Tag Archives: china

Fetch Me at Pearl Nest Street: Rhubarb Pills as Panacea in Qing China

He Bian

In the late eighteenth century, American ginseng opened up a new niche market in Qing China. At the same time, Chinese rhubarb (dahuang) roots, harvested from the northwest regions of the empire, were transported by Chinese traders all the way to the southeast coast and sold off to foreign customers in Canton (Figure 1). Part of these transactions took place in the Ryukyu Kingdom (present-day Okinawa Islands), a vassal state of the Qing but also an important node of global trade that crisscrossed the West Pacific. At some point in 1789, the Qing court issued an edict to the Ryukyu king that explicitly forbade him from selling rhubarb to Russians, with whom the Qing was then engaging in an all-out trade war. Rhubarb featured prominently in the Qing strategy because they believed that Europeans imported so much of this drug that they could not live a day without it.[1]

Figure 1. Chinese or Turkish rhubarb (Rheum palmatum): flowering and fruiting stem with leaf. Coloured zincograph after M. A. Burnett, c. 1842. Credit: Wellcome Collection, https://wellcomecollection.org/works/cvty3qqk
Figure 1. Chinese or Turkish rhubarb (Rheum palmatum): flowering and fruiting stem with leaf. Coloured zincograph after M. A. Burnett, c. 1842. Credit: Wellcome Collection, https://wellcomecollection.org/works/cvty3qqk

Yet is it really true that pharmacological visions in early modern China and Europe were so different that they could not possibly reach a consensus over rhubarb’s properties ? Classical Chinese pharmaceutical literature listed rhubarb as a drug with a “very cold” nature, and generations of physicians were taught not to use the cold drug in curing cold-natured diseases. This suggested that Russians (and other Westerners, as seen in this post on rhubarb in early modern England) had different bodies than the Qing Chinese, as they depended on rhubarb as an all-round cure. Pharmacological theories, in other words, engendered a vision of difference that seemed insurmountable.

During my recent reading of Qing medical recipe books, however, I discovered that rhubarb in fact functioned as nothing short of a panacea for Qing Chinese. This is evident in the text Bianyong liangfang (Excellent Recipes for Expedient Use), which appeared in the Jiaqing reign (1796-1820). Compact (only 2-juan in length) and very nicely printed (with carved woodblocks), it arranges pills, powders, tinctures, and decoctions by symptom. The book has about 120 pages, and most recipes are merely a few lines in length. What surprised me was that one very long recipe at the end of the text takes up the entirety of 13 pages. The remedy in question, mi shou Qingning wan (Secretly transmitted pill of purity and tranquility), calls for “several dozen pounds” of good quality rhubarb roots as the principal ingredient. Rubbed clean and steeped in rice water, the rhubarb was sliced, sun-dried, processed with “ash-less good rice liquor” for three days, and then put through a lengthy, elaborate protocol of fifteen rounds of steaming. Each steam involved a different set of herbs. Finally, makers took the resultant rhubarb paste, mixed it with “yellow ox milk” (using cooked honey as substitute if there was no milk), boy’s urine, ginger juice, and rolled it into tiny pills. The recipe listed hundreds of common illnesses that could be treated with this pill, ranging from headache and hemorrhage to gynecological disorders.

Figure 2. Luo Benli ed. Bian yong liang fang. Vol. 2b, p. 50b. c. 1796-1820. Princeton University Library. Downloadable PDF available at http://pudl.princeton.edu/objects/fn107159v
Figure 2. Luo Benli ed. Bian yong liang fang. Vol. 2b, p. 50b. c. 1796-1820. Princeton University Library. Downloadable PDF available at http://pudl.princeton.edu/objects/fn107159v

I have tried to look up this recipe in earlier Chinese medical texts, and my preliminary findings suggest that it probably came into existence no earlier than the seventeenth century. It became wildly popular in the eighteenth century, and recipe books serve as evidence of its widespread consumption. On the last page of Bianyong liangfang (Figure 2), the compiler, Luo Benli, announced that he had a batch of rhubarb pills prepared during his tenure in Guizhou – a southwestern province of China – and that, in case of emergency, readers could “call upon my house on Pearl Nest Street” and look for the “residence of Mr. Luo of the Ministry of Defense (bingbu Luo zhai).” Pearl Nest Street (zhuchaojie), a neighborhood in Qing Beijing not far from the Forbidden City, featured prime real estate. As a military official who had served in the frontier provinces, Luo was less bound by medical norms of the day and possessed the financial and political capital to manufacture elaborate pills like these. Was there, in other words, a sub-culture of health and medication championed by military elites such as Luo, which stood distinct from classical prescriptions?

One last word about this recipe that hints at a hidden connection between different cultural realms in early modern China: Sun Xingyan (1753-1818), a prominent scholar who combed through medieval sources for fragments of ancient texts, published the same recipe for Pill of Purity and Tranquility in his scholarly series. The inclusion of this Qing text alongside ancient monographs so bewildered modern bibliographers that they mistakenly attributed the recipe’s author to a seventh-century figure. In fact, Sun Xingyan made it clear that it was a contemporary remedy and provided an elaborate scholarly argument to defend rhubarb’s all-around efficacy to cure both hot and cold-natured illnesses. He also suggested that “vulgar physicians” despised the pill because if everyone had access to this remedy then their businesses would be lost. Therefore it does appear that, when it comes to rhubarb, Qing Chinese scholars and military commanders were no less enthusiastic than what they imagined about the Russians.

 

[1] I recommend this excellent essay by Chang Che-Chia (translated by Penelope Barrett) for more on this curious episode.

Fragrant Protection: Saffron in Medieval China

By Yan Liu

In 647, an emissary from Gapi, a kingdom in northern India, presented a plant called “yu gold aromatic” (yu jin xiang) to the court of Tang (618-907). The foreign herb flowered in the ninth month of the year, with the shape of a lotus. The color of the flowers was purplish blue, and their fragrance could be smelled over tens of paces.

This account comes from a tenth-century institutional history of Tang (Tang huiyao), in a section that reviews a list of plants and animals submitted by the foreign countries to the Tang. The event took place at a time when the Tang was ascending to a powerful and cosmopolitan empire, expanding its territory into Central Asia. As a result, the period witnessed a vibrant material exchange between China and India, Tibet, Persia (and from the mid-seventh century on, the Arabic empire), and even as far as Europe (see Edward Schafer’s classic work on this topic, also see an earlier post). Saliently, a wide array of foreign aromatics entered China, such as aloeswood and camphor from Southeast Asia, frankincense from India, and myrrh from Persia, which greatly enriched Chinese pharmacy.

What then is “yu gold aromatic”? Most likely, the name refers to saffron in medieval Chinese sources. “Gold” (jin) probably specifies the color of the flower, and “aromatic” (xiang) naturally points to its characteristic smell. Intriguingly, the word “yu” conjures up a fragrant herb in ancient China, which was used to scent ritual wine. Therefore, medieval Chinese writers took a familiar word from the past to name a foreign plant thereby readily integrating it into their own cultural terrain.

Not surprisingly, the earliest account of saffron in Chinese sources identifies the herb as a wine-scenting agent. According to a third-century text on natural history (Nanzhou yiwu zhi), saffron grew in Kashmir—still a major site of saffron production today—where local people offered its fresh flowers to Buddha whilst collecting the withered flowers to make fragrant wine. In the following centuries, saffron entered China either as a diplomatic gift (shown in the opening story) or as a commodity of trade. It was an expensive substance due to the intense labor involved in harvesting the three red stigmas of each flower. To obtain one pound of saffron, based on one estimation, seventy thousand flowers must be manually collected. This “circumstantial rarity,” to use Paul Freedman’s term, has made saffron one of the most costly spices in the world.

How was saffron used in medieval China? Noticeably, it became a powerful antidote. According to the eighth-century pharmacological work Supplement to Materia Medica (Bencao shiyi), saffron can dispel all types of noxious odors. Often mixed with other aromatics, it can eliminate malignant qi and demonic possession in the body. Later medical texts (Fig. 1) make it explicit that the fragrant plant can counter all poisons, highlighting its antidotal value.

Figure 1: Illustration of saffron in an early 16th-century pharmacological text (Bencao pinhui jingyao, 1505). Image from Zhonghua dadian, ed. Zheng Jinsheng, 2008

In addition, saffron appeared in Buddhist healing rituals. In a seventh-century scripture titled “Sutra of Golden Light,” we encounter a recipe of thirty-two aromatics (saffron included) that promises to cure all disorders and ward off adverse influences (Fig. 2). In particular, the recipe recommends that the aromatic mixture be employed to cleanse the body, with the following instruction: on the eighth day of the month, take an equal amount of each aromatic, pound and sift them, and collect the powder. Next, cast a spell on the powder for one hundred and eight times before adding it into water to wash the body. Situating drugs in a proper ritual—in this case an incantatory performance—was vital for their efficacy.

Figure 2: A recipe of thirty-two aromatics in the 7th-century Buddhist text Sutra of Golden Light. The purple box highlights saffron, written in both Chinese and Sanskrit names. Dunhuang manuscript S. 6107. Image courtesy of the International Dunhuang Project (British Library).

 

Given its strong scent, saffron was also used as a perfume in medieval China. The seventh-century medical work Essential Emergency Recipes Worth a Thousand in Gold (Beiji qianjin yaofang) by Sun Simiao, for example, offers a number of recipes to perfume clothes. One utilizes eighteen aromatics including frankincense, clove, aloeswood, musk, and saffron. Upon pounding into powder, they are mixed with boiled honey and jujube, and made into pills. Burning these pills creates vapor to scent clothes. Due to the high price of saffron at the time, it is conceivable that only the wealthy elites could afford such a perfume. Consistent with this, several Tang poems associate saffron with the sumptuous clothes of elite women. The scent of the exotic flower became a sign for patrician beauty.

Finally, I must say a few words about saffron as a spice in China. This is the primary function of the herb today, especially in Indian and Middle Eastern cuisine. It also constituted the chief use of the herb in medieval Europe, for enhancing the flavor and color of food. Yet the culinary use of saffron was minimal in medieval China; we have to wait until the 14th century, when China was under Mongol rule, to see the use of saffron as a spice, especially for preparing meat dishes. This practice, though, remained marginal in the following centuries. Today in China, saffron, curiously called “Tibetan Red Flower” (zang hong hua), is harnessed primarily as a medicine, not as a spice. Why? This is a fascinating puzzle that awaits further research, which invites us to ponder the untold journeys from smell to taste, from medicine to food, from the exotic to the familiar.

Storytelling and Practical Skills in Medical Recipes

By Ying Zhang

What constituted a medical recipe in late imperial China? Literati physicians often touted the efficacy of a medical formula by contending that it conforms to traditional order of the emperor and his officials. They might also praise the suitability of the drug combination for treating that individual body’s ills. (See discussion on drug knowledge in China elsewhere on this blog). While texts by literati physicians have attracted most scholarly attention, they might not contain some of the most widely circulated and used medical recipes in everyday settings. People in late imperial China had access to a wide range of vernacular texts to find a recipe for self-treatment. During this period, we see the circulation of many practice-oriented recipes through vernacular literature as well as personal networks. These sources included daily-use encyclopedias, almanacs, meritorious books, and fiction. These recipes functioned as a practical instruction for domestic use and a textual form that articulated practical health care knowledge through literary narratives. They highlighted the techniques of making medicine as an essential part of a medical recipe that non-expert could follow in their own homes.

The first page of the “Recipe from a bare-foot immortal for pills made with fish maw to help insemination.” Image credit: Berlin State Library.

One fascinating example which I’d like to bring to you today is the “Recipe from a bare-foot immortal for pills made with fish maw to help insemination,” which was collected and recorded in A Convenient Survey of Medical Recipes (Yifang bianlan), a manuscript written by a person with the sobriquet Gaoyangshi in the nineteenth century. This recipe presents a story at its beginning, which starts with the encounter in a certain famous mountain between an immortal and a sixty-one-year old men with the surname Zhou from Yunnan who has one wife and nine concubines but has been unable to conceive a child:

…[Zhou] talked about his family [with the immortal], saying that he does not have any children and asking for a good recipe. Moved by his sincerity, the immortal gave him a recipe. The medicine [made according to the recipe] has a character that is clearing but not cooling, warming but not heating. If men take it, [it] could strengthen the muscles and bones, invigorate the vitality, replenish the marrow, nourish the yin, and reinforce the primordial. If women take it, it could regulate the menstrual period, replenish the Blood, prevent miscarriage, regulate the qi, benefit the yin, and ease fertilization. Zhou bowed and received it [meaning the recipe] (bai er shou zhi), and refined and mixed [the medicine] according to the recipe (yi fang xiuhe)…

Following the story, the recipe lists the individual drugs required and, after each drug, it provides instructions on how to process it. For the chuan fuzi (Aconitum carmichalii Debx, Chinese aconite) from Sichuan, for instance, one needs to select the following:

Two pieces with each weighing four liang and five qian, cut off their sprouts and cut each of them into four pieces, soak them with raw gancao (Glycyrrhiza uralensis, Licorice) water for seven days, change the water every morning, and then cover them with half jin of wet flour, heat until cooked over a slow charcoal fire, cut them into pieces, and then heat to dry.

At the end of its drug list, the recipe summarizes, “to cook and make the listed drugs according to the [described] methods” (yi shang zhu yao ru fa paozhi). The word “paozhi” here refers to processing the drugs according to the methods listed under each drug. The recipe then continues with instructions on how to grind the drugs into powders and mix the powders into pills, and also explains the way to take the medicine.

It is interesting to note that the story at the beginning of the recipe uses the word “yi fang xiuhe,” a more general term referring to all of the work from processing individual drugs to mixing them together into pills. It suggests that the recipe worked well exactly because Mr. Zhou made the pills following all the technical details required by the recipe as a way of self-cultivation and demonstrated his piety in the making process. It was Mr. Zhou, not any physician or pharmacy, made the pills. The narrative episodes not only validated the efficacy by stating the mythical origin of the recipe, but also affirmed the efficacy by stating that this Mr. Zhou then had seven sons after taking the pills and lived to ninety-seven years old. They thereby presented the production of medicine as a personal endeavor that anyone could pursue. While the recipe exhibited a world of practical skills to handle medical substances and required utensils, the story advertised these specialized skills of drug processing as everyday household knowledge. The story also functioned to attract collectors through literary embellishment. This was especially desirable when recipes traveled out of medical contexts and became collectable artifacts in the context of literati sociability, connoisseurship, and moral practice. Recipes garnished with literary creation and moral teaching in this context usually encouraged its collectors to distribute it to more people to accumulate merit. Thus, when we exam the circulation and use of recipes out of medical context, we could find storytelling an essential part of medical recipes intended for household use.

Ying Zhang received her Ph.D. degree from Johns Hopkins University in 2017. Her dissertation titled “Household Healing: Rituals, Recipes, and Morals in Late Imperial China” investigates China’s rich tradition of household healing practices and reinterprets these practices in relation to religion, gender roles, and morality from the seventeenth to the early twentieth century. Drawing on a wide range of texts people used in their daily healing practices and texts about household healing, this research contributes to a deeper understanding of the heterogeneous health-related practices beyond the domain of learned medicine. It demonstrates the various ways in which the home served as a central site of healing technology in late imperial China. Through the study of the circulation of health related texts, it also sheds new light on the circulation of information in the context of literati sociability, philanthropic activities, and religious commitment in late imperial China. She can be reached at yzhang82@jhu.edu.

Pain, poison, and surgery in fourteenth-century China

Yi-Li Wu

It’s hard to set a compound fracture when the patient is in so much pain that he won’t let you touch him. For such situations, the Chinese doctor Wei Yilin (1277-1347) recommended giving the patient a dose of “numbing medicine” (ma yao).  This would make him “fall into a stupor,” after which the doctor could carry out the needed surgical procedures: “using a knife to cut open [flesh], or using scissors to cut away the sharp ends of bone.” Numbing medicine was also useful when extracting arrowheads from bones, Wei said, enabling the practitioner to “use iron tongs to pull it out, or use an auger to bore open [the bone] and thus extract it.” More generally, Wei recommended using numbing medicines for all fractures and dislocation, for it would allow the doctor to manipulate the patient’s body at will.

Wei’s preferred numbing medicine was “Wild Aconite Powder” (cao wu san), and he detailed the recipe in his influential compendium, Efficacious Formulas of a Hereditary Medical Family (Shiyi dexiao fang), completed in 1337 and printed by the Imperial Medical Academy of the Yuan dynasty (1271-1368). In his preface, Wei affirmed that medical formulas were the foundation of medicine and that a doctor’s ability to cure depended on his ability to use these tools skillfully. Wei’s family had practiced medicine for five generations, and he synthesized their knowledge with that of other doctors to produce a comprehensive treatise encompassing internal medicine; the diseases of women and children; eye diseases; illnesses of the mouth, teeth, and throat; ulcers and swellings; and diseases caused by invasions of “wind” (ailments with sudden onset, including febrile epidemics and paralytic strokes). Numbing medicine appeared in Wei’s chapters on bone setting and weapon wounds.

Wei’s Wild Aconite Powder is the earliest datable recipe that I have found for surgical anesthesia in a Chinese text, and it is a valuable window onto practices that were largely transmitted orally, whether in medical families or from master to disciple.  Dynastic histories relate that the legendary doctor Hua Tuo (110-207) employed a formula called mafeisan  to render his patients insensible prior to cutting them, even opening up their abdomens to excise rotting flesh and noxious accumulations. Some scholars have hypothesized that mafeisan (literally “hemp-boil-powder) may have contained morphine or cannabis (ma), but its ingredients remain a mystery.  A text attributed to the twelfth-century physician Dou Cai (ca. 1146) recommended using a mixture of powdered cannabis and datura flowers (shan qie zi, also called man tuo luo hua) to put patients to sleep prior to moxibustion treatments, which in this text could involve a hundred or more cones of burning mugwort placed directly on the patient’s skin.  Wei Yilin’s recipe provides important additional textual evidence for a tradition of anesthetic formulas based on toxic plants, one that was clearly in circulation long before he wrote it down.

At least as far back as the Divine Farmer’s Classic of Materia Medica (3rd c.), medical authors had described aconite as highly toxic (for contemporary Roman views of aconite, see blogpost by Molly Jones-Lewis). In the right hands, however, aconite was a powerful drug, and part of the Chinese practice of using poisons to cure (see blogpost by Yan Liu).  Warm and acrid, aconite could drive out pathogenic wind and cold from the body, break up stagnant accumulations, and invigorate the body’s vitalities. In the language of Chinese yin-yang cosmology, it nourished yang—all that was active, heating, external, and ascending. The main aconite root was considered more toxic than the subsidiary roots (designated by the separate name fu zi, “appended offspring”), and the wild form was more potent than the cultivated variety.

Images of toxic medicinal plants from China’s most celebrated pharmacological work, Li Shizhen (1518-93), Compendium of Materia Medica (author’s preface dated 1590). Woodblock edition of 1603. Wild aconite is the middle image in the top row. Cultivated aconite (main and subsidiary roots) are in the bottom right corner. Image credit: National Library of China. Posted on-line at the World Digital Library.
Images of toxic medicinal plants from China’s most celebrated pharmacological work, Li Shizhen (1518-93), Compendium of Materia Medica (author’s preface dated 1590). Woodblock edition of 1603. Wild aconite is the middle image in the top row. Cultivated aconite (main and subsidiary roots) are in the bottom right corner. Image credit: National Library of China. Posted on-line at the World Digital Library.

Wei’s numbing recipe consisted of 13 plant ingredients, including the main roots of both wild and cultivated (Sichuanese) aconite, along with drugs known as good for treating wounds:

Young fruit of the honey locust (zhu yao zao jiao)
Momordica seeds (mu bie zi)
Tripterygium (zi jin pi)
Dahurian angelica (bai zhi)
Pinellia (ban xia)
Lindera (wu yao)
Sichuanese lovage (chuan xiong)
Aralia (tu dang gui)
Sichuanese aconite (chuan wu)
Five taels each[1]

Star anise (bo shang hui xiang)
“Sit-grasp” plant (zuo ru), simmered in wine until hot
Wild aconite (cao wu)
Two taels each

Costus (mu xiang), three mace

Combine the above ingredients. Without pre-roasting, make into a powder. In all cases of crushed or broken or dislocated bones, use two mace, mixed into high quality red liquor.

Wei most likely learned this formula from his great-uncle Zimei, a specialist in bonesetting and wounds. Its local origins are also suggested by its use of zuo ru, literally “sit-grasp”, a toxic plant whose botanical identity is unclear. However, according to the eighteenth-century Gazetteer of Jiangxi (Jiangxi tong zhi), sit-grasp was native to Jiangxi, Wei’s home province, and was used by indigenes to treat injuries from blows and falls.  While classical pharmacology focused on the curative effects of aconite, Wei’s anesthetic relied on aconite’s ability to stupefy and numb, while curbing its ability to kill. If an initial dose failed to make the patient go under, Wei said, the doctor could carefully administer additional doses of wild aconite, sit-grasp herb and the datura flower.

Additional images of toxic medicinal plants from Li Shizhen, Compendium of Materia Medica. Sit-grasp herb is in the middle of the top row, and datura flower in the middle of the bottom. Image credit: National Library of China. Posted on-line at the World Digital Library.
Additional images of toxic medicinal plants from Li Shizhen, Compendium of Materia Medica. Sit-grasp herb is in the middle of the top row, and datura flower in the middle of the bottom. Image credit: National Library of China. Posted on-line at the World Digital Library.

In subsequent centuries, as medical texts proliferated, we find additional examples of numbing medicines that employed aconite, datura, and other toxic plants, employed when setting bones and draining abscesses, and to numb injured flesh before repairing tears and lacerations to ears, noses, lips, and scrotums.  Such manual and surgical therapies are an integral part of the history of healing in China.

Yi-Li Wu is a Center Associate of the Lieberthal-Rogel Center for Chinese Studies at the University of Michigan, Ann Arbor (US) and an affiliated researcher of EASTmedicine, University of Westminster, London (UK).  She earned a Ph.D. in history from Yale University and was previously a history professor at Albion College (USA) for 13 years.  Her publications include Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (University of California Press, 2010) and articles on medical illustration, forensic medicine, and Chinese views of Western anatomical science.  She is currently completing a book on the history of wound medicine in China.

Acknowledgements
This research was funded by the Wellcome Trust Medical Humanities Award “Beyond Tradition: Ways of Knowing and Styles of Practice in East Asian Medicines, 1000 to the present” (097918/Z/11/Z). I am also grateful to Lorraine Wilcox for directing me to the work of Dou Cai.

*****

[1] The weight of the tael (Ch. liang) has varied over time, but during Wei’s lifetime would have been equivalent to 40 grams.  A mace (Ch. qian) is one-tenth of a tael.