Tag Archives: Japan

Transmission of drug knowledge in medieval China: A case of Gelsemium

By Yan Liu

Figure 1. Illustration of gouwen (Gelsemium) in an early sixteenth-century materia medica text (Bencao pinhui jingyao, 1505). Image from Zhonghua dadian, ed. Zheng Jinsheng, 2008.
Figure 1. Illustration of gouwen (Gelsemium) in an early sixteenth-century materia medica text (Bencao pinhui jingyao, 1505). Image from Zhonghua dadian, ed. Zheng Jinsheng, 2008.

One striking feature of classical Chinese pharmacology is the abundant use of toxic substances. Prominent examples are aconite, arsenic, and bezoar. Fully aware of the toxicity, or du, of these materials, Chinese doctors developed a variety of methods to prepare and deploy them for therapy. How was such knowledge produced in traditional China? And how did it migrate from one space to another? Here I use several medical documents from the seventh century to explore these questions, focusing on gouwen 鈎吻 (Gelsemium), a toxic herb growing in southern China (Fig. 1).

The seventh century is a crucial moment in the history of Chinese medicine. The favorable political environment of early Tang dynasty (618-755) fostered the flourishing of medical ideas and the formation of a number of influential texts. One of them is the Newly Revised Materia Medica (Xinxiu bencao 新修本草, 659), the first state-sponsored pharmacopeia produced in China. Compiled by more than twenty court scholars, the text reflects the government’s effort to standardize medical knowledge. Gelsemium is one of the 850 drugs in the book (Fig. 2). Defined as warming, pungent, and highly toxic, the root of the herb could cure, among others, wounds inflicted by metal weapons ulcers, swelling, and convulsion. The authors also stressed the great danger of the herb by showing that drips squeezed from one or two leaves would suffice to kill a person. But not a goat. Quite the contrary, its sprouts could make the animal grow large. It must be, the authors mused, the case that everything in the world submits to something else.

Figure 2. The entry of gouwen (Gelsemium) in the Newly Revised Materia Medica (659). This copy of the text is from Dunhuang (P. 3714), dated to 667. Image courtesy of Bibliothèque nationale de France (Gallica).
Figure 2. The entry of gouwen (Gelsemium) in the Newly Revised Materia Medica (659).
This copy of the text is from Dunhuang (P. 3714), dated to 667. Image courtesy of Bibliothèque nationale de France (Gallica).

Gelsemium was also embraced by contemporary doctors. Sun Simiao 孫思邈 (?-682), one of the most famous doctors in Chinese history, incorporated the drug into his Essential Recipes of A Thousand Gold Worth (Qianjin yaofang 千金要方, mid-seventh century). The toxic herb appears in nineteen prescriptions in the text, primarily for topical treatment. In one case, Sun presented a recipe called “Ointment of Gelsemium” to treat toxic swelling, pain and numbness in the limbs, ulcers, weak feet, among other conditions. At the end, Sun warned: “This recipe should not be given to vulgar people. Be cautious.”

Why did Sun keep the recipe away from vulgar people, a term referring to commoners? Two possible reasons. First, handling Gelsemium was a delicate matter. Due to its high toxicity, any misuse of the herb could result in devastating, if not lethal, consequences. Commoners may not possess the proper knowledge of deploying the herb, hence they should refrain from taking this recipe. Second, because Gelsemium straddled medicine and poison, laymen might easily use it to harm others. By restricting its access, Sun tried to prevent such malicious misuse. Contemporary sources echoed Sun’s concern. According to an eighth-century statute of medical practice, private families were forbidden to possess Gelsemium. The government tightly controlled the access of the toxic herb to prevent it from falling into the wrong hands.

Figure 3. Gelsemium root preserved in the house of Shosoin in the Todaiji  Temple in Nara, dated to the eighth century. The roots are 0.5-2.0 cm in diameter and 17-24 cm in length. Image courtesy of the Imperial Household Agency website.
Figure 3. Gelsemium root preserved in the house of Shosoin in the Todaiji
Temple in Nara, dated to the eighth century. The roots are 0.5-2.0 cm in diameter and 17-24 cm in length. Image courtesy of the Imperial Household Agency website.

This begs the question whether the plant was actually used as a medicine. At the high level of the society, this is likely the case. The evidence came from a precious collection of medicines preserved in the Todaiji Temple in Nara , donated by the Empress Dowager Komyo in 756 as a gesture of benevolence. Because of the vibrant cultural interaction between China and Japan at the time, many drugs of Chinese origin travelled eastward. Gelsemium was one of them (Fig. 3). It is possible that the herb reached Japan as an item of exchange between the two imperial courts that appreciated its medicinal value.

Figure 4. Drug substitution in a seventh-century manuscript from Dunhuang (P. 3731). The recipe of the “Ointment of Illicium” is highlighted by the blue box. The arrow points to the note, written in small characters, that specifies the substitution of Phytolacca for Gelsemium. Image courtesy of Bibliothèque nationale de France (Gallica).
Figure 4. Drug substitution in a seventh-century manuscript from Dunhuang (P. 3731). The recipe of the “Ointment of Illicium” is highlighted by the blue box. The arrow points to the note, written in small characters, that specifies the substitution of Phytolacca for Gelsemium. Image courtesy of Bibliothèque nationale de France (Gallica).

In the local community, the situation is different. We get a clue from a seventh-century manuscript from Dunhuang, a town located in the far west of the Tang Empire on the Silk Road. The manuscript contains miscellaneous recipes, many for external application. One, called “Ointment of Illicium,” merits our attention (Fig. 4). It closely resembles Sun Simiao’s recipe that I showed above, but with an important variation: it doesn’t use Gelsemium. Underneath the ingredient Phytolacca (danglu 當陸), we find an explanation: “The original recipe uses Gelsemium. Nowadays it cannot be obtained, so one uses Phytolacca to replace it.” We can posit why this happened, given Gelsemium’s habitat in southern China, that is, far away from Dunhuang and its restricted access to commoners, as explained earlier. By contrast, Phytolacca was a local herb whose medical function substantially overlapped with that of Gelsemium, making it a reasonable substitute for the distant, unattainable plant.

This example of drug substitution is telling. Compared to social elites, lay people in local communities faced the challenge of limited medical resources. Consequently, they sought alternative options. The rise of authoritative texts at the imperial center thus went hand in hand with its fluid transformation as it moved in various geographical and social domains. Medical knowledge, upon transmission, was destabilized, begetting varied practices in society.

Was there a recipe for Korean ginseng?

By Daniel Trambaiolo

Ginseng_in_KoreaGinseng, one of the best known drugs of the East Asian herbal tradition, can be purchased today almost anywhere in the world, but in the early modern period its availability was much more limited. The roots of Panax ginseng could be harvested only from its natural ecological range, in a region stretching across Manchuria, Siberia, and the Korean peninsula. In countries like Japan, where doctors relied on Chinese styles of herbal therapy but did not have direct access to herbal drugs that grew only on the continent, the roots had to be imported at high cost.

The cost of Korean ginseng became a source of concern in Japan during the final years of the seventeenth century, as the need to pay for the drug contributed to a steady outflow of Japanese silver that was used to pay for foreign products. During the early eighteenth century, the Japanese shogunal government encouraged doctors and herbalists to develop a domestic substitute, either by finding a native plant with similar medicinal properties or by discovering a way to cultivate Korean ginseng plants on Japanese soil.

Panax ginseng did not grow natively in Japan, but the related species Panax japonicus appeared similar and promised to have similar medicinal properties. However, the roots of the native Japanese species had a distinctive segmented appearance that led to Japanese doctors calling it “bamboo-segment ginseng”; their flavour was also more bitter and less sweet than the imported Korean product–a concern for many doctors, who believed that flavor was closely related to therapeutic efficacy. Some drug sellers claimed to possess secret methods that could transform the native herb into an equivalent of the imported drug, but how could these claims be evaluated?

Korean doctors were one obvious source of authoritative information on ginseng, but it was difficult to discuss the matter with them because the shogunal government had enacted strict policies limiting the movement of foreigners into Japan. Among the rare exceptions were the Koreans who travelled to Japan on diplomatic missions. Starting in 1682, these missions included a “medical expert” (K. yangǔi, J. ryōi 良醫) whose functions were to provide medical care for the members of the embassy and to allow Japanese doctors the benefit of Korean medical knowledge.

"KoreanEmbassy1655KanoTounYasunobu" by I, PHGCOM. Licensed under CC 表示-継承 3.0 via ウィキメディア・コモンズ - http://commons.wikimedia.org/wiki/File:KoreanEmbassy1655KanoTounYasunobu.jpg#/media/File:KoreanEmbassy1655KanoTounYasunobu.jpg
An early modern Korean embassy to Japan.

Neither the Japanese nor the Koreans could speak each others’ languages, so they communicated by writing down questions and answers in classical Chinese, a form of conversation known as “brush talks” (K. p’ildam, J. hitsudan 筆談). The records of these conversations were often preserved in manuscripts or books printed for wider dissemination, and they can offer us insights into the styles of cross-cultural communication that these embassies facilitated–as well as into the ways Korean and Japanese doctors tried to derive benefits from each other without giving away too much in return.

The following exchange on ginseng took place between the Japanese doctor Kawamura Harutsune and the Korean doctor Cho Hwalam during the Korean embassy of 1748. (The translation is based on the published version of their conversations, which was distributed by the prominent Edo bookseller Suwaraya Mohei.)

Kawamura: In our country there is a type of ginseng whose stem, leaves, flowers and berries are just as described in the Materia Medica; its roots are similar in shape to what Zhang [Zhicong] calls “bamboo-segment ginseng.” It is very bitter in flavor and unsuitable for use, so people customarily boil it with licorice root or process it with honey water. But although the bitter flavor departs and a sweet flavor emerges, it is not the original flavor.

However, my father found a processing method that is quite acceptable; it does not rely on the flavors of other drugs, but the bitter flavor departs and a sweet flavor emerges. When my father consumed [imported] ginseng, he would always see blood in his phlegm. When he consumed the ginseng that he had processed himself, he would also see blood in his phlegm. Looking at it this way, is its efficacy similar to the ginseng from your country?

Cho: While I was in Osaka, I already heard people talk about your country’s ginseng. Although when you see the stem and leaves it looks similar, after tasting its flavor and inspecting its form it is clearly not genuine. You can perform all sorts of marvelous transformations to alter its bitter flavor, but how could you use it? There is no method for processing ginseng: you should use it just as it is naturally. Don’t be confused about this!

Kawamura: Your explanation is sufficient to dispel doubts. However, among several pounds of ginseng from your country, some roots have a burnt yellow color and seem to have undergone processing. Moreover, during [the embassy of] 1711 the Korean doctor Ki Tumun transmitted a processing method to a disciple of my grandfather. However, the paper has been eaten by insects and is now difficult to read. I will briefly write it down here, but I beg you to enlighten me further.

[Thereupon, he told me the method for processing ginseng. It is marvelous, and I have submitted it to the authorities. I do not record it here, but I have recorded it elsewhere and keep it in my home.]

Unfortunately, there are no surviving records of what Cho transmitted to Kawamura, so it is impossible to know whether it was a genuine recipe used by Koreans for processing ginseng or merely one he invented on the spot to deflect Kawamura’s questioning. Kawamura may have decided to omit the recipe from the published version of the brush talks in order to profit by selling ginseng processed according to a “secret Korean recipe.” However, his opportunities for doing so would probably have been quite limited. A few years before the meeting between Cho and Kawamura took place, a different group of Japanese herbalists succeeded in cultivating Korean ginseng from seedlings smuggled into Japan from Korea. As this new source of cultivated ginseng became commercially viable, the demand for “processed” ginseng dwindled rapidly and the recipes for such processing were gradually forgotten.

Seiseinyū and secrets: problems of recipe attribution in early modern Japan

In my last post, I looked at the problems faced by early modern Japanese doctors trying to figure out how to manufacture a new mercurial drug called seiseinyū, which had first appeared in the Chinese doctor Chen Sicheng’s Secret Record of Syphilis (1636). Yet although Japanese doctors eventually found ways to produce seiseinyū, the complicated movement of books and ideas between China, Europe and Japan during this period meant that even doctors who knew how to make the drug could be confused about where their recipes had come from.

The syphilis doctor Tokujitsu Junchoku, hero of Funakoshi Kinkai’s “Illustrated Syphilis War Tales” (Ehon baisō gundan, 1838). Courtesy of Waseda University Library.

One of the most detailed manuscript recipes for seiseinyū was written down in the late eighteenth century by a doctor called Haruhi Gen’an. Gen’an claimed this recipe had been passed down in his family since the time of his ancestor Haruhi Genryō, who in turn had received it from a Dutch doctor called “Seirukettan” in Nagasaki in 1711. Gen’an believed that the Dutch themselves were reluctant to share this secret recipe, and he took great pride in his lineage’s knowledge of it; imagine his surprise, then, when he discovered that Chen Sicheng’s Secret Record of Syphilis, which had recently been reprinted in Japan, contained a recipe identical to the one his family had for generations been treating as secret.

After some thought, Gen’an came up with an explanation for what had happened: just as his ancestor had learned the recipe from the Dutch doctor Seirukettan, the Chinese had also learned about the recipe from European visitors in the early seventeenth century, and Chen Sicheng had tried to pass the recipe off as his own. Indeed, it is curious to note that Chinese and European doctors started using mercurial drugs to treat syphilis quite soon after the disease’s arrival, and difficult to rule out the possibility that maritime contacts might have allowed one medical culture to learn the idea from the other. However, European and East Asian mercurial therapies for syphilis differed in their details, and it seems safer to conclude that they developed independently.

An army of antisyphilitic drugs defeats the syphilis demons. Funakoshi Kinkai, Illustrated Syphilis War Tales (1838). Courtesy of Waseda University Library.

But why did the Haruhi lineage attribute their seiseinyū recipe to the mysterious Dutch doctor “Seirukettan”? It isn’t possible to offer a definitive answer to this question, but a little background knowledge concerning the circulation and uses of medical texts in eighteenth-century East Asia is enough to suggest a plausible hypothesis.

Patients seeking treatment for syphilis tended to seek out specialists in “wound medicine” (yōka), a field that included the application of topical cures as well as surgical techniques. Eighteenth-century Japanese doctors were highly receptive to learning about European surgery and anatomy, which were much more developed than their East Asian counterparts at that time; it would thus be unsurprising for a Japanese practitioner of wound medicine to think of a cure for syphilis as more likely to be European than Chinese.

Nevertheless, Japanese practitioners of wound medicine would also have known about the Chinese surgical tradition and probably would have kept some classic Chinese treatises on surgery in their library. One such treatise was the Complete Book of Proven Remedies for Wounds and Ulcers (Chuangyang jingyan quanshu 瘡瘍經驗全書): the first edition of this book was produced in 1569, and an expanded edition published in 1717 included an additional chapter entitled “The Secret Record of Syphilis” – this was none other than Chen Sicheng’s book, incorporated into the new edition without attribution.

Early modern Japanese doctors often made their own manuscript copies of such medical treatises, especially if the only available printed versions were expensive editions imported through Nagasaki. Sections of multiple books could be copied into a single manuscript volume or a single book could be copied into several separate volumes; as a result, authorial attributions and the status of chapters as sections of larger works could easily become unclear. If something like this had happened to the Haruhi family’s copy of the Complete Book of Proven Remedies for Wounds and Ulcers, the original source of their recipe for seiseinyū could easily become forgotten, giving rise to a family legend that the recipe derived from a Dutch doctor in Nagasaki.

Syphilis and seiseinyū: manufacturing a mercurial drug in early modern Japan

絵本黴瘡軍談6
The Syphilis King consults with his minions prior to launching an invasion of the human body. Funakoshi Kinkai, “Illustrated Syphilis War Tales” (Ehon baisō gundan, 1838). Image courtesy of Waseda University Library.

Syphilis arrived in Japan in the early sixteenth century and spread rapidly through the country. The symptoms of the disease were severe but there was no truly effective treatment, and many patients thus turned in desperation to toxic substances such as corrosive sublimate (HgCl2, known in Japanese as keifun) in the hope that violent drugs might be able to expel the disease from their bodies.

A method for producing corrosive sublimate had been discovered by Chinese alchemists at least as early as the sixth century AD. The procedure involved mixing mercury, alum, and common salt into a paste and applying them to the base of a pottery vessel that was then sealed and heated over a fire while the lid was cooled with water. When the vessel was opened, the corrosive sublimate had condensed as small white crystals on the inner surface of the lid. The Japanese soon learned of and adopted this process, so by the time syphilis arrived in their country they had been manufacturing corrosive sublimate for nearly a thousand years.

Patients who consumed corrosive sublimate as a drug for syphilis would salivate and eventually suffer from suppuration of the mouth cavity. Doctors interpreted these effects as positive signs of the drug’s toxic efficacy, but the disease had an unfortunate tendency to return even after patients thought they had been cured, and there was a widespread desire for an improved formulation that might be able to cure the disease more permanently.

One such formulation was seiseinyū, a drug originally invented by the early seventeenth-century Chinese doctor Chen Sicheng. Chen had developed a large number of remedies making use of seiseinyū and published them in his book The Secret Record of Syphilis (Meichuang milu, 1636). This book was largely forgotten in China after his death, but a copy was brought to Japan and reprinted there, and it quickly became a standard reference for Japanese doctors who wished to treat syphilis using the latest Chinese methods.

Chen’s recipe for seiseinyū was similar to the standard recipe for corrosive sublimate, but it included a number of additional ingredients, the most prominent of which was an arsenical mineral called yoseki. Arsenical minerals were known to be highly toxic, but yoseki may have been included in the recipe for precisely this reason – either because doctors hoped that its toxicity would help expel the disease, or because they thought it might somehow balance the toxicity of the mercury in the recipe to yield a drug whose side effects were less severe than those of regular corrosive sublimate.

黴毒要方1
Illustration of a vessel for manufacturing corrosive sublimate and seiseinyū. Ishibashi Masaaki, “Essential Formulas for Syphilis” (Baidoku yōhō, 1810). Image courtesy of Waseda University Library.

Japanese doctors who wanted to make use of Chen Sicheng’s remedies needed to produce their own seiseinyū, but Chen’s description of his recipe was couched in unusual vocabulary that they often found difficult to interpret. Even a relatively common word like yoseki could lead to misunderstanding. In China, this word normally referred to arsenopyrite (FeAsS) or the related mineral loellingite (FeAs2); in Japan, however, this word was often understood to refer to arsenolite (As2O3), which was a common mineral obtained as a by-product from silver mines and sold commercially as “Iwami rat poison.” Many other variants of this mineral were available, ranging from a high-quality “peach-blossom” variety through yellow and white varieties to a low-quality grey variety; the choice among these varieties was thought to significantly effect the quality of the seiseinyū produced.

In contrast to the basic recipe, which was widely available in published form, these more subtle forms of manufacturing knowledge were usually passed down in secret by family lineages of doctors. It was not until the final decades of the eighteenth century that some doctors began to publish more straightforward popular accounts. In my next post, I will consider one of the more unusual consequences of this tradition of secrecy: that at least one lineage of doctors thought their family recipe for seiseinyū derived not from China, but from Europe.

Chinese and Japanese Names and Terms
J. keifun = C. qingfen 輕粉
J. seiseinyū = C. shengshengru 生生乳
J. yoseki = C. yushi 礜石
Chen Sicheng 陳司成
Meichuang milu 黴瘡秘錄
Funakoshi Kinkai 船越錦海
Ehon baisō gundan 絵本黴瘡軍談
Ishibashi Masaaki 石橋正炳
Baidoku yōhō 黴毒要方