Yan Liu. Healing with Poisons: Potent Medicines in Medieval China. Seattle: University of Washington Press, 2021. Illustrations, tables, map. 276 pp. $99.00 (cloth), ISBN 978-0-295-74900-6; $30.00 (paper), ISBN 978-0-295-74899-3.
Reviewed by Xiaolin Duan (North Carolina State University)
Published on H-Sci-Med-Tech (August, 2022)
Commissioned by Penelope K. Hardy (University of Wisconsin-La Crosse)
Healing with Poisons: Potent Medicines in Medieval China offers a detailed pharmacological analysis of poisons in China from antiquity to the eleventh century, focusing on the medical understanding of poisons and the pharmaceutical principles underlying their use. This book covers two critical moments from the Han dynasty to Song China: the fifth and seventh centuries. By scrutinizing these two crucial moments in the history of Chinese pharmacology, Yan Liu unpacks the rich culture of drugs in medieval China. In particular, he situates the history of medicines within the broader context of Chinese political history, especially the state’s active engagement in medicine. Liu discusses two genres of historical documents: bencao (Materia medica) and fangshu (formula books). He also incorporates rich scholarship in Japanese, Chinese, and Western languages.
In the introduction, Liu points out that throughout Chinese history, the understanding and use of poison remained an integrated part of Chinese medical knowledge. He contrasts this with examples from colonial Indian and Western history. The rest of the book consists of three parts: "Malleable Medicines," "Knowledge, Authority, and Practice," and Enhancing the Body."
Part 1 follows a chronological order, covering Han, the Era of Division, Sui, and early Tang periods. Chapter 1 starts with a Han dynasty text to explain the ancient meaning of du, which describes threats posed by dangerous creatures in nature. This chapter explains how writings on the poison acotine provided both cosmological and political metaphors: just as everything in the cosmos contains yin and yang components, so du is both poison and medicine, and just as a skilled doctor recognizes the usefulness of this otherwise potent poison, so a wise ruler can recognize the value of diverse people in the world.
Chapter 2 discusses the relationships between nature and technology. The technical intervention was vital for transforming poisons into medicines. Liu introduces different steps of the pharmaceutical preparation of drugs, including drug dose management, combining, processing, and selling. Many of these steps, however, were separated from physicians over time. For instance, some people specialized in picking up herbs and operating drug stores. Physicians in the fifth and sixth centuries expressed increasing concern about their alienation from the activities of harvesting and preparing drugs and associated therapeutic knowledge.
Part 2 looks into the empire-wide production and dissemination of knowledge. In chapter 3, Liu examines using poison to treat poisoning (yi du gong du). He claims that the practice of poisoning highlights an ontological model that regards disease as a kind of entity that invades healthy people. Chapter 4 focuses on the intersection of the state and pharmaceutical practice in the Tang dynasty. The Tang court collected a set of potent drugs from across the empire through the tributary system, while also acquiring medicines and practices from local regions. Meanwhile, the common knowledge circulated in local regions was shaped by regional conditions and specific needs. The seventh to early eighth centuries witnessed an active engagement of the state in standardizing pharmaceutical knowledge and regulating medical practice. Chapter 5 explores famous physician Sun Simiao’s writing, which offers examples of interaction between text and practices. Liu points out that Sun promoted a new knowledge production model rooted in personal experience.
In part 3, chapter 6 focuses on the Five-Stone Powder, a controversial drug made from five mineral ingredients. The considerable difficulty involved in employing the drug safely provoked animated debates among physicians and scholars. Chapter 7 considers elixirs and alchemists' interpretation of drugs, extending the discussion of poisons to religious practice.
In conclusion, Liu reveals how the concept of poison was embodied in pharmaceutical techniques, political agendas, and religious aspirations. He proposes that there was a three-layer transformation in medical history: Chinese pharmacy has the transformative capacity, the knowledge of it was subject to transformation, and medicines could profoundly alter the body. He traces such a changing landscape of Chinese medicine by examining a diverse group of people practicing medicine and accumulating new drug knowledge.
This book shows a sensitivity to the material dimension of poisons, including growing, collecting, and making poison. The fluid materiality is in contrast to modern medicine. In the medieval Chinese case, medicines are fluid substances that do not fit into rigid categorizations such as good or bad, legal or illegal. No absolute essential core exists; everything is relative. Moreover, such fluid materiality was also demonstrated by the adaptivity of manuscript culture. Copying and circulating manuscripts about medical books before the Song dynasty led to a wide variety of regional writings that informed diverse practices.
This book offers a fresh view into the comparison between traditional Chinese medicine and contemporary pharmaceutical knowledge and practice. The blurred boundary between poison and medicine might be one thing that resonates between traditional Chinese and modern Western medicine. However, one difference between the two concerns the concept of side effects, which did not quite exist in Chinese medicine.
Furthermore, this book showcases the circulation and creation of knowledge in Middle Period China. For instance, the author discusses how therapeutic knowledge was affected by the separation between drug preparations and prescription and also by the court's engagement with local herbs and drug documentation. While discussing the state management of medical knowledge, Liu also shows that the rise of authorities and standardized medical knowledge occurred alongside its fluid transformations in distant regions. Middle Period China witnessed the simultaneous development of state standardization of local expertise and the local adaptation of centralized information within and beyond the field of medicine.
The discussion of medical information opens a new analytical space for understanding the spread of knowledge in Chinese history. As Liu argues at the end of the book, the documentation of medicine often revealed a complex relationship between the human self and the world. The accumulation, recording, and dissemination of knowledge about poison resulted from and also facilitated people's understanding of and interaction with the surrounding world. Poison was also applied to harness and control the world, as when people attempted to use elixir to achieve longevity or when the state collected and cultivated local herbs.
This book is crucial for people interested in medicine, religion, and political history; the development of these topics through the Song; and comparisons of traditional Chinese medicine to modern medicine. Chapters could also be assigned for graduate and undergraduate students in courses on premodern Chinese history and the history of medicine.
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Xiaolin Duan. Review of Liu, Yan, Healing with Poisons: Potent Medicines in Medieval China.
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