usually takes the form of a god appearing in a dream to grant the wish, the devoted son cutting his thigh or liver to make medicinal soup, or the natural world responding to extreme grief or devotion during mourning and restoring the patient to life.⁶⁶

The term “literary logic” is a way of explaining the causal relationship between a therapy and its effects. “Magical” correspondences can also be understood as literary correspondences. The logic of metaphor, the logic of homophones, symbolic correlation, metonymy, and the meaning inherent in Chinese characters—derived from component parts of a character, its etymology, and its polysemy—all fall under the rubric of literary logic. For instance, peach blossoms kill demons that have infected the body, because arrow shafts were made of peach wood and killed things outside of the body.⁶⁷ The logic of homophones is a major part of knowing the uses and properties of objects in the natural world dating back at least to the Classic of Mountains and Seas (Shanhai jing, 4th–1st century BCE). This is the sort of thinking that asserted that a patient would not be lost or confused (mi) if he wore some lost-mulberry (migu) in the belt. Although not strictly a book of pharmaceutical medicines, the Classic of Mountains and Seas employs literary logic to illustrate the tie between the nature of the drug and the disease it treats—the best-known example of this being the claim that eating hermaphroditic animals will cure jealousy, because such an animal presumably does not require a mate.⁶⁸ These kinds of logic lie outside of the yinyang and five-phases systems of correspondence and were all well represented in materia medica, almanacs, and encyclopedias.

Early Qing medical scholars produced a corpus of diverse and complex new knowledge that absorbed folk or popular medicine into the elite canon.⁶⁹ Although demonology was, by most accounts, the most influential system of healing in China, literati physicians did not traditionally practice it.⁷⁰ The late Ming and Qing periods marked a change in the tradition, in part because medical authors became keen on incorporating demonology, which had existed independently of Confucian doctrine, into systematic correspondence. This period saw a flourishing of literate doctors who were deeply invested in pharmaceutical treatments as well as demonological, apotropaic, and magical medicine. Virtually all of the best-known authors of Ming and Qing medical works, including Yu Bo (fl. 1515), Li Shizhen, Li Ting (fl. 1570), Xu Chunfu (fl. 1570), Gong Tingxian (fl. 1615), Xu Dachun (1693–1771), and Sun Derun (fl. 1826), along with a host of less-well-known medical authors, acknowledged the pathogenic influence of demons as a self-evident fact, though they also frequently declined to offer up treatments for those maladies. Belief in the existence of luck, of evil spirits, and in a cosmos that is tied together in mysterious ways was not at all limited to the lower or uneducated segments of the population. Historians of medicine in China have made it clear that both kinds of healing practice—elite medicine and “other” kinds of healing (folk, popular, and apotropaic)—very frequently coexisted in practice, if less often in printed medical texts.

Among the more symbolic of the apotropaic cures in the Systematic Materia Medica, old mirrors (gujing) are particularly effective in repelling demons. Li Shizhen says that mirrors are the essence of gold and water. They are bright (ming) on the inside and dark (an) on the outside. Like ancient swords, ancient mirrors are capable of dispelling malevolent spirits, evil, and disobedient demons (bixie meiwu e). Li quotes Ge Hong’s (283–343) Master Who Embraces Simplicity (Baopu zi, 317, revised 330), saying that ancient creatures can take the shape of a human, but that mirrors reveal their true forms. This is why Daoists hang mirrors on their backs when walking in the mountains, because when a demon sees his own true form, he will be frightened and run away. In the Materia Medica and elsewhere, stories abound of people looking into mirrors to see things that would ordinarily be hidden.⁷¹ For this reason (and because they are also able to dispel a child’s night crying), Li recommends that “every family should hang a big mirror up to prevent invasion by devils and evils.”⁷²

In fiction, mirrors are a figure for individual subjectivity, and in both fictional and medical literature, mirrors cure demons and illusions. In The Story of the Stone, Jia Rui is told to look at the back of a mirror depicting a skeleton as a way of curing him of an illness brought on by longing and depletion. The skeleton is either that of Jia Rui himself or the object of his desire, and thus a (Buddhist) reminder that life and desire are ephemeral. This act of looking into the back of the mirror also points the reflective surface of the mirror away from himself, and therefore Jia Rui is unwittingly also fending off demons tempted to infect him or carry off his soul because of his physical depletion and moral transgressions. The mirror, after all, is said to cure “diseases of rushing indiscriminately into action because of evil thoughts” (xiesi wangdong zhi zheng), a term that can simply mean “illnesses that come from impure mental activity,” or, if taken literally, a disease caused by the demons that rush into those who overexert themselves with thinking.

The Systematic Materia Medica details many treatments for illnesses such as demonic influence (guizhu, or sex with demons), demons (guimei), evil (heteropathic) qi (xieqi or e’qi), ghost/demon qi (guiqi), and ghost essence (guijing). Apotropaic medicine employs a metaphorical logic, but it also subverts metaphorical readings in fiction. To differing degrees for different people, demons were real, and the way they were read in fiction would have been meaningfully different based on that degree of belief. Readers might consider the demons in fiction to be “personal demons” or character flaws, or they just as easily could view them as real demons that punish character flaws with illness. To mention just one more example from Story of the Stone, Baoyu’s jade is literally a talisman that he wears around his neck. It does (or claims to do) almost everything apotropaic medicine seeks to achieve: guard against evil spirits (chu xiesui), cure retributory illnesses (liao yuanji), and predict disaster and fortune (zhi huofu) (fig. 1.2).⁷³

Figure 1.2. One example of Baoyu’s talisman from a late eighteenth-century edition of The Story of the Stone. From Cao Xueqin, Honglou meng yibai ershi hui, call number D8653500, University of Tokyo Library.

When Baoyu loses his jade talisman, he exhibits all of the symptoms of soul loss.⁷⁴ It was commonly thought that a person had two souls—a spiritual soul (hun), which governs the higher faculties of mind and heart and corresponds to yang forces, and a bodily soul (po), which is tied to yin and governs physical senses and bodily functions.⁷⁵ The spiritual soul, light and volatile, can easily be separated from a living person. This separation can happen during sleep, be caused by fright or shock, or be the work of soul-stealing demons or magicians.⁷⁶ It results in a state characterized by trances and madness, and leads to death.⁷⁷ The condition is cured with a ritual known as “calling back the soul” (zhaohun, shouhun, or jiaohun).⁷⁸ Baoyu’s fits of delirium are caused by the bewitching of a specialist hired by Aunt Zhao; by being frightened when the maid Nightingale teasingly tells Baoyu that his love, Lin Daiyu, is returning home to the south; and by the loss of his jade, which is repeatedly referred to as his “very soul” by characters and commentators alike. Apotropaic medicine is described when Baoyu loses his jade and falls ill because of it (chapter 113), when exorcising demons from the garden (chapter 102), when repelling demons that have come to take his friend Qin Zhong to hell (chapter 16), when keeping demons at bay during Qin Shi’s funeral (chapter 14), and when combating the spell put on Baoyu and Wang Xifeng (chapter 25).⁷⁹ Distinguishing between healing and metaphor in fiction requires more than a disambiguation between represented reality and metaphorical magic, since magic was a part of the real world.

FAMILIAR FANTASTIC STORIES

Stories in medical texts normalize the weird and bring treatments that skeptical readers find incredible down to earth. Authors of such texts most often resorted to textual precedent to bolster their claims, but they also referred to stories from cases or personal experience. Medical manuscripts in particular show a good deal of concern with veracity, or at least with how to lay claim to it. A prescription frequently is followed by the comment “has been effective” (yanguo) or “has been effective x times” (yanguo x ci). Sometimes, as in medical case histories, prescriptions include details, such as the names and addresses of the patients who were successfully treated. This gives claims of the prescription’s efficacy the appearance of fact. Other times, folk recipes are accompanied by remarks such as “passed on from Beijing” (Beijing chuanlai) and “transmitted from Wei county” (Weixian chuanlai), details meant to convey the authority of knowledge that comes from a major city or county center.

Pharmaceutical and recipe books encompassed a much broader definition of medicine than more traditional texts, often citing fantastic or miraculous stories that illustrated the miraculous effectiveness of some medicine. A typical example is the story attached to the prescription “barefoot great immortal’s recipe of pills with a fish’s swim bladder to seed sons” (chijiao daxian yubiao zhongzi wanfang). The story features a sixty-year-old man named Zhou who had one wife and nine concubines but no sons. His “body was weak, his essence cool and his marrow cold, and his original yang unstable,” and therefore it was difficult for him to beget a son. Since he was distressed to be without male offspring, he traveled to a famous mountain where he met a Daoist master. The immortal, impressed with Zhou’s sincerity, gave him a good recipe that “strengthens muscles and bones, adds to the essence, and supplements marrow. It nourishes the yin, and stabilizes the foundations.” Zhou respectfully received the medicine, followed the Daoist’s recommendations, and felt his body regain strength and vigor. His bones became firm, and his eyes became clear. His hair turned black. Subsequently he fathered seven sons; his clan expanded enormously. Zhou died at the age of ninety-seven.⁸⁰ There are no details in this story that point to historical truth. We are not provided with Zhou’s full name or the name of the Daoist, nor of the prescription, its ingredients, effects, or indications, or anything else about it. This made the story useful for arguing the effectiveness of any aphrodisiac the physician cared to prescribe. The story is listed under the prescription for “black goat pills” (wuyang wan) in one manuscript, and could easily fit under any number of prescription recipes. There are many such stories, and many versions of the same story. They must have been convincing for them to have been so often repeated. In materia medica and pharmaceutical literature, these sorts of fantastic stories are usually found under the sections in each entry for a drug that discusses the author’s own experience with it. Stories were most commonly attached to drugs relating to sex and procreation, but they were also appended to drugs whose origins and effects are not clearly linked to their names or to symbolic properties.

Medical case histories, told from one doctor’s perspective, became a subspecialty of Chinese medical literature, and were collected and published as stand-alone volumes for the first time in the late Ming, and commonly in the Qing.⁸¹ Cases told stories of effective doctors, described symptoms as a narrator does, showed doctors in dialogue with the patient, and ultimately ended with the doctor demonstrating superior knowledge of medicine by curing the patient when others were unable to do so. Many extant manuscripts from the late Qing and Republican periods either quote from published collections of medical case histories or record case histories from the practices of their teachers or friends, or of their own practice. Recorded cases presumably served as models or teaching texts for novice doctors, and perhaps also as arrows added to the quiver of a shady medicine peddler.⁸² In addition to approximating the form of legal cases (gong’an or yanyu) and court-case fiction (gong’an xiaoshuo), medical cases have been compared to “tales of the strange” (zhiguai) and “unofficial histories” (yeshi), and are characterized by brief anecdotal accounts of events purportedly witnessed or heard about by the author. These are written in simple prose and mainly unadorned by literary techniques such as allusion or metaphor.⁸³

The employment of a drug in medical cases implied a reading, a diagnosis. The following example illustrates how medical cases shared linguistic codes and structures with detective fiction, the graphic details of novels, and the secret and miraculous events of “stories of the strange.” This case comes from Xu Dachun’s Medical Cases of Huixi (Huixi yi’an), written in the mid-eighteenth century, and published posthumously in 1855, with commentary by the prominent Qing physician Wang Mengying (1808–1867). In this case of “lower chancres” (xiagan), a common designation for syphilis or similar venereal disease, Dr. Xu narrates,

Shen Weide of Puyuan, terrible lower lesions, his penis down to the root had completely rotted off, and he urinated through a slit between bones, which caused him to cry out with pain. His anus was also festering to a depth of half an inch. He had been taken to the Yu family, where he had been told that he would be lucky if his life could be saved. [Doctor] Yu had never seen such an illness and was reluctant to try to cure it. He gave him pills to remove the poison and strengthen the blood, and a topical medicine to relieve the pain. After a few applications, it got to the point where it no longer hurt. After two months, it formed a scar and [Shen] was able to walk. But all that remained of his penis was the root. [At that time] Yu by chance was reading a secret book. In it was a prescription to grow a penis. The prescription called for a dog fetus. The Yu family dog had just given birth to three puppies. They took one, covered it in mud, and baked it. They added it to other things. Two years later [Weide] unexpectedly had a son. His entire extended family was in an uproar: without a male member, how could he conceive a son? This was probably because Weide had family wealth and the beneficiaries had covetous feelings. His parents-in-law made secret inquires to me. Shen said, “After I took the medicine, my member grew back. How can you doubt my having a son?” I then gathered Shen’s family together to see it, and the penis had completely grown back, but the member only had joints and no skin [like bamboo]. After that, he had another son. The many who heard this [story], both near and far, took it as an extraordinary event. Even today, those who hear it consider it remarkable.⁸⁴

As in the discussion of stories attached to aphrodisiac prescriptions, that this story is fantastical is simply brushed aside by saying that those who hear it consider it “remarkable.” It is this deviation from the norm that purportedly somehow makes the story more believable, but this deviation also called for the story’s telling in narrative form.

Li Shizhen in the Systematic Materia Medica relates another remarkable story of a drug found in Hong Mai’s (1123–1202) compendium of anomalous events, the Record of the Listener (Yijian zhi):

Mr. Lu Ying, official title Jinshi of Xiuchuan, suddenly vomited blood profusely, with spasms and contractions, fright, and maniacal manner. Late at night, the patient wanted to jump out of the window. This was repeated the next night. Drugs of all kinds had been tried to no avail. He dreamed of seeing Guanyin [Goddess of Mercy], who told him a secret prescription—one dose of which would root out the ailment. The scholar remembered the prescription and managed to have it filled and prepared. He recovered after taking it. The prescription is as follows . . .⁸⁵

Dreams in which people encounter immortals or bodhisattvas are often authoritative sources for prescriptions in the variety of materia medica literature.

Relying on a literary logic and archetypal plot structure normalizes the miraculous. Stories also account for what does not fit into an orderly cosmos. The tremendous number of prescriptions handed down by immortals, bodhisattvas, dreams, and accident all amount to a deus ex machina in a chaotic world of disease and illness left unattended by emperor and officials.⁸⁶ In the absence of imperially sponsored medicine, and given a vast sea of medical knowledge transmitted by word of mouth, the precedent provided by stories, as well as the literary logic imposed on that knowledge, helped to distinguish efficacy from chaos.

Some medical recipes have much in common with, or perhaps were influenced by, anomalous accounts, such as Pu Songling’s (1640–1715) “Liaozhai’s Records of the Strange” (Liaozhai zhiyi). One example comes from a late-Qing medical manuscript titled “A Convenient Overview of Medical Formulas” (Yifang bianlan), one of the few works of ordinary medical literature to record a “recipe to treat bewitchment by coquettish fox [spirits]” (zhi humei fang):

Whenever a fox seduces a male or female, it sucks with its mouth human semen during daylight and engages in sexual intercourse like a human person at night. Smear tung tree oil [tongyou] on the genitals, and the [fox spirit] leaves by itself. Or rub them with pearl orchid root [zhulan gen],⁸⁷ and the animal will die. Dry the animal’s meat, grind it to powder, and ingest it. This is even better.⁸⁸

Another medical manuscript records the same prescription: “To treat persons confused by a fox spirit, regardless whether male or female. Smear genuine tung tree oil [an emetic] into the vagina or onto the penis. The fox will vomit severely and then leave.”⁸⁹ These are mundane prescriptions compared to many more elaborate apotropaic remedies to expel or protect against demons that require talismans, special objects or times of year, incantations, and so on. The first recipe suggests that the patient ingest the powder of the dead fox in a sympathetic gesture that uses the virility of the fox as a tonifying (buyang) drug that can undo the depletive harm caused by the fox.⁹⁰ Mundane cures for fantastic illnesses place the weird in a nosology that is a logical extension of knowledge (in this case, sympathetic medicine—“like cures like”) found in fiction and medicine.

The range of medical belief and practice is particularly wide in these manuscripts. Although the prescription to treat bewitchment by fox spirits is uncommon, the range of implied medical belief in the manuscript that contains it is not. This manuscript, for example, contains a lengthy section titled “Strange Illnesses, Strange Cures” (Qizheng qizhifa) with some particularly bizarre prescriptions—syphilis is treated with “black gold paper” (wujin zhi) and red silk that has been used by a married woman. Some of these strange prescriptions were copied from Li Lou’s Extraordinary Recipes for Unusual Pathoconditions (Guaizheng qifang, 1592). The manuscript combines the strange with the mundane, with a great number of practical prescriptions and a large section with long quotes from several printed books on external medicine. This section focuses on recipes to cure syphilis (yangmei) and includes extensive theoretical and etiological discourses on syphilis taken from doctors such as Zhu Danxi, Xue Lizhai, and Wang Ren’an.⁹¹ Following this are sections on “apotropaic remedies,” (jinyao), as recorded in Zhao Xuemin’s Qing dynasty work Strings of Refined [Therapies] (Chuanya, 1759).⁹² The manuscript takes information from other, presumably similar, sources relating the knowledge and experience of itinerant healers. Prescriptions are culled from both published works and regional sources. Although more than three quarters of this manuscript are devoted to medicine, like many other medical manuscripts, it also includes tangential or unrelated information. It lists several methods of writing invisibly, and of making invisible writings appear, as well as directions on how to write on difficult surfaces such as oilpaper and water. It explains how to breed animals and how to prevent them from growing, such as “how to raise dwarf chickens” and “how to raise dwarf dogs,” as well as “how to raise turtles with green fur,” “how to raise pigs and have them become fat easily,” and “how to raise colored chickens.” Furthermore, the text gives advice on cosmetics, on pharmaceutical substances that will protect a fetus, and on how to give up smoking opium.⁹³ Another manuscript, which quotes many of the same recipes, adds a section on gynecology, discourses copied from Instructions on the [Movements in the] Vessels in [Verses of] Four Characters (Siyan maijue, Song dynasty) with commentary, and a section on talismans (shufu).⁹⁴ Some of these talismans are recommended for gynecological problems and abscesses, while others are for “expelling evil” (bixie), “suppressing ghosts” (zhenguai), and “protecting the body” (hushen). This comingling of the practical and the fantastical is reminiscent of tales of strange events, as well as the Classic of Mountains and Seas.⁹⁵

Many of the stories draw on a familiar literary or sympathetic logic, and they are not set off by introductory remarks that suggest that they are anything less than factual. The world implied by these medical manuscripts and by pharmaceutical literature is full of strange creatures and things that are primarily useful and only secondarily curious. One prescription, for example, a “recipe to treat choking disease” (zhi yebing fang), was supposedly “transmitted by a strange priest” (yiseng suochuan):

To drink fresh goose blood several times will bring the cure. Once there was a priest named Zijiu of the Xianhua temple outside the small south gate of Wuchang. He suffered from a choking disease, and no drug was effective. When he was about to die, he said to a disciple, “As I suffer like this, I should think that there is an object [in me] that deserves to be held in high esteem. After I have passed on, dissect me before you encoffin me.” The disciple did as he was told and found [in the priest’s throat] a bone shaped like a hairpin. He took it and placed it on the table with the sacred scriptures, where it remained for many years. [One day], a priest from the Rong people happened to visit the temple. When [Zijiu’s] disciple set out to slaughter a goose and was just about to cut the animal’s throat, he suddenly saw the bone. He took it and pierced the animal so that its blood spurted out. The bone melted. When Zijiu’s disciple himself began to suffer from choking disease, he concluded that goose blood could bring the cure. He drank it several times and was healed. He gave this recipe to many people, and it was effective in all cases.⁹⁶

There is a distinct aversion to questioning serendipity in these stories copied into manuscripts, as seen in figure 1.3, below. They record effective treatments, and the proof of their efficacy relies on the fact that the medicine has a story. Eyebrows should have been raised at a story that includes dissection (which was frowned upon by Confucians as a violation of filial piety) and happenstance, but the logic that goose blood could dissolve a [presumably goose] bone is powerful. The logic of that story imputes why a certain cure is effective, no matter how fantastical.

Li Shizhen, in his Systematic Materia Medica, was a bit more skeptical. He evaluated claims of efficacy and found many to be wanting. Ge Hong claims, in his Master Who Embraces Simplicity, that spiders and leeches could be used to make a pill that allowed a person to live under water. Li points out, “These fantastical accounts of the remedy masters cannot be believed.”⁹⁷ But it is clear from his penchant to cite all kinds of miraculous tales that it is only some tales, perhaps only those of the remedy masters that should not be believed. Not only did Li cite fantastic tales, he also cited books in the genre “tales of the strange” as proof:

Urine from a white horse has proven effective in curing diseases [arising from] obstruction in the belly. According to Zu Taizhi’s Records of the Strange [Zu Taizhi zhiguai]: Once, a man and his servant both suffered from a painful illness of the heart and stomach. When the servant died, the man cut open his body and found a white turtle [bie] with red eyes, still alive. The man stuffed all manner of drugs into the turtle’s mouth, but it still would not die. Another man riding by on a white horse noticed this. His horse urinated on the turtle, and the turtle’s head started to shrink. The turtle was given horse urine to drink, and soon the turtle dissolved into water. At this point, the man realized that taking a white horse’s urine would cure his illness. This proves the efficacy of the drug.⁹⁸

The structure of the horse urine story and the goose blood story is repeated in hundreds of stories in materia medica and recipe books (fangshu). Symptoms of an illness are described, a cause is discovered by investigation or observation (often involving dissection or some other taboo violation), something odd or miraculous happens, a connection is made to a cure, it is said to be effective, and the matter is thus proved. No questions are asked about why horse urine works to cure abdominal blockages or how a turtle got into the servant’s belly, let alone that of the master. Various “turtle” (bie) illnesses are discussed in the Systematic Material Medica, most of which describe the malady as a blockage caused by a turtle [-shaped] conglomeration—that is, a blockage in the shape of a turtle. Here, as often happens in fiction, a medical notion that depends on metaphor or figurative language paradoxically becomes literalized in the tale. Li does not question the provenance of this story, coming as it did from a collection of records of strange occurrences. In the last paragraph of Li Shizhen’s voluminous work, he writes about human anomalies and in so doing explains his underlying principle with regard to the fantastic:

Figure 1.3. From a late-Qing manuscript, “An Easy View of Medical Formulas” (Yifang bianlan), showing (left) a section on “strange illnesses, strange cures”; (center) a prescription for curing “bewitchment by coquettish fox spirits” (which is not one of the strange illnesses or cures); (right) a cure for choking disease. Staatsbibliothek zu Berlin—Preußischer Kulturbesitz, East Asia Department Slg. Unschuld 8453.

The evolution and transformation of the Heaven and Earth are boundless. Human beings also have endless changes. . . . All changes are based on the condition of the qi. When a person who is not well-versed says that such things in strange forms and odd shapes are unbelievable, it means he has not learned that all things are subject to infinite changes in infinite time. How can it be said “It is impossible?”⁹⁹

Which is to say, the more learning a person has, the more he has read, the more familiar the fantastic becomes.