Conclusion
THE EMPIRICAL STRATEGY on which this book has focused appeared in medical literature in the fifth century, became more elaborate in the late ninth century, and rose in salience during the Song dynasty, especially after the eleventh century. It by no means developed along a linear trajectory. The rise of the empirical strategy can be attributed to both individual authorial agendas and broader societal changes in publishing and epistemic cultures that took place between the ninth and twelfth centuries. Beginning in the late ninth century, increasing numbers of authors came to emphasize the importance of establishing the veracity of the information they recorded and disseminated. This included witnessing successful outcomes of formulas, describing the historical contexts in which a poem was composed or circulated, and empirically verifying putative regional phenomena (especially those in the Lingnan region). Such emphases grew apace in the Song era.
Although most Song medical authors did not attribute their inspiration for this new emphasis to their ninth-century predecessors, it is hard to ignore similarities in the great stress that the two groups of authors laid on confirming the veracity of the information they distributed. The burgeoning phenomenon that began in the late ninth century signaled three profound changes in epistemic cultures: greater acceptance of knowledge acquired through hands-on experience as worthy of documentation, the greater presence and epistemic autonomy of individual authors, and the related enhanced intellectual value of the reliability of a given text. Modern scholars have focused specifically on the Song dynasty’s contributions to the development of these three trends. But those innovations were not entirely the work of Song authors. Rather, they were continuous with developments that began in the late ninth century and became widely expressed in the Song dynasty.
The abovementioned trends in epistemic cultures in middle-period China appeared in both medical and nonmedical writings, the latter of which included notebooks, travel accounts, and inventories of things. Medical literature in this era engaged in a close intertextual dialogue with nonmedical writings, particularly with notebooks. That is, medical authors could, and often did, comment on medical opinions that had been expressed originally in nonmedical writings, and authors of nonmedical writings often cited and commented on medical treatises. There was no clear boundary between knowledge to be recorded and discussed in medical literature and similar knowledge appearing in nonmedical writings. In combination, this close intertextual dialogue and the absence of a clear boundary render it difficult to gauge the extent to which those nonmedical writings influenced the rise of the empirical strategy in medical literature. At best we can say that the proliferation of this strategy was a function of these broader changes in epistemic cultures, and its prominence in turn enhanced the visibility of these trends.
In addition to these new trends in epistemic cultures during middle-period China, another significant factor contributing to the rise of the empirical strategy in medical literature during the Song period was the new environment surrounding medical publications and learning that emerged in this era. The Song dynasty witnessed prodigious growth in medical text publishing, which resulted in no small part from the Northern Song imperial court’s unprecedented sponsorship of the dissemination of medical knowledge and a trend among the literati toward distributing medical texts for the public good. The publishing boom meant greater availability of and access to such texts, therefore expanding the types and numbers of readers interested in medical treatments, a critical mass of whom was unknown to those authors. To convince those readers that their writings were reliable, many of the authors related scenarios in which they empirically verified putative regional phenomena and a given remedy reached a successful outcome. Those narrative accounts worked primarily to affirm the historical factuality of a remedy’s efficacy. Some authors (such as Shen Kuo) assumed that their accounts could additionally give lay readers—those who could read medical texts but were unable to customize treatments on their own—clues for matching a sick person’s specific symptoms with a given remedy. The empirical strategy thereby helped authors present themselves as benevolent and reliable knowledge distributors.
Meanwhile, the Song dynasty saw increasingly intensified intertextual debates. Readers showed keen interest in comparing and commenting on various medical claims that their contemporaries had written. This interest depended on the simultaneous accessibility of numerous readily available medical texts, an abundance made possible by the expanding public attainability of such literature during this period. Some readers even composed new medical texts containing their own comments, intensifying intertextual debates in which they engaged with other Song authors. To win these debates, some authors (such as Kou Zongshi, Xu Shuwei, and Wang Fei) turned to an empirical strategy.
THE EMPIRICAL STRATEGY IN THE SOUTHERN SONG ERA
In the Southern Song era, the growing visibility of the empirical strategy in medical literature went hand in hand with the wider spread of print technology, as this period witnessed the printing of treatises at unprecedented rates. Among the published treatises, the empirical strategy was used principally to attest to the veracity of events that authors related.
In Southern Song accounts of pharmacological knowledge, authors often used the empirical strategy to verify the efficacy of local medicinal substances and healing practices. This strategy appeared widely in medical and nonmedical literature, such as pharmacological manuals, notebooks, and travel accounts. Apart from verifying textual claims, some authors began recording local medicines that they witnessed, and then compiled those records into independent books. One example of this new practice is Materia Medica on Lüchan Rocks (Lüchan yan bencao, 1220, hereafter Lüchan Rocks), the earliest extant pharmacological manual in China that was devoted to introducing medicinal substances originating from a specific and narrow geographic region. Its author, Wang Jie, presumably served in the inner court of Ling’an (in Hangzhou city, Zhejiang) during the Qinyuan regime (1195–1201). Wang stressed that all of the some two-hundred medicinal substances that Lüchan Rocks recorded were herbs that grew locally, near where he lived on the west slope of Ciyun Mountain (in Zhejiang, near West Lake), and which he observed and used.1 For instance, in an entry on “bee grass” (mifeng cao), Wang noted that his gardener once let him smell the grass’s leaves, and he thought it smelled like honey. This led Wang to conclude that this was why it was called bee grass.2 Lüchan Rocks even included illustrations that Wang drew of each of the herbs that he recorded.
In Southern Song formularies, the primary goal in using the empirical strategy was to attest to the historical factuality of a remedy’s therapeutic efficacy. Authors often documented informants’ names, occupations, and social relations (such as recording that a person lived in the author’s home county or was the author’s relative). For instance, Hong Zun (1120–1174), in his Mr. Hong’s Collection of Effective Formulas (Hongshi jiyan fang, 1170), documented the source of his information, indicating the efficacy of almost every remedy he recorded. Such sources typically included his, his relatives,’ or his acquaintances’ experience applying remedies to achieve the desired efficacy, as well as their witnessing of a successful outcome of a given remedy. For example, Hong remarked that when he was in Poyang (in Jiangxi), a person had seemingly died of drowning, but the remedy brought the victim back to consciousness.3 In an entry about using moxibustion, Hong indicated that it was “Guo Tinggui, the administrator of a district,” who had transmitted this method to him. Hong described how Guo witnessed its miraculous efficacy.4 In many entries, Hong meticulously noted each informant’s name, bureaucratic position, and geographical location, demonstrating his heedfulness of the need to prove the historical factuality of his records.5
Two other exemplary formularies whose authors used the empirical strategy to prove that they were historically factual and therapeutically effective are Ye Dalian’s Mr. Ye’s Collection of Effective Formulas (Yeshi luyan fang, 1186) and Wei Xian’s Mr. Wei’s Family Collection of Formulas (Weishi jiacang fang, 1227). Ye, who was a low-ranking official, carved his formulary into woodblocks in 1186. In its preface, Ye said that that the formulas collected in the treatise came from “those his previous generations passed down” and “those he favored to use in the ordinary day”; as for medical formulas that “I had seen no one using, I applied them but did not see their efficacy, and those I doubted and dared not rashly apply, all of such formulas I dare not transmit to others.”6 Wei remarked that his formulary collected 1,151 formulas, all based on remedies that he, his father, and his grandfather used and found effective.7 Notably, Wei Xian, Ye Dalian, and Hong Zun all expressed their intentions to print their formularies to extend the scope of their works’ circulation.
The emphasis on the historical factuality of recorded events and authors’ keen attention to noting information sources prevailed in Southern Song notebooks, among which Hong Mai’s Record of the Listener is emblematic. Record of the Listener was widely printed across Southern China. Hong Mai (the younger brother of Hong Zun) was a high-ranking civil official and had great interest in collecting occult anecdotes. His collection ended up in Record of the Listener, a series of books containing some 3,000 supernatural stories. Hong asserted that his stories were not fabricated and that the events described did take place; in his words, “All of the stories have their factual sources.”8 At the end of each, he often documented the informant’s name and sometimes their occupation and social relations. Many informants claimed to have witnessed the anomalous events. By including such details, Hong enhanced the claimed historical factuality of his stories.
THE SONG PHYSICIANS’ VIEW
The Song medical authors discussed in the four main chapters of this book were all scholar-officials who had either earned examination degrees or were civil officials. How did Song physicians consider and apply the empirical strategy? In general, when using persuasion strategies, they, even in the Southern Song period, preferred to demonstrate their command of various and numerous texts. Those they cited went beyond medical literature, extending to various literary and historical genres, such as poems, notebooks, and standard histories.
One case in point is Chen Yan, a physician who once lived in Yichun (in Jiangxi) and Yongjia (in Zhejiang) and wrote a pharmacological encyclopedia between 1227 and 1248. In the work, Synthesizing Views on Materia Medica in the Baoqing Regime (Baoqing bencao zhezhong), Chen cited a wide range of medical, literary, and historical genres. In addition to including numerous bookish references, he expressed a conservative view of the evidential value of witnesses. Chen claimed that he “witnessed” (muji) a great number of medicinal substances that originated near where he lived that had demonstrated therapeutic efficacy; however, “without seeing ancient people’s evidence, I dared not arrogate to myself establishing entries [on those substances in my Synthesizing Views on Materia Medica].”9 The evidence, on my reading, refers to earlier authors’ writings about the therapeutic efficacy of those substances. Chen’s words clearly prioritized authority derived from ancient texts over knowledge claims based on his empirical observation.10
Another instance of Song physicians’ preferred persuasion strategies can be found in Yang Shiying’s writings. As a physician who was active in Sanshan (in Fujian), Yang wrote four lengthy medical treatises and printed them in the 1260s. In them, he cited a wide spectrum of texts, ranging from medical works to Buddhist classics to notebooks (such as Record of the Listener).11 When expressing his opinions, he wrote frequently as if they were matters of fact and rarely documented his successful practices to buttress the credibility of those opinions.
To be sure, some Song physicians recorded their healing practices in medical treatises that they wrote and published; however, those records occupy no central place in their works. This tendency is evident in The Formulary for Saving Lives with Factual Evidence (Huoren shizheng fang, hereafter Formulary with Factual Evidence) by Liu Xinfu (fl. early 13th century) and Correcting Errors in the Easy and Concise Formulary (Yijian fang jiumiu, hereafter Correcting Errors) by Lu Tan (fl. 13th century). Liu, like Xu Shuwei, had attended civil service examinations over many years, but was not as lucky as Xu. Facing ever-worsening odds against examination success in the thirteenth century, Liu never passed the examinations and eventually earned his living as a physician. He composed The Formulary with Factual Evidence in 1216, a title that reminds us of Zhu Gong’s Saving Lives and Xu’s Formulary with Explanatory Historical Contexts. In many formulas, Liu added case narratives that described successful cures and indicated witnesses’ names. He described others’ successful cures using almost the same format in which he narrated his own. The first-person pronoun used in some of the case narratives was often the only hint that an account of a successful outcome might have derived from Liu’s own practice.
The similarity between the narrative formats in which Liu recorded his successful cures and others’ cures suggests that his primary purpose in documenting case narratives was unlikely to have been stressing his own healing virtuosity. Instead, as shown in the phrase “factual evidence” in the formulary title, his purpose was more likely to provide testimony to the historical factuality of the efficacy of the remedies he recorded. This purpose closely resembled Shen Kuo’s, Kou Zongshi’s, Li Qiu’s, and Wang Fei’s purposes in documenting case narratives in their medical treatises. Liu’s formulary enjoyed such wide popularity that he was asked, presumably by a commercial publisher, to write a sequel.12 The subsequent work similarly includes the phrase “factual evidence” in its title.
Like Liu Xinfu, Lu Tan in his Correcting Errors did not push his case narratives into the foreground but devoted much more space to his diagnosis and prescription theories. Lu was a physician who was active in Yongjia, a prosperous region featuring a competitive medical marketplace. In Correcting Errors, he harshly criticized physicians and formularies that were popular there, such as that of his rival healer, Sun Zhining, as well as Sun’s formulary. When disputing Sun’s prescriptions in his formulary, Lu heavily relied on theoretical reasoning regarding diagnosis and pharmacological knowledge, such as correspondences between sets of symptoms and the effects and perceived natures of drugs. Another persuasion strategy Lu frequently deployed was citing medical classics and then elaborating on his interpretation of those quotations. The main texts that he quoted were The Inner Canon and Treatise on Cold Damage. Lu depicted Sun as a physician who not only misread the latter but also had little pharmacological knowledge.13 Occasionally, Lu included case narratives, which served to illustrate his medical arguments and his interpretations of doctrinal texts.
Why did Song physicians, when applying persuasion strategies, tend to prioritize their erudition over presenting narratives of their successful cures? Before attempting to answer this question, we need to account for historiographic bias; that is, that the extant works of the Song physicians were, for the most part, composed by learned physicians, many of whom had prepared for and attended civil service examinations over the decades, becoming adept at composition. The less-educated healers—such as midwives, spirit mediums, and pharmacists—were by and large not literate enough to compose medical treatises or even to leave any words to us in our time, even though they outnumbered the learned physicians in the medical marketplace. This historiographic disproportion between the extant works of learned physicians and the work of less educated healers heavily conditions our understanding of the Song physicians’ preferred persuasion strategies. When modern scholars discuss how various healing practitioners in the Song era built up their reputations via documentary media, the extant sources allow us to observe only how learned physicians promoted themselves.
Despite this bias, a significant portion of the explanation of the learned physicians’ preference for the bookish strategy lies in the particular configuration of the medical marketplace in Song China. Competition already existed in earlier periods, but the establishment of the Imperial Pharmacy in the Song era greatly intensified that competition. The Song court established the pharmacy in the capital in 1076. It sold ready-made medicines to the public below market prices. In the late eleventh century, the court compiled The Imperial Pharmacy’s Formulary (Taiyi ju fang).14 This served as a self-help manual to help the sick and their caregivers choose and purchase formulas for medicines that were sold in the pharmacy. It thereby relieved individuals of the financial burden involved in consulting physicians. The Northern Song state fell shortly afterward.
In 1151, the Southern Song court reestablished the Imperial Pharmacy, editing and disseminating a new edition of The Imperial Pharmacy’s Formulary, titled The Formulary of the Bureau for Benefiting People and Compounding Formulations in an Era of Great Peace (Taiping huimin heji jufang). Several local governments then established branches of the pharmacy in their administrative prefectures, some of which were located in present-day Guangdong, Fujian, and Zhejiang. The Imperial Pharmacy’s Formulary then underwent revision and expansion during the course of the Southern Song era and was printed at least twice in the Shaoxing regime (1131–1163) and again in 1208. The wider geographical distribution of the pharmacy and the printing of The Imperial Pharmacy’s Formulary in the Southern Song era together provided the public with additional opportunities to choose cheaper, ready-made medicines than in the Northern Song period, which intensified competition in the medical marketplace. The formulary moreover empowered less-educated healers to ignore patients’ individual bodily particularities by prescribing the pharmacy’s ready-made medicines.15 Learned physicians, in turn, stressed their erudition to defend their expertise and differentiate themselves from their less-educated competitors.
MEDICAL CASE NARRATIVES IN PREMODERN CHINA AND EUROPE
The world in which Chinese physicians plied their trade had changed dramatically by the time the Ming state was founded in the fifteenth century. The Ming court retreated from active medical governance, ceasing to manage imperial pharmacies. Meanwhile, a printing boom expanded access to medical texts and accelerated the influx into the medical marketplace of both educated elites and others from lower social strata.16 Facing the increasingly diverse marketplace, learned physicians in Ming China, unlike their Song counterparts, exhibited a more assertive attitude toward publishing collections of their case narratives as a means of self-promotion. Starting in the sixteenth century, ever-growing numbers of physicians began including their case narratives in their medical treatises, which they then printed. These narratives thus formed the bulk of these works’ major content.
A shift in the role of case narratives occurred in the sixteenth century. A group of authors began to prioritize them over remedies in their treatises. Such treatises mark the emergence of a new genre of Chinese medical literature, which modern scholars have called the yi’an (medical case statements) genre. Yi’an authors were predominantly physicians and their disciples. In disseminating their books, they in general sought to recruit more disciples and to elevate the prestige of their own prescription styles and learning lineages.17 While sharing a common aspiration, the Ming-era yi’an books exhibited variations in the literary styles through which cases were narrated and classified.18 Bearing this variety in mind, we can gain further insight into changes and continuities of empirical evidence in medicine in imperial China through a comparison between the Song medical case narratives and those found in Ming-dynasty yi’an books.19
One obvious similarity between the Song case narratives and the Ming yi’an genre is their evidential function: both the Song and Ming case narratives in a given medical treatise served to buttress their reliability for publication. The chief aim of the majority of Song case narratives was to prove the historical factuality of the efficacy of recorded remedies. Some authors in the Song era attested to the attention given to factuality by including phrases such as “explanatory historical contexts” and “factual evidence” in their formulary titles. Although the narratives in the Ming yi’an genre still served this purpose, they additionally become significant and commonly used means of propagating a physician’s expertise in diagnosis and prescription. Another, more important, similarity lies in their close association with pharmacology, especially with individually tailored prescriptions. Song and Ming medical authors often used their case narratives to emphasize the importance of tailoring pharmacological knowledge to each sick person’s symptomatic and bodily particularities (one thinks here, for example, of the five difficulties Shen Kuo discussed). In the Song era, this emphasis often appeared as a concern about standardized remedies that the government enthusiastically provided to treat the public and to teach and transform laypersons. In the Ming era, during which government medical activism diminished considerably, the emphasis appeared more often in the context of debates between rival healers regarding diagnosis and treatment as they vied to win patients’ patronage.
Song medical case narratives differed from those in the Ming yi’an genre in three major respects: the scope over which cases were collected, the degree to which authors were aware of the narrative as a form of medical writing, and fields of knowledge related to medical cases. The most apparent difference is in the scope of a collection. Extant Song sources leave us no clues regarding the existence of collections in which the cases were taken from a single person’s healing practice. In Song treatises in which case narratives form the major part (such as Xu Shuwei’s Formulary with Explanatory Historical Contexts and Liu Xinfu’s Formulary with Factual Evidence), those records always came from multiple healing practitioners, who often lived centuries apart and so no master-disciple relationships were involved. For their part, many Ming authors compiled anthologies of case narratives. One example is Classified Cases from Famous Physicians (Mingyi leian, completed in 1552, but printed in 1591). Beginning in the sixteenth century, however, late imperial–period case collections representing individual practitioners appeared with increasing frequency. Three early instances are Sayings of a Female Doctor, Stone Mountain Medical Cases, and Mr. Han’s Generalities on Medicine (Hanshi yitong, 1522).
The abovementioned differences in the scope of the collected cases relates to vital elements that established the credibility of case narratives. The credibility of a Song case narrative was built primarily on the specificity of the information it conveyed, which could include the authors’ witnesses, names, occupations, the social relations of persons who attended the event, informants’ names and backgrounds, and geographical locations and times of day. With few exceptions, in the Song period, an author’s expertise in medicine was not the central element establishing the credibility of a case narrative, whereas in the Ming yi’an genre, the central element became the main actor’s medical expertise.20
In comparison with Song medical authors, Ming authors working in the yi’an genre demonstrated much greater awareness of the case narrative as a form of medical writing. This heightened awareness is evident in the Ming authors’ efforts to design a structured format for recording them. For instance, Han Mao in his Mr. Han’s Generalities on Medicine proposed a format that began with “in place X [relating to] person Y on date Z, I fill out this medical case” and then described in sequence the patient’s figure, height, appearance (such as being “glossy” [run] or “withered” [gao]), sound, pitch, pulse patterns, and so forth.21 In a similar vein, Wu Kun in his Language of Pulse Patterns (Maiyu) proposed another structured format.22 As Han Mao envisioned it, a case record following his format could not only prevent a physician from omitting important points in making a diagnosis but also could help a patient save the record and then consult other physicians for their opinions.23 Ming authors never quite made case records in structured formats prevalent, and even Wu and Han in their writings did not strictly follow the format they proposed. Nevertheless, the Ming authors’ proposed structured format testifies to their awareness of the case narrative as a particular medium for transmitting medical knowledge and physicians’ professional capacity.
Song medical authors, in contrast, demonstrated little interest in forming a structured sequence of steps when narrating a case, and provided no guidelines for writing them up. Although they wrote without following a structured format, Song authors by no means documented what happened as free-form notations. They seemed to share a tacit understanding that a case narrative at least included informants’ information, such as their names or social backgrounds.
When explaining why they recorded case narratives in writing, Song medical authors analogized physicians’ decision-making to decisions made on battlefields. For instance, Wei Xian in Mr. Wei’s Family Collection of Formulas cited the words of the famous Northern Song scholar Shao Yong (1012–1077), who observed that “applying drugs to attack disorders is like joining soldiers in battle.”24 Another example comes from the preface to The Formulary with Factual Evidence. The author of the preface, Ye Linzhi, argued that “physicians attacking disorders is like ‘military strategists’ (bingjia) attacking enemies.” He praised the case narratives collected in this formulary for enabling readers to make informed decisions about treatments. Ye considered this pedagogic usefulness similar to that of military books for military strategists.25 The analogy between physicians and military strategists was still commonplace in late imperial writings.
When explaining the usefulness of yi’an books, Ming authors frequently appealed to perceived similarities between medical cases and legal cases.26 These similarities, however, rarely appeared in Song authors’ explanations. For instance, Cheng Lu, the author of the preface to Stone Mountain Medical Cases, believed that one benefit of this treatise was that “when those who came after peruse the case narrative, isn’t it just like the use made by legal experts of settled cases?”27 The accumulation of medical case narratives, like that of legal cases, was thought to serve potentially as a historical archive to help succeeding learners make pertinent medical decisions. After Stone Mountain Medical Cases, yi’an literature often drew parallels between physicians’ decision-making in clinical situations and that of legal officials’ in the judicial process. Wu Kun appealed to this parallel as follows: “When medicines get to work and the disorders in question hide away, one must act like an experienced legal official hearing a case, who cites the law and fixes the penalty so that the guilty have no place to go.”28 Modern scholarship has pointed out that the Ming authors’ likening of medical cases to legal ones involved analogizing diagnosis to interrogating a subject, analogizing efforts to discern the etiologies of disorders to obtaining a confession, and analogizing prescribing medicines to citing laws and rendering a verdict.29
Comparison of Song medical case narratives with those found in Ming yi’an literature reveals important variations over time. Some features of the former are reminiscent of findings in scholarship on the development of the case narrative in medical genres in Europe.30 To be very brief, in premodern Europe, physicians consistently recorded their own successful cures. In the middle decades of the sixteenth century, however, they began publishing collections of those records, which they called curationes, observationes, and historiae. These were published primarily to tout a physician’s expertise and fame. Before that, published case narratives were inserted as anecdotes or examples in medical texts. Although there existed a genre devoted to cases, the consilium, its aim was to define them within the framework of doctrinal knowledge. Song medical authors likewise often appended a case narrative before or after describing a remedy (usually a drug formula) and sometimes used the narrative to illustrate a theoretical argument that they drew or developed from medical classics.
On the one hand, case narratives developed similarly in China and Europe before the sixteenth century: in both cases, they functioned merely as textual examples but did not acquire a distinctive status in medical writings. On the other hand, the medical learning environments in medieval Europe and Song China were very different. In Europe, case narratives were transmitted mainly as private records in manuscripts that were passed from masters to disciples or within a teacher’s familia. In China, although medical knowledge was often transmitted within a family and through an apprenticeship, autodidacts who acquired it through reading were plentiful. To persuade such self-taught practitioners, Song authors highlighted their own case narratives (and other accounts based on personal experience) as evidence of the reliability of their writings. The evidential power of these comes not from interpersonal familiarity between authors and readers but rather from the historical factuality that authors claimed for it.31
Empiricism as a mode of verifying therapeutic efficacy continued to underpin medical authority in both Europe and China in the centuries that followed the historical eras on which this book has focused. Hands-on testing of drugs was central to medicine and the rise of scientific experiments in early modern Europe.32 In early twentieth-century China, when not only Western biomedicine but also the Chinese government seriously questioned the legitimacy of classical Chinese medicine, its advocates launched a number of measures to reinstate their authority.33 One such measure involved highlighting the empirical tradition, characterizing classical Chinese medicine as an experience (jingyan)-centered healing praxis. Those advocates set up a relationship of opposition between classical Chinese medicine and Western biomedicine by declaring that the former was based on “experience with the human body” whereas the latter relied on “animal experiments.” Chinese medicine, they claimed, was accordingly more appropriate for application to human bodies. This opposition was not merely a rhetorical strategy, as it affected the protocol for scientific research on Chinese drugs in modern China.34 Even in our own time, supporters of traditional Chinese medicine (TCM) still hotly debate the relative benefits of pragmatic and clinical trials as standards of scientific proof in TCM. In this sense, how to prove therapeutic efficacy to the public continues to haunt TCM communities today as much as it troubled Song-dynasty men of letters.
Song authors’ efforts to establish the reliability of knowledge to be published (via manuscripts or stone inscriptions, or in print) occurred not only in medical literature but also in many literary and historical writings during this period. The life-and-death nature of healing knowledge, however, gives such efforts extra weight when medical knowledge was involved. The challenge involved in ensuring a published treatise’s reliability had ancient roots: the absence of any threshold for writing and publishing medical texts since the classical age in China, when any literate and resourceful author could compile, compose, and circulate such treatises. In addition to these ancient roots, the challenge intensified following the boom in medical text publishing in the Song era, when authors endeavored to prove the credibility and trustworthiness of the treatises they wrote and published, employing several persuasion strategies. Among these, highlighting the evidential value of the empirical strategy was often chosen. The authors’ efforts to make knowledge trustworthy during the publishing boom, with no threshold of truth over which they had to pass, even across a span of eight hundred years, echoes our contemporary struggle to build a system that ensures the reliability of knowledge claims in the face of an information explosion.