Category Archives: Series: Imperial Chinese Studies

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.

Human Milk as Medicine in Imperial China: Practice or Fantasy?

By He Bian

What does milk have in common with blood? According to Kou Zongshi (fl. 1110-1117), author of Bencao yanyi (Extended Interpretations on Materia Medica), they are basically the same vital fluid produced by the female body at two critical moments in a woman’s life. While the first menstrual period signifies the maturation of reproductive power, motherhood is the consummation of that power–miraculously causing the vital fluid to flow upward as milk. After nursing ends, the flow of milk again reverses back to blood, as evident from the return of the menses.

“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.
“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.

For centuries, Kou’s comment was repeatedly quoted as the dominant theory over lactation in the realm of learned medicine. It also coincides with parallel attempts to speculate on the metaphysical foundation of sex differences in women, and the consolidation of women’s medicine (fuke) and pediatrics (erke) as medical specialties.[1]

However, Kou’s original aim was to make sense of medical recipes. In particular, he was trying to figure out why do so many recipes for eye medicine use human milk to mix up powdered mineral drugs: a practice that has parallels in different cultural contexts. Since blood is essential for the five senses to function and human milk is essentially blood, Kou reasoned, this makes it an excellent medicine for eye diseases. Another recipe that may have been on his mind is the recommendation to drink “three portions of human milk” to help with obstructed menses. It makes sense if they were considered of the same origin. Like cures like.

Let’s pause here to consider what this means. Working with Chinese materia medica texts often means untangling different strands of thought, modes of compilation and miscellaneous quotations. The entry on each substance (e.g. human milk, renru or ruzhi) often begins with a learned survey of previous literature, including passages from classical literature and histories, and ends with a large (and often unwieldy) body of recipes. The problem is that the prescribed uses of the substances in the first part do not always sit well with the recipes, which are messy, opaque, and often outright strange.

In fact, Kou Zongshi’s work could be understood as a scholar-physician’s attempt to impose order and coherence on the unruly recipes, which were becoming increasingly available in print. [2] The incongruities and tension between theory and recipes, however, allows us to follow the intricate dance between empiricism and rationalism in such texts: when did authors equate recipes with real-life experiences, and when did they treat them as exemplars of theory and formulaic principles? When did book culture begin to shape the ways in which medicines were prepared, consumed, and invented?

Back to Kou Zongshi’s ingenious, if somewhat contrived, speculation over the nature of lactation. It did not seem to have caught much attention immediately. The twelfth and thirteenth centuries witnessed a growing suspicion among medical experts to discipline and curb wet nurses’ sway over childcare, and pediatric treatises abound with warnings against drunken, naughty wet nurses whose milk turns unwholesome to the infant.[3] Again, the female body’s power to nourish but also intoxicate with her transformed milk resonates with similar discourses discussed elsewhere on this blog; notably, alcoholic drinks were seen to be a bad thing that excites her passions, in contrast to ancient Roman recommendations.

In addition, the conquest of Mongols brought about increased consumption of cow and goat’s milk.[4] A leading physician active in the fourteenth century advised consuming those over human milk, which is easily “tainted with poisonous passions.” It looks like the arrival of more abundant dairy products would transform the existing pharmacopeia once and for all.

But not so simple. By the sixteenth century in China, human milk had become a “super food” of sorts, especially among elite families. Kou Zongshi’s dusty theory became a dominant trope, fanning the imagination of the female body as a machine of alchemical wonders, and her milk a sort of elixir that revitalizes the frail and depleted bodies. In the sixteenth-century encyclopedia Systematic Materia Medica (Bencao gangmu), Li Shizhen, the erudite naturalist and capable physician, criticized the excessive fetishizing of human milk. The prudent Li nevertheless included twelve “new recipes” that involve human milk as medicine. Li’s encyclopedia was first printed in 1596; soon after the turn of the century, dietary manuals began to teach people how to prepare dried milk powder at home, after collecting fresh milk from “strong women who just gave birth to boys”. Presumably, women sold their milk not as wet nurses, but directly to pharmacists (as depicted in the picture above).

So did people in imperial China consume human milk as medicine? Quite likely. But was it ubiquitous? Probably not. Recipes can be practical and fantastic, and theorists can explain and inspire. What matters is that human milk as medicine gradually came to be taken out of the context of nursing and acquired a more abstract quality as commodity.

[1] Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History: 960–1665 (Berkeley, CA: University of California Press, 1999).

[2] Asaf Goldschmidt, The Evolution of Chinese Medicine: Song Dynasty, 960-1200 (London ; New York: Routledge, 2009).

[3] Ping-Chen Hsiung, “To Nurse the Young: Breastfeeding and Infant Feeding in Late Imperial China,” Journal of Family History, 20, 3 (1995), pp. 217-38.

[4] Paul D. Buell, E.N. Anderson, and Charles Perry, A Soup for the Qan : Chinese Dietary Medicine of the Mongol Era as Seen in Hu Sihui’s Yinshan Zhengyao, 2nd Rev. and Expanded ed. (Leiden, The Netherlands: Brill, 2010).