Organized Medicine in Ming-Qing China: State and Private Medical Institutions in the Lower Yangzi Region

Vol. 8, No. 1 Late Imperial ChinaJune 1987 ORGANIZED MEDICINE IN MING-QING CHINA: STATE AND PRIVATE MEDICAL INSTITUTIONS IN THE LOWER YANGZI REGION Angela Ki Che Leung* Between the fourteenth and the nineteenth centuries the people of China, like those of Europe, experienced periodic outbreaks of epidemic disease, as well as a high rate of mortality from endemic smallpox, measles , influenza and dysentery-chronic killers in early modern society. Indeed, factors of urbanization and population growth facilitating serious public health problems from a wide variety of infections probably had been established in China well before the Ming dynasty. From the beginning of the imperial era, instances of epidemic were regularly reported to the throne by local officials as omens reflecting upon the state of the Heavenly Mandate. Denis Twitchett has shown us the close relation between pestilences and demographic decline in the Tang era.1 During the Yuan dynasty a sharp and mysterious drop in population occurred; some suspect that plague may have played an important role.2 Helen Dunstan, in her preliminary survey of late Ming epidemics, suggests that great human losses occurred at this time as well.3 In this situation, the idea of the state's responsibility in matters of public health benefited from the development of a "rational" classical medical system whose therapeutics was based on a sophisticated materia medica. Learned medicine, although it did not replace or even seriously challenge ritual healing and religious propitiation of the gods as popular means of I would like to thank Professor Charlotte Fürth for her generous encouragement and her valuable comments on this paper. Professors Jacques Gernet, Susan Naquin and Evelyn Rawski also attentively read earlier versions and gave me very helpful advice. All errors and shortcomings are purely mine. Parts of this research were done at the Harvard-Yenching Institute and the East Asian Studies Department of Princeton University in 1985-86. I wish to thank the above institutions as well as the Fulbright Foundation which financed my research stay in the U.S.A. 1 Twitchett, 1979. 2 McNeill, 1976:144, 168. We have no positive evidence for this hypothesis yet. 3 Dunstan, 1975. 134 Organized Medicine in Ming-Qing China135 combatting illness, supplied experts and strategies which could become the basis of "pragmatic" state policies. Such strategies became part of imperial social welfare responsibility in the Song. However, under the Ming dynasty this tradition of official activism in matters of public health atrophied. By the late Ming, the state had quite ceased to assume its traditional role of providing for health care as an aspect of the people's welfare. The present study focusses upon the evolution of health policy during the last two imperial dynasties, and the gradual replacement of state by private organization during the Ming-Qing transition. The lower Yangzi region, as the empire's cultural and economic pacesetter, is where this transition occurred first, and where it was most thoroughgoing. State Health Policy From the mid-Tang through the Mongol era, the imperial authorities periodically took an active role in initiating and maintaining public health institutions, not only in the capital but throughout the empire.4 Despite the rather scanty extant sources available to him, Naba Toshisada has given us an interesting description of official Tang medical policy.5 The publication and the free distribution of prescriptions were an important part of this effort. One collection of medical formulas recommended by the imperial court was the famous Guangli fang (Broadly Beneficial Prescriptions). These prescriptions together with officially-fixed prices of medicines were engraved on stones erected in public places, and it was decreed that the poor and sick should be able to obtain money from the national treasury to buy them. This publication of official prices was also designed to moderate the cost of medicines sold in private pharmacies . Arab and Persian merchants, who travelled widely in China in the ninth century, witnessed and reported on all these measures. Moreover, we know that charity infirmaries or sick wards existed under the Tang, originally under the sponsorship of Buddhist monasteries. When monastic institutions were nationalized after the imperial persecution of Buddhism in AD 845, the state assumed responsibility for the...