bubble_chart Description

After the establishment of the Song Dynasty, the Imperial Medical Bureau was initially set up following the previous dynasty's system and was renamed in the third year of Emperor Taizong's Chunhua era (992). In the fourth year of Emperor Renzong's Qingli era (1044), official medical education was formally established within the Imperial Medical Bureau. The scale of the Song Dynasty's Imperial Medical Bureau was somewhat smaller than that of the Tang Dynasty, with a greater emphasis on cultivating medical talents. It gradually developed into a place for medical students to study, similar to today's medical colleges.

The Imperial Medical Bureau initially belonged to the Court of Imperial Sacrifices. In the ninth year of Emperor Shenzong's Xining era (1076), it was no longer under the jurisdiction of the Court of Imperial Sacrifices. A commissioner and a judge were specially appointed, with the judge being someone knowledgeable in medical affairs. It was divided into nine departments, including large formula pulse, wind department, minor formula pulse, etc., with over 300 students at its peak. The Imperial Medical Bureau had officials such as commissioners and assistants, as well as teachers like professors and assistant professors. Assessments were divided into six categories: ink meaning, pulse meaning, great meaning, discussion of formulas, hypothetical cases, and luck. Various states and counties also had officials responsible for medical education, under the jurisdiction of the Imperial Medical Bureau. Additionally, the Imperial Medical Bureau had attached drug stores selling prepared medicines and drugs to the general public, later becoming independent institutions like the Medical and Drug Harmonization Bureau and the Medical and Drug Beneficence Bureau.

1. The separation of medical administration and medical education in the Song Dynasty made the Imperial Medical Bureau the highest national medical education institution, supplying the country with a large number of medical talents.

The Imperial Medical Bureau first strictly controlled the source of students, usually enrolling in the spring each year, stipulating that students must be over 15 years old, with a recommendation from a commanding officer, envoy, or a Hanlin medical officer. Students formed groups of three, acting as mutual guarantors, and could only obtain a provisional admission qualification after auditing for one year at the Imperial Medical Bureau. The so-called provisional admission qualification meant that students could not immediately start studying at the Imperial Medical Bureau, as each department had a fixed number of students. Only when a vacancy arose could students with provisional admission qualifications participate in the selection test for that department. The test consisted of essay questions, with examiners posing ten questions from the Nan Jing, Suwen, Zhubing Yuanhou Lun, Shennong Bencao Jing, etc. Answering more than five questions correctly was considered passing, and the Court of Imperial Sacrifices would issue a "diploma" for formal admission, allowing students to begin their studies at the Imperial Medical Bureau. The study period was one year, and graduation required passing an exam. Outstanding students could be selected to the Hanlin Medical Academy.

During the Song Dynasty, besides the Imperial Medical Bureau, which had a medical education institution (sometimes referred to as the Medical School), during Emperor Huizong's reign, to improve medical standards and the status of doctors, a "Medical School" was established at the Imperial Academy, modeled after the three-tier system of the Imperial College, specifically referred to as the "Medical School" in the Song Dynasty. In subsequent history, the Imperial Medical Bureau and the Medical School went through several periods of rise and decline, but most of the time they were cultivating medical talents for the Song Dynasty, gradually forming a comprehensive medical education system and a medical officer assessment system that integrated teaching and research, laying a good foundation for the development of medical education in the Jin and Yuan dynasties, and promoting the development of traditional Chinese medicine and the dissemination of medical knowledge.

The establishment of the Imperial Medical Bureau and the Medical School was a highlight in the history of medical education development in the Song Dynasty, but since they were both located in the capital, with limited spots, their service area was confined to the capital region, making it difficult to cover the local areas. Although the court often sent good doctors to provide relief in times of disaster or epidemic, this could only provide temporary relief. Most of the time, local doctors were actually "without any guidance," leading some remote people to seek help from shamans when they fell ill. In fact, throughout the Song Dynasty, the Song government continuously strived to improve the level of local medical education and healthcare.

2. The establishment of the Beneficence Bureau and the Harmonization Bureau had an impact on the Song Dynasty and later generations

(1) Contributions to contemporary healthcare

In 1076, the ninth year of the Xining era under Emperor Shenzong of the Song Dynasty, the Song government established an official medical bureau in the capital, Bianliang, called the "Imperial Medical Bureau Shouyao Suo," also known as the "Medicine Selling Bureau." This initiative was part of the reforms led by Wang Anshi, aimed at addressing the issue of counterfeit drugs being produced and sold at the time. The state monopolized the purchase and sale of medicines, prohibiting individuals or other departments from privately producing and selling drugs. The pricing of medicines was also differentiated: medicines were provided free of charge to extremely poor households, sold at low prices to the general poor, and sold at normal prices to the wealthy. This policy reflected the government's efforts to assist the poor and ensured the quality of medicines. After the failure of Wang Anshi's reforms, the Medicine Selling Bureau persisted and further developed, expanding to seven bureaus by 1103. In 1130, the Southern Song government reestablished the medical bureau in Lin'an, which was later renamed the "Taiping People's Welfare Bureau."

(2) Promoting the compilation of Taiping Huimin Heji Jufang In 1078, these government-run pharmacies compiled the prescriptions of their proprietary medicines into a book to standardize the quality of pharmaceutical production. After several revisions and additions, it became the Taiping Huimin Heji Jufang we see today. This book categorizes the formulas into 14 sections, including wind disorders, cold-damage diseases, qi disorders, phlegm-fluid retention, deficiency disorders, chronic cold, accumulated heat, diarrhea, eye diseases, throat and oral diseases, Zabing, sores and swellings, fractures, women's diseases, and children's diseases, totaling over 700 formulas. Many of these are commonly used folk prescriptions with significant effects, such as Supreme Treasured Pill, Bovine Bezoar Heart-Clearing Pill, Styrax Pill, Purple Snow Bolus, Four Ingredients Decoction, Peripatetic Powder, and Patchouli Qi-Righting Powder, which are still in use today.

(3) Influence on Chinese medicinals processing of materia medica

The Taiping People's Welfare Bureau, building on previous experience, standardized the processing of materia medica and preparation methods during pharmaceutical production. In its formulary Taiping Huimin Heji Jufang, the processing methods are more advanced and comprehensive than those in Leigong Paozhi Lun. Starting from Taiping Huimin Heji Jufang, the processing methods for Chinese medicinal decoction pieces were established as legal pharmaceutical standards. From the Song Dynasty onwards, the purpose of "processing" shifted from merely reducing toxicity to becoming an integral part of pharmaceutical production. This reflects the transformation in the purpose of processing, the expansion of its scope, and the rapid advancement of processing techniques. Taiping Huimin Heji Jufang documents the processing methods for 187 Chinese medicinals, forming general processing principles equivalent to modern pharmacopoeias, with strong authority. For example, Taiping Huimin Heji Jufang specifies the processing methods for Pinellia and Arisaema in the appendix "On Processing Three Categories of Medicinal Stones." It states, "For Pinellia, first soak in boiling water, then wash off the slime when warm, repeating this seven times before use. For decoctions, slice and use whole. If it still irritates the throat, grind it into powder, mix with an equal amount of Fresh Ginger Rhizome, knead into a paste, let it sit overnight, shape into cakes, and dry. Grinding it again into powder and mixing with ginger paste, then drying, yields an even better result, ideal for decoctions." For Arisaema, it specifies, "Process by cracking in hot ash before medicinal use. Other methods may be applied as per specific formulas," covering 11 processing methods.

(4) Influence on later medical thought

The compilation of Taiping Huimin Heji Jufang advanced the development of Chinese medical formulas, enabling doctors to select appropriate proprietary medicines based on patients' conditions. These medicines were easy to store, carry, and widely applicable, and their official endorsement gave them strong authority, making them popular among doctors and patients at the time. As Zhu Dan-xi noted in his commentary on Taiping Huimin Heji Jufang: "The book Hejiju Fang allows one to check formulas against symptoms and use them directly, eliminating the need for a doctor or preparation, as ready-made pills and powders can be purchased to cure diseases." However, Zhu Dan-xi also pointed out: "From the Song Dynasty to the present, the government has upheld it as law, the medical profession has passed it down as practice, patients rely on it for survival, and society has adopted it as custom." "Now, collecting past effective formulas to treat modern limitless diseases is like carving a boat to seek a sword or looking for a horse with a picture—hoping for a chance success is difficult!" This reflects certain issues: doctors at the time followed the Taiping Huimin Heji Jufang rigidly, adhering to established methods without innovation, leading to a trend of neglecting disease origins and overusing warm tonics and aromatic stimulants, as well as a lack of emphasis on syndrome differentiation and treatment. Zhu Dan-xi of the Yuan Dynasty believed that some formulas contained pungent and drying ingredients that harmed yin and blood, making them unsuitable for yin deficiency. This contributed to his academic theory of "excess yang and insufficient yin." While the proprietary medicine formulary Taiping Huimin Heji Jufang had its flaws, it also played a role in advancing the "nourishing yin" school during the Jin-Yuan period.