Introduction

It was the summer of 1843, and in Tai County the okra flowers had just bloomed. Lu Yitian’s aunt, Madame Zhou, enjoyed making medical concoctions and people came from all around seeking her treatment. There was a man who had been severely scalded, so that his body was covered in festering sores, and no one had been able to affect a cure. He came to beg for a prescription of Ms. Zhou. She thus consulted the novel Flowers in the Mirror (Jinghua yuan, 1818) by Li Ruzhen (1763?–1830) because she knew that it “used a great deal of well-documented and extensive evidence” (zhengyin haobo) and because the “medical prescriptions work very well” (zhibing douxiao). She found in this satirical fantasy of adventures to strange lands a prescription for burns that called for okra flowers soaked in sesame oil to be applied topically. Ms. Zhou followed the prescription, and the patient recovered quickly. Thereupon, she picked all of the okra blossoms in the area, put them in bottles of sesame oil, and distributed them. According to Lu’s cousin, who related this story to him, there were none who, having received this medicine, were not cured with it.¹

The ways that novels and medicine illuminated each other in the last decades of imperial rule in China may seem like an unusual topic, but this passage provides some clues about what can be gained from such an investigation. The aunt of a medical expert (or, rather, a literate medical amateur, author, and official) gets a prescription from a novel, and her nephew incorporates it into his store of medical knowledge. He then records the story and the prescription in his medical text and his collection of notes, which further circulates the prescription, its source, and use. This story and its dissemination raise questions of intended and actual audience and of what texts written in the vernacular are meant to “do,” especially considering the explicit fictionality of some of the sources used by healers. This sort of reading that focused on gathering useful knowledge for daily life disregarded the nature of the text in which it was found—a manner of reading that was possible precisely because there was so much medical information circulating by the late Qing in various forms. That a medical amateur’s reading of a novel was reprinted in Medical Discourses from Cold Hut (Lenglu yihua, 1858) gives some indication that the authority surrounding practices like reading and healing were becoming diffuse.² Lu Yitian’s passage suggests that readers were as interested in the nonnarrative, encyclopedia-like aspects of the novel as their authors were in filling novels with displays of every kind of knowledge.³ Madame Zhou was able to separate the fantastical plots and hyperbolic descriptions in the novel from what she believed to be the very real and useful knowledge that they contained. But story and knowledge are not mutually exclusive. Fantastical plots helped to sell, literally and figuratively, the useful knowledge included in these novels. Moreover, novels were an efficient way to transmit this kind of knowledge, particularly, as many believed, if the author was hoping to accumulate merit by spreading useful (and secret) pharmaceutical recipes to as many people as possible. In any case, Ms. Zhou consulted Flowers in the Mirror rather than some other, more strictly medical text such as the Systematic Materia Medica (Bencao gangmu, 1596), a text known to all who practiced the most orthodox, elite medicine, and from which the prescription was likely taken.⁴ She even participated in the tradition of transmitting prescriptions, modeling herself on the protagonist Tang Ao (and author Li Ruzhen?) who disseminated prescriptions as acts of charity. Perhaps she trusted Flowers because Tang Ao is a model practitioner of medical virtue. Or maybe it was because Flowers had been published only a few years earlier that Ms. Zhou considered the knowledge in it to be up-to-date, or to have some other quality she deemed valuable. Or perhaps Ms. Zhou trusted the novel to cure her neighbors because Flowers contained so many different kinds of pragmatic knowledge—about flood control, mathematics, navigation, poetry, and even linguistics—that it seemed a reliable encyclopedia.⁵

A world of change faced literate men in late imperial China. It was harder to gain official employment than it ever had been before. The civil service examinations that determined the amount of official responsibility and compensation had become so crowded with candidates that passing them was virtually impossible. Odds of securing employment were also reduced by increasing graft and the practice of purchasing office by those rich merchants who, despite their wealth, were otherwise looked down upon. Literati had been turning to other professions, such as tutor, doctor, editor, or author, for a few centuries, in greater numbers near the end of the Ming dynasty (1368–1644) and in still greater numbers during the Qing (1644–1911) when Manchu rulers were even less inclined to appoint Han Chinese to office.

This was the time that the novel began to establish itself as a new and important genre in China. The situation of literati, turning their esteemed hobbies into mundane, practical professions, is likely one of the reasons why the Chinese novel (xiaoshuo) has a particularly encyclopedic nature. After spending their youth memorizing philosophical and historical texts, literati who failed the official exams that were the sole determinant of official employment had to ply a trade—and tutoring, writing, and practicing medicine were among the most popular of these. This context gave rise to the “scholar-novel,” identified by unity of plot, structural coherence, and single authorship, in contradistinction to folk novels, with their patchwork of traditional stories, incorporated a broad range of practical knowledge. Many novelists in China turned to vernacular literature in part to display their knowledge of medicine, science, architecture, mathematics, poetry, and myriad other areas of inquiry. The new genre accommodated (and later served as) encyclopedic texts as much as it portrayed quotidian life, entertained the reader with complex plots, and enabled literati to comment on their increasingly nebulous place in society.

The account of Ms. Zhou’s practice, even if it is apocryphal, illustrates that medical belief and practice were intersecting with fiction in early modern China. Educated doctors who read the literature of elite medicine by day and entertainment literature by night encountered these intersections, as did lay practitioners and readers. Literate people, an increasingly diverse group who read and produced diverse texts, understood the world and their bodies’ place in it through a frame of both elite and vernacular knowledge. When ill, we want to know not just the etiology of our disease but what our disease means. In China, as elsewhere, the experience of disease was conditioned by peculiarities of culture. What is more, the meanings of disease defined by popular entertainments affected thinking about etiology, and a complex discourse evolved between novelistic and medical texts. Practitioners were evaluated in the pages of fictional texts, and their representation in novels resonates with doctors’ recorded cases and autobiographies written at the same time. Literate patients were also amateur practitioners; they wanted to know how to treat themselves, their sick family members, and neighbors. They availed themselves of all kinds of popular guidebooks and practical medical texts, and even novels. Through a sustained analysis of early modern fictional and medical texts, as well as fiction commentary, criticism, newspaper advertisements, medical manuscripts, essays, collectanea, biographies, oral tales, performance literature, and more, this book examines how vernacular knowledge of medicine and the body was created and transmitted, and how much of it persisted into the modern era.

Each chapter of this book is organized roughly according to chronology, but because the materials used to investigate each thematic topic are different, discussions of historical context necessitate moving back in time to differing degrees in each. Many of the texts discussed have no publication date, little publication data, or were never published, which means that precise dating of the creation or consumption of these texts must yield to logical approximations. In this study, the terms “early modern China” and “late imperial China” are not incompatible. The “early modern” period of China here refers to the seventeenth through nineteenth centuries—the longue durée period extending across the dynastic boundary between Ming and Qing. I am more concerned with understanding the relationships of medicine and fiction in this period than in situating them in a strict, diachronic history of belief or practice. It is, however, important to understand the late Ming and Qing as “early modern,” since China’s modernity has a domestic history, as this study demonstrates with regard to medical knowledge.⁶ This is not to say that belief and practice in the seventeenth through nineteenth centuries were only early modern. The chapters in this book each culminate in the last decades of the nineteenth century or the first decades of the twentieth, but this is not meant to suggest that their investigations are all entwined, mutually influential, or products of one cultural moment.

Illness and the body are complex topics that demand interdisciplinary approaches. Vernacular entertainments, themselves complex, polygeneric, and interdisciplinary texts, are also a vast cache of depictions and explanations of the quotidian and popular knowledge. They illuminate how illness and the body were understood in individual works and as trends in literary history. As complex texts that are both narrative and instructive, written by and for literati, scholarly novels of early modern China share much with medical compendia and case histories, and even materia medica produced in the same period. Fictional texts were used or imagined as medical texts, but medical texts increasingly looked like fiction and drama—containing a great deal of narrative and dialogue, and drawing upon a wide range of sources, including poetry and fictional literature, as evidence to back their claims. Studying these kinds of texts together also makes sense because they were being published in great numbers for the first time starting in the sixteenth century, often sharing the same publishing houses, editors, readers, and, sometimes, authors.⁷ Metaphor and figurative language are powerful forces that alter how people understand their bodies and their world, but they also codify complex notions, and resist change. The flourishing of these texts marked a watershed moment in publishing and reading culture, and they exerted long-term effects on the public imaginary with both their content and their form.

NOVEL MEDICINE AND POPULAR KNOWLEDGE

“Novel medicine” refers here to medicine found in novels, as well as works of drama and short stories, which shared the same kind of readers.⁸ “Novel” medicine is also meant as a corrective to the emphasis put on the “medicine of systematic correspondence,” the paradigm emphasized more than any other in scholarship on Chinese medicine (which focuses on yinyang and five phases correlations that underlie relations between particular medicines and bodily dysfunctions), and in contradistinction to which many widely held beliefs and common practices seem “strange” or “unorthodox.” Novels also presented and represented elite medicine, but vernacular literature was one of the few printed sources that recorded these “other,” vernacular traditions of healing practice. Medicine, or, more precisely, healing, included all phenomena that affected the body: hard masses and strong emotions, miasmas and wind, ejaculation and diarrhea, corpse worms (shichong) and ghosts, and a multitude of other pathogenic factors. Novel medicine also implicates the ways in which medicine illuminates vernacular literature. We cannot understand how early modern Chinese readers comprehended fiction without investigating the history of medicine and the body of the period. But we cannot fully appreciate how bodies were understood without trying to access the most popular and important representations of the body—those found in entertainment literature—and the literary logic that under-girded those representations.

“Popular knowledge” refers to vernacular or common knowledge, and to ways of knowing that lie in the lived practice of everyday individuals, outside “official,” elite, or formal discourse or modes of education.⁹ Much of medical knowledge at that time lay outside elite medical practice; employed local, folk, or apotropaic remedies; or was transmitted through texts written in the vernacular and likely intended for mass consumption. But “popular knowledge” also refers to ways of knowing and strategies of transmission that employed narrative technique, metaphor, metonymy, linguistic correlation, and other kinds of logic found in entertainment literature. Much of what nonelite healers knew about medicine came from vernacular sources—novels, dramatic literature, household manuals, encyclopedias, and almanacs.

In English, the word “medicine” commonly refers to a specialized form of healing codified in and accessible through written literature and thus holding privileged orthodox status.¹⁰ “Healing,” by contrast, is encompassing in its inclusion of medical theory and practical reality. In Chinese the word yi can refer to any variety of healing practice but is most commonly used to identify the practices of elite medicine, or perhaps acupuncture or moxa (historically the purview of more lowly specialists). Healers in imperial China could be graduates of the imperial medical academy or other diverse types of doctors, shamans or spirit mediums (wu), “remedy masters” or magicians (fangshi), or other kinds of caregivers. The differences between these practitioners and the beliefs that undergirded their practice were not always clear.

There were essentially three strata of medical practitioner in early modern China: those who responded to a command (court physicians), those who responded to an invitation, and those who solicited business.¹¹ Court physicians, or physicians-in-waiting (usually known as yuyi, neiyi, taiyi, or daiyi), served only the court and were paid a fixed salary. Other doctors, often known as “business physicians” or “city physicians” (shiyi), practiced medicine in a fixed location in town and made house calls in response to a call from a family, who then paid them an examination fee (zhenjin). These physicians constituted the largest number among all medical practitioners, and historically were those who represented literate medicine, though this was a diverse group jostling for authority and prestige in a field without much regulation. This group could also include local midwives, shamans, astrologers, and others who were amateurs or part-time practitioners. Local physicians are prominent among healers in fiction. Doctors who solicited customers tended to wander between small towns and villages in the countryside and treat those who did not otherwise have access to medicine. Commonly known as “bell doctors” (ling yi), “grass and marshes doctors” (caoze yi), “wandering doctors” (zoufang yi), “doctors [who pass] over rivers and lakes” (jianghu yi), and “common doctors” (yong yi), they were figures of city marketplaces as well, since many urban dwellers lacked the financial resources to pay the fees of a regular doctor. This group also encompassed monks and nuns; peddlers of nostrums, aphrodisiacs, and abortifacients; and dentists and surgeons. Although each strata of medical practice was represented by a diverse group of practitioners, with differing medical and educational backgrounds, they were separated by mobility, with one group fixed as local doctors, and another as itinerant ones. It was these city excursions that brought mainstream doctors into contact with traveling doctors, and these points of contact inspired the vitriol and disdain of one group toward the other.

Beginning with the Yuan (1260–1368) and Ming dynasties, notes on itinerant physicians began to appear more frequently in medical literature, voicing both praise and criticism. Mostly, these are case histories recording the successful conclusion of a treatment after a faulty approach by some itinerant physician. It seems that only in the Qing did itinerant doctors begin to constitute a group that was perceived to have its own medical tradition.¹² Some writings contain prompt notes for use by itinerant physicians. These provide lengthy discourses on the origins of disease and therapeutic practice with points clearly meant to punctuate a sales pitch. This performance was meant not to educate but to befuddle and to sell medicine. The earliest extant text by an itinerant doctor was published in 1593, though the text detailing the practices and knowledge of wandering doctors that caused a great stir among “city physicians” was that recorded in Zhao Xuemin’s (ca. 1730–1805) Strings of Refined [Therapies] (Chuanya, 1759).¹³ Zhao explains that he excised the prompt notes for pitching nostrums and other tricks of the trade because he did not want to spread immoral or illegal knowledge.¹⁴ Based on a large collection of medical manuscripts held in the Berlin library, the practice of willfully cheating patients was not uncommon. Many of these manuscripts reveal strategies to persuade reluctant patients to purchase treatment, or to pay high prices for medicine.¹⁵ The linguistic talent of these itinerant physicians is summed up in one manuscript: “To sell medications and to predict one’s fate—this entirely depends on rhetoric.”¹⁶ The manuscripts also show that in the late Qing there was a good deal of competition within the group of itinerant healers.

Suspicion of doctors dates back to at least the first century CE and the earliest extant biography of a doctor, in which the Prince of Huan warns, “Physicians, fond of profit, try to gain credit by [treating] those who are not ill.”¹⁷ Evaluations like this one were reiterated, often in fiction, until the modern period, and point to a consistent ambivalence regarding the status of medicine and its practitioners. The most common way of representing doctors in traditional Chinese fiction was as comedic quacks. Given the absence of licensing laws and formal medical instruction in the Ming and Qing, and the long-standing suspicion of any profession practiced for money (usually classified as craftsmen [gong] or technical specialists [ji]), doctors vied with each other for legitimacy.¹⁸ Doctors also contributed to their profession’s own bad reputation by frequently bemoaning the proliferation of quacks generally, or attacking specific medical groups or individual practitioners. Both elites and hereditary doctors (shiyi) sought to appropriate some of the others’ legitimacy, but hereditary physicians and scholar-physicians wanted to distinguish themselves from folk healers, mendicants, women practitioners, and peddlers of medicine.¹⁹

Those who sought to legitimize the practice of medicine relied to some extent on the Confucian values of humaneness, benevolence, and rightness. They defined these as the qualities of the ideal doctor, a “literati-physician,” “scholar-physician,” or “Confucian-physician” (ruyi). Early uses of the term ruyi (twelfth century) refer to hereditary physicians with Confucian (ru) values. The term also applied to men from families of ruling elites who eschewed government service to practice medicine, though it is more likely that they turned to the medical profession once their path to officialdom became blocked.²⁰ Scholar physicians are significant marginal figures—their scholarliness elevating them above common doctors, their medical practice excluding them from the category of scholar-officials.²¹ That is to say, even physicians of the higher order were still not quite gentlemen.²² These elite outsiders, who were elevating the practice of medicine—in status, at least, if not in efficacy—play a part in the history of fiction and drama, just as authors of fiction and drama were similarly seeking to establish those genres as legitimate practices of educated gentlemen.

Ruyi status identified people who read—texts, the body, and patterns (li). The Golden Mirror of the Medical Lineage (Yizong jinjian), published for use as a teaching manual at the Qing Imperial Academy (Taiyi Yuan), stated, “If physicians are not intimately familiar with books, they will not understand principle [li]. If they do not understand principle, they will not be able to recognize the situation clearly. Then when they go to treat illness, they will vacillate and be indecisive, their medicines will not accord with the sickness, and it will be difficult to obtain an efficacious result.”²³ Those who claimed status as ruyi created for themselves a new lineage of texts, and vilified the old one that relied on transmission of knowledge from one person to another as a tainted heredity that could not discern patterns.

Which practice, practitioner, or idea is esteemed over others as “medical” is often a point of contestation between elite and popular texts. Complicating the situation, the knowledge and ability of literate medical amateurs overlapped with those of professional physicians, yet early modern observers clearly considered certain people to be doctors and others not.²⁴ Ms. Zhou, who consulted Flowers in the Mirror for a prescription, was a healer, and her nephew Lu Yitian was not a physician in the strict sense but a literate medical amateur, yet he claimed authority for himself by publishing medical texts. Moreover, that Ms. Zhou herself was a literate healer reflects an increasing access to textual medicine and the degree to which medical publishing incorporated popular methods of healing.²⁵ Popular medicine increasingly was communicated through published works as literacy rates increased and many medical texts in the late Ming–and Qing–contained useful medical knowledge. Before the late imperial period, most of these were books published by renowned physicians to engage their peers on topics of medical theory. These texts were reprinted in the great imperial collections and discussed by other famous physicians down through the centuries. They remained elite but were no longer the only textual sources of medical knowledge.

Medicine had been elite because of its written status, and the status of its practitioners, who were officials or scholar-physicians (yi, ruyi), was privileged over that of the “illiterate” healers—shamans, laymen, midwives, nuns, and countless others. In the Ming and Qing periods, that status was challenged, complicated, and subverted by all manner of printed texts propagating the kind of vernacular knowledge that had once been the purview primarily of medical outsiders.²⁶ Increasing literacy and the growth of printing gave many of these outsiders access to a panoply of medical texts. Clashing schools of thought, such as “warm-epidemic” and “cold-harm,” sought to draw more and more followers to their camp.²⁷ Part of that strategy included publishing texts that were accessible to a broader audience. Additionally, elite medicine was incorporating literary forms (narrative and dialogue) familiar to a less-elite readership and content useful for amateur practitioners (prescriptions, incantations, and therapies) previously eschewed by the literate medical tradition. Other kinds of printed texts contained practical and theoretical medical knowledge but were not primarily or explicitly concerned with medicine and healing, or did not advertise themselves as such. Vernacular knowledge of the body was thus expanding to include what had formerly been confined to elite medical texts.

Many of the “medical texts” that inform this study would not merit that term by historians of medicine. In this context, the term refers to texts that claim to be useful, true, or verified, as opposed to works that by virtue of their form (drama, libretto, etc.) or content (fantastic tales) are clearly meant to entertain but that also contain a great deal of medical knowledge. Most of the medical texts discussed here meet one or both of these criteria: they were produced for popular consumption (including, or particularly, texts that had commercial value), and they lent themselves to being used as guides for direct action by nonexperts, even if their intended audience included experts (e.g., “If you have this symptom, take this drug.”). “Vernacular” medical texts, like published medical case collections (yi’an), collections of medical recipes (fangshu), and pharmacopeia (bencao), are of primary interest, as these were appealing to a broader audience in late imperial China and often represent healing practices not found in elite medical texts—demonology, apotropaic medicine, sexual therapy, and so on.²⁸ These vernacular medical texts merit the designation because they were meant to be used and because every aspect of practice is represented there. Thus they, like fictional texts, are revealing in their depiction of how people thought about their bodies in relation to the world. From elite medical use of prescriptions to talismanic rituals to folk remedies to astrological prognostication, fiction and vernacular medical texts represent these practices and the varied beliefs that undergirded them.

Vernacular medicine encompasses many traditions, but one of them is usually characterized by historians of medicine as “magic.”²⁹ Some have discussed these magical medical beliefs as falling into two categories: homeopathic magic, in which linguistic or other resemblances give power to a treatment (walnuts nourish the brain because they look like little brains), and contact magic, in which a part stands for a whole (a fingernail or a hair can be used to steal the soul of the person from which they came). These medical concepts are not only similar to but dependent upon literary devices and figurative language such as metaphor and metonymy. I call these kinds of correspondences, upon which much vernacular medicine is based, “literary logic.”³⁰ Foundational medical texts such as the Systematic Materia Medica use literary logic as the basis of common sense. Ironically, practical medical texts also employ stories, particularly fantastic stories, as evidence for their claims of efficacy.

Clues to the way people read novels and other entertainment literature can be found in newspapers, published notebooks (biji), commentary, and other paratexts, and, importantly, in a treasure trove of hand-copied medical manuscripts from the nineteenth and early twentieth centuries by people who practiced medicine. These manuscripts are records of how people practiced medicine and how they read the variety of texts that fall under that rubric.³¹ They, like novels, practical medical texts, and other guidebooks, reflect a robust belief system of competing and complementary treatments, but they also reveal the degree to which literature was a part of those practices.