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The so-called "trace" is what the foot leaves behind, but it is not the foot itself; "writing" is what the sage creates, but it is not the sage.

——Baopuzi‧Dispelling Doubts

　　　　　　　　　　　　　　　　I.

　　Last summer (2002), I visited the School of Basic Medical Sciences at Beijing University of Chinese Medicine, carrying a long-standing question: Why is it necessary to read classical texts in the process of Chinese medicine education? When I posed this question to a professor at the university, he retorted, "Who said Chinese medicine must study classical texts? Reading this textbook is enough." He showed me Yin Huihe's "Basic Theory of Chinese Medicine" [2]. However, when I asked another professor the same question, he said that classical education is, of course, the foundation of Chinese medicine; the quality of modern textbooks is getting worse and not worth reading. Then, this professor gave me several recent debate articles titled "Save Chinese Medicine" and urged me to study them carefully.
　　The content of these debates is quite shocking. The reports cited representative senior Chinese medicine practitioners and researchers from the mainland, who launched extremely fierce attacks on the current state and educational methods of Chinese medicine. These articles include "Will There Still Be Chinese Medicine in a Hundred Years?", "Where is the Root of the Disease in Chinese Medicine, Which is Deeply Ill?", and "Is There Still a Cure for Chinese Medicine?" [3]. From these titles, it is not difficult to imagine the sense of crisis in Chinese medicine; compared to the past suppression of Chinese medicine by political forces, this wave of criticism comes from within Chinese medicine itself. One of the self-rescue policies proposed at the end of the debate is: "Strengthen the status and role of Chinese medicine classics."
　　The vast number of traditional Chinese medical texts is a noteworthy historical phenomenon. In fact, although there have been many studies on the history of Chinese medicine in the past, involving different fields, the most significant achievements have been concentrated in areas such as literature compilation [4]. Strictly speaking, this is about managing medical books rather than managing history. These outstanding scholars are particularly concerned with the issues of traditional bibliography, such as the transmission and versions of texts. I believe that the focus of future research should be on how Chinese medical texts were copied, read, and re-taught over the long course of history.
　　I am particularly interested in the history of the formation of the "canon" in ancient medicine. The so-called canon refers to the exemplary texts of a discipline. Although the literature of Chinese medicine is vast and numerous, there are only a few essential texts (such as the Neijing) that serve as norms and authorities for the medical community; the process of their production, maintenance, and change involves the role of books in establishing the professional identity of disciplinary members, defining disciplinary boundaries, and establishing academic traditions [5].
　　In fact, not all medical traditions rely on texts. For example, witchcraft and ritualistic medicine rely more on symbolic language and actions in practice [6]. The medical practices of the witchcraft lineage have not left behind systematic texts. Medical traditions that rely on texts do not necessarily produce canons, such as the texts on immortals and sexual practices from the Neijing era, which have mostly been lost over time [7].Chinese medicine not only has texts and canons, but all fundamental texts were formed before the 3rd century AD, such as the Neijing, Nan Jing, Shennong Bencao Jing, and the "Treatise on Cold Damage Diseases." In other words, while Chinese medicine emphasizes oral instruction and demonstration by teachers, it also underscores the necessity of ancient texts in the transmission of knowledge.
Below, I will first analyze the significance of the book-receiving rituals in the Shiji‧Bian Que Canggong Liezhuan and the current version of the Huangdi Neijing; secondly, discuss the intellectual context of the "entrustment" in medical texts; and finally, explore the reasons for the decline of book-receiving rituals during the Han and Wei periods. I hope to elucidate the core issues in the history of Chinese medicine through several independent yet interrelated conceptual groups.


　　　　　　　　　　　　　　　　II、

Medical knowledge in the pre-Qin period was mainly preserved in government institutions. As clearly stated in the "Han Zhi‧Fang Ji Lue," "Fang Ji are tools for life preservation, one of the duties of the royal officials." The medical activities of the government at that time are slightly reflected in books such as the "Zuo Zhuan" and "Zhou Li" [8]. Among them, the "Zhou Li" records cases where the royal physician failed to cure and resulted in death [9]. However, medical texts were largely the product of private learning among the populace from the Warring States period onward. This is specifically manifested in the knowledge transmission process between Chang Sang Jun, Bian Que, and Chun-yu Yi. The most notable concept of this period is the "forbidden prescriptions" or "forbidden prescription books."
The term "forbidden" implies secrecy and carries a shamanistic connotation. In terms of the transmission of medical knowledge, it was not directly passed from master to disciple. Chang Sang Jun observed Bian Que for over a decade and privately told him, "I have forbidden prescriptions, and as I am old, I wish to pass them on to you. You must not disclose them." Bian Que replied, "I respectfully agree." Thereupon, Chang Sang Jun gave his hidden forbidden prescription books to Bian Que and then disappeared [10]. What is particularly noteworthy here is the central role of books in the knowledge transmission process and the prohibition of "non-disclosure" in the book-receiving ritual.
The form of knowledge transmission involving the granting of "forbidden prescription books" is also seen between Chun-yu Yi and his disciples. Chun-yu Yi primarily studied medicine under Gongsun (SP4) Guang and Yang Qing. Gongsun (SP4) Guang possessed "ancient transmitted prescriptions," and Chun-yu Yi "received prescriptions, transformed yin-yang, and learned verbal methods." Besides receiving Gongsun (SP4) Guang's medical prescription books, Chun-yu Yi also personally absorbed his oral teachings on empirical methods. Gongsun (SP4) Guang warned Chun-yu Yi, "These are the marvelous prescriptions I received in my youth, I give them all to you, do not teach them to others." Chun-yu Yi replied, "It is my great fortune to serve you and receive all the forbidden prescriptions. I would rather die than recklessly pass them on to others." Here again, there is a prohibition against disciples recklessly transmitting or disclosing the prescriptions.
Later, through Gongsun (SP4) Guang's recommendation, Chun-yu Yi became a disciple of Yang Qing and studied medicine with him for three years. Yang Qing instructed Chun-yu Yi to "discard all his old prescriptions and instead receive all the forbidden prescriptions, transmitting the pulse books of Huangdi and Bian Que." The master-disciple relationship was established through the receiving of books. The books Chun-yu Yi received from Yang Qing included: "Pulse Books: Upper and Lower Classics," "Wuse Diagnosis," "Qi Ke Techniques," "Kui Du," "Yin-Yang External Transformations," "Discourse on Medicine," "Stone Deities," and "Connecting Yin-Yang Forbidden Books," among others, which he "received, read, interpreted, and verified." That is, the transmission of medical knowledge involved several related steps: (1) receiving books; (2) reading; (3) interpreting and understanding; (4) experiencing and verifying. Here, the owner of the texts also played the role of text interpreter and experience transmitter.
Moreover, Chun-yu Yi's medical records (booklets recording diagnoses) primarily based disease diagnosis on citations from texts and teachings of masters.As in the case of the illness of the royal physician Sui of Qi, "This is what is called the general principle of discussion, which must have its rules and essentials. A clumsy physician who fails to master even one aspect will find the logic and yin-yang principles confused" (ancient medical theories could only grasp the general situation, and physicians must grasp its principles and essentials. Mediocre physicians who fail to observe even one aspect will find their reasoning disordered and yin-yang unclear). Another example is the case of the illness of the former King of Qi, who had yang deficiency, "When diagnosing, I could not understand its meridian explanation, only roughly identifying the location of the disease" (When I diagnosed him, I did not know how to use meridian theory to explain this disease, only roughly identifying the location of the disease). In other words, Chunyu Yi's case records heavily relied on existing "discussions" or "meridian explanations" and other texts.
The aforementioned processes of medical transmission are: receiving books, reciting, understanding, and verifying; medicine is indeed primarily based on experience, and practical experience is especially indispensable, but the texts themselves are also a manifestation of medical experience, and reciting the insights of ancient texts is a necessary process in learning medicine. The chapter "Jinfu" in the Lingshu can be seen as echoing this point.
The "prohibition" in "Jinfu" is the same as the "prohibition" in "prohibited formulas," meaning secrecy; "fu" means to follow and adhere to the teacher's teachings. In this chapter, Huangdi appears as a teacher, and Leigong receives his teachings:
Leigong asked Huangdi: I have received your teachings and have mastered the sixty chapters of the "Nine Needles," diligently practicing them day and night. The recent ones
have worn out their bindings, the older ones have become soiled, yet I still recite them without ceasing, but I have not fully understood their meaning. The "Waichuai" says "to bundle the whole into one,"
but I do not know what this means. The great has no outside, the small has no inside, the great and small have no limits, the high and low have no measure, how can they be bundled?
The talents of scholars may vary, their wisdom may be shallow, unable to grasp the profound and deep, but if they strive in learning like me, I
fear that it will be scattered in later generations, lost to descendants, dare I ask how to condense it? Huangdi said: A good question indeed. This is what the former teachers
prohibited, to sit and privately transmit it, it is a covenant sealed with blood, if you wish to obtain it, why not fast? Leigong
bowed twice and rose, saying: I beg to hear the command of the king. Then he fasted for three days and asked: Dare I ask, today is the full sun, I wish to
receive the covenant. Huangdi then entered the fasting chamber with him, and they cut their arms and sealed the covenant with blood. Huangdi personally prayed: Today is the full sun, we seal the covenant with blood to transmit the formula, anyone who dares to betray these words will suffer the consequences. Leigong bowed twice and said: I receive it. Huangdi then took his left hand,
and with his right hand gave him the book, saying: Be careful, be careful, I will speak for you. The principle of all acupuncture begins with the meridians, to manage their paths,
to know their measures, to internally needle the five organs, to externally needle the six viscera, to truly observe Weiqi, the mother of all diseases, to regulate their deficiency and excess, deficiency and excess
will cease, to drain their blood vessels, when the blood is exhausted, there will be no danger. Leigong said: This is all what I have mastered, but I do not know how to condense it
Huangdi said: To condense a formula is like tying a bag, if the bag is full and not tied, it will spill, if the formula is complete and not condensed, then
the spirit will not be with it. Leigong said: I wish for those of lesser talent, not to fill but to condense it. Huangdi said: To know how to condense before it is full is to be a craftsman, but not to be a teacher of the world. Leigong said: I wish to hear about being a craftsman.
What is particularly noteworthy is the role of "recitation" in the process of learning medicine. "Feng" is to memorize; "song" is to read the scriptures with rhythm. Today's teaching mainly focuses on understanding, often overlooking the ancient learning process of memorization and recitation. Most of the Neijing is in dialogue form, and many dialogues are layered explanations of existing theories
[11]
. The Nan Jing is even more formatted in a question-and-answer style; the "question" part is mostly based on existing theories [12].
Furthermore, because Leigong did not understand the core theme of the "Nine Needles," there was a second ceremony of book transmission. Leigong received the alliance and transmitted the methods, and a blood oath ceremony was held in the fasting chamber. The hidden text Benjing obtained this transmission through this ritual. As mentioned above, Huangdi granted the book and provided explanations, and those who mastered the texts were also the transmitters of interpretation and experience. In other words, books, teachers, and experience were unified.
Interestingly, in the above text, the debate between Leigong and Huangdi about "fullness" and "conciseness" refers to the difference between erudition (mainly through reciting ancient texts) and simplicity, or grasping the essentials. Huangdi believed that "knowing conciseness without fullness" could only make one an ordinary craftsman, not a master of heavenly purgation. Leigong, however, responded, "I wish to hear about being a craftsman."
The transmission of ancient Chinese medical knowledge, referred to by Xiao Guan as the "period of specialized transmission" [13], was mainly preserved in government offices during the pre-Qin period, with a hereditary and secretive nature. After the Warring States period, folk itinerant doctors emerged, transmitting medical knowledge through book-receiving ceremonies. As stated in the Neijing, it was "following the classics to receive teachings" [14] and "receiving techniques and reciting books" [15], meaning that after personally receiving the books, one would practice medical techniques through reciting the texts. The Suwen-Jiejingwei Lun chapter also states, "I receive the teachings you pass on to me and teach others based on the content of the classics." In contrast to the emphasis on enlightened masters in practices like immortality and bedroom arts [16], and the focus on language and performance in ritualistic healing like Zhuyou, Chinese medicine is "text-centered." Texts like the Neijing and Nan Jing, though not yet considered "classics" in the Han dynasty, undoubtedly held the meaning of "canon" or "standard" under the concept of orthodoxy. These texts served a "communally regulative function."


　　　　　　　　　　　　　　　　III.

The authority of ancient medical knowledge transmission was not based on the teacher themselves but relied on ancient "sages," as mentioned in the Lingshu-Jinfu: "This is what the ancient masters forbade." Chun-yu Yi also attributed pulse techniques to "ancient sages" [17]. In other words, ancient medical texts were not only records of practical experience but also the words of sages.
The "attribution" form of ancient medical texts originated from the "Creation Chapter" of the Shiben. The term "shi" refers to lineage, tracing bloodline inheritance and clan origins. The "Creation Chapter" describes ancient inventions and creations, such as attributing medicine to Wupeng and pharmacology to Shennong [18]. However, during the Warring States and Qin-Han periods, the sages attributed to in medical texts were primarily Huangdi, reflecting the same cultural context as the emergence of a series of "Huangdi texts" at the time [19].The image of the sage in the current version of the Neijing is actually the archetype of the sage in the Huang-Lao thought:
　　　The sage engages in non-action, delights in the ability of tranquility, follows desires and satisfies aspirations in the emptiness of nothingness, thus achieving infinite lifespan, ending with the heavens
　　　and earth. This is the sage's way of governing the body[20].
The technique of non-action in the Huang-Lao thought during the Warring States and early Han periods has two aspects: governing the state and governing the body. In this regard, the content of medical texts and Daoist texts often complement each other, hence the book of Laozi can often be understood in terms of health preservation and medical techniques[21].
　　　It is particularly noteworthy that the concept of the sage in the Qin and Han eras has two meanings: one refers to the emperor or ruler himself, as stated in the Mozi·Tianzhi Xia: "He is placed in the highest position, established as the emperor to be the law, and is called the sage," or as in the Da Dai Liji·Gaozhi: "Those who governed the world in ancient times must be sages." Additionally, the sage refers to the teacher of the king, as in Laozi's "those who assist the ruler with the Dao." The Huangdi Sijing·Cheng states: "The emperor's ministers are named ministers, but in reality, they are teachers."[22] The medical texts of the Han dynasty, relying on the dialogues between Huangdi and his ministers, reflect the close relationship between the Dao and techniques:
　　　Huangdi sat with his nose, summoned Leigong and asked him: Do you know the way of medicine? Leigong replied: I have recited it but
　　　have not yet understood it, understood it but not yet distinguished it, distinguished it but not yet clarified it, clarified it but not yet manifested it. It is sufficient to govern the officials, but not sufficient
　　　to reach the feudal lords and kings. I wish to receive the measure of the heavens, the harmony of the four seasons and yin-yang, to distinguish the stars and the light of the sun and moon (GB24), to
　　　manifest the medical techniques, to make them clearer for future generations, to connect with Shennong, to establish the ultimate teaching, and to question the two emperors. The Emperor said: Good! Do not lose it,
　　　this is all about the correspondence of yin-yang, the exterior and interior, the upper and lower, the male and female, and the way of knowing the heavens above, the earth below, and human affairs in between,
　　　which can last long, to teach the masses, and also not to doubt or be in danger. The medical way discussed in the chapters can be passed on to future generations and can be considered a treasure. Leigong
　　　said: Please teach me the Dao, I will recite and understand it[23].
The above text reflects the sage's governance of the state, the human body, and the natural order through the order of resonance. The entire Neijing is a layered derivation of the medical way within the framework of dialogues between sages.
　　　However, what is more intriguing is why medical texts adopt the form of dialogues between sages? Since the Warring States period, the writings of various philosophers and the compositions of poets often assumed the names of hosts and guests, engaging in mutual exchanges. The Neijing's dialogues between Huangdi and his ministers also use this form of dialogue for teaching. However, learning has stages, progressing from the entrance to the inner chamber, following order and sequence. The process of receiving texts, reciting, understanding, and verifying mentioned above reflects the characteristic of knowledge transmission that it is passed on to the right person and not taught to the wrong person. That is, receiving instruction does not necessarily mean mastering it, and mastering it does not necessarily mean fully inheriting the tradition. The Suwen-Qixue Lun chapter mentions the concept of "the sage is easy to speak to":
　　　Huangdi asked: I have heard of the 365 acupoints (KI13) corresponding to a year, but I do not know their locations, I wish to hear about them in detail. Qibo
　　　kowtowed and replied: What a difficult question! If not for a sage emperor, who could exhaust its principles! Therefore, I ask to express my thoughts fully and speak of their
　　　locations. The Emperor clasped his hands and retreated, saying: Your opening of the Dao for me, though my eyes have not seen its locations, my ears have not heard its numbers, yet
　　　my eyes have become clear, and my ears have become sharp. Qibo said: This is what is called the sage is easy to speak to, and a good horse is easy to control.
The above text emphasizes the difficulty of comprehending the medical path, stating, "If not for the sage emperors, who could fully understand its principles?" However, sages easily grasp and accept the profound medical theories. The "Lüshi Chunqiu: Stuttering Chapter" mentions, "The sage listens to the soundless," and the Mawangdui silk manuscript "Five Elements Chapter" also states, "To hear and know is the mark of a sage." [24] Sages possess a unique talent to hear what others cannot. Therefore, the prohibition against teaching is not about non-transmission or refusal to teach, but rather about teaching only the right person.
Students also hold a respectful attitude toward their teachers' explanations and related texts. The "Lingshu: Yinyang Ershiwu Ren" states: "Qibo said, 'What a thorough question! This is the secret of our predecessors. Even Bogao could not fully understand it.' Huangdi rose from his seat, bowed, and said, 'I have heard that failing to teach the right person is a grave loss, and revealing it to the unworthy will incur heaven's displeasure. I wish to understand it, store it in the golden cabinet, and dare not publicize it.'" Medical principles are passed down and preserved through the dialogues of sages. The "Neijing" repeatedly emphasizes prohibitions such as "dare not reveal," "dare not disclose," and "dare not show" without proper purification [25]. Secret texts are reserved for those with special insight and are not made public, a stance quite different from the Confucian attitude toward texts.
Exemplary texts like the "Neijing" and "Nan Jing" not only convey practical medical knowledge but also define the core conceptual categories of the discipline, limiting the scope of major questions. For example, they address qi, pulse, yin-yang and the five phases, as well as related concepts like zang-fu, exterior-interior, deficiency and excess, tonification and purgation, and so on [26]. Xu Fuguan said, "Strictly speaking, without understanding the Han dynasty, one cannot thoroughly understand modern times." [27] This statement also applies to the development of Chinese medical thought. In essence, the academic tradition of Chinese medicine derives from the cultural classification concepts found in a few exemplary texts.
Furthermore, the practice of "yituo" (依托) not only explains the transmission of medical techniques but also serves to establish a lineage of scholarly tradition. For example, the lineage of the "Nan Jing" as described by Tang dynasty's Wang Bo:
"The 'Huangdi Bashiyi Nan Jing' is the secret record of medical classics. In ancient times, Qibo passed it to Huangdi, who then passed it through nine teachers to Yi Yin. Yi Yin passed it to Tang, who transmitted it through six teachers to Taigong. Taigong passed it to King Wen, who transmitted it through nine teachers to Yi He. Yi He passed it through six teachers to Qin Yue-ren, who first established the chapters and verses. Qin Yue-ren transmitted it through nine teachers to Hua Tuo, who passed it through six teachers to Huang Gong. Huang Gong then passed it to Master Cao. Master Cao, whose given name was Yuan and courtesy name Zhendao, claimed to be from Jingzhao. He mastered Huang Gong's techniques, deeply understood medical principles, and could even discern qi and colors from afar, see through zang-fu organs, and perform surgeries like intestinal cleansing and chest opening. He wandered among people, unknown to most." [28].
This lineage of the "Nan Jing" is undoubtedly fabricated, as the mentioned timeframes (e.g., passing through six or nine teachers) do not align with historical chronology. However, in the context of medical knowledge transmission, it holds significance by emphasizing the orthodoxy of Master Cao's (suspected to be a Daoist) knowledge, linking him to Bian Que and Hua Tuo. Through the form of "yituo," the establishment of this scholarly lineage further asserts Master Cao's accumulation of symbolic authority.
Immersed in the culture they rely on for a long time, as Yu Jiaxi said: "The various schools of thought on numerology and technical books also all believe themselves to be the true teachings of Huangdi and Shennong" [29]. Unlike what modern scholars of textual criticism suspect, that they merely borrowed the names of sages to deceive the world, they genuinely believed in the existence of sages, and their books were truly the books of Huangdi and Shennong. The Ming dynasty physician Zhang Jie-bin dismantled the original text of the Neijing, reclassified and reordered it, and wrote the Leijing, stating: "Some say that the Suwen, the Zhenjing, and the Nose are not books of Huangdi, but seem to have originated from the Warring States period. Could the writings of the Warring States period be like this? The preface by the Song minister Gao Baoheng and others has already refuted this. This conjecture is baseless and not worth deep discussion." [30] These assertions are typical products of a mindset that relies on tradition.


　　　　　　　　　　　　　　　　IV.

As previously mentioned, "classics" play a central role in the process of transmitting classical medical knowledge. Through the ritual of book transmission, the owner of the classics is also the interpreter. However, this ritual of book transmission showed a tendency to decline during the transition period between the Han and Wei dynasties. The famous medical historian Xie Liheng said: "The ancient specialized transmission of learning had already gradually disappeared after the Wei and Jin periods" [31]. He found that the medical characteristics from the Wei and Jin to the initial stage of the Tang dynasty [first stage] mainly focused on collecting and compiling fragmented texts, with contributions from Wang Shu-he, Huang-fu Mi, and others in organizing and preserving previously scattered and repetitive texts.
The decline of the book transmission ritual is mainly due to two historical structural factors: one is the rise of hereditary medicine, which Fan Xingzhun referred to as "aristocratic medicine" [32]; the other is the formation of Taoist medicine [33]. These two forms of medicine have their own preconceptions about the definition of "medicine" itself and the methods of knowledge transmission. Let's discuss the former first.
The lineage of medical transmission during the Warring States, Qin, and Han periods is unclear, with a blank period after Bian Que and Canggong until the appearance of Hua Tuo and Zhang Zhongjing in the late Han dynasty. However, with the rise of family-based medical transmission, clearer "family methods" gradually emerged, such as those of Fan Wang, Yin Zhongkan, and Wang Min during the Eastern Jin, the Xu family of Donghai with eight generations of heritage during the Northern and Southern Dynasties, and the Li family of Guantao in the Northern Dynasties [34]. This type of medicine values inherited experience and secret formulas, as mentioned in the preface of the "Cold-Damage Disease Treatise": "Observing today's physicians, they do not seek to understand the principles of the classics to expand their knowledge, but each adheres to their family techniques, following old ways" [35]. The so-called "family techniques," compared to physicians who seek to understand the principles of the classics, have a more closed and conservative nature of transmission.
Secondly, the relationship between early Taoist groups and medical knowledge was quite close. From the medical and health-preserving content reflected in the "Taiping Jing," such as "guarding the one," "inheriting burdens," and "the spirits of the five zang-organs," it can be seen that there is an interchange with general medical content [36].However, as Ge Hong stated in the *Baopuzi·Zaying*: "In ancient times, those who practiced the Dao all cultivated medical skills to save themselves from immediate disasters." Yet, the most important aspect of Daoist health cultivation was the great elixir of immortality. Ge Hong criticized the physicians of his time: "Most physicians inherit their profession from their ancestors, having fame without substance, merely nurturing empty reputations to seek wealth and profit." [37] The position of medicine within the Daoist health cultivation system was not highly regarded, and Daoists also looked down upon those who inherited medical practices in such a manner. [38]
In terms of the form of knowledge transmission, Daoism emphasized direct instruction from an "enlightened master." The *Baopuzi* contains many passages mocking those who only read Daoist texts without diligently seeking an enlightened master, yet still hoped to achieve immortality. Ge Hong said: "There are some enthusiasts who genuinely wish to practice the Dao but fail to diligently seek an enlightened master or prepare the necessary elixirs. Instead, they spend day and night reciting and lecturing on irrelevant books, amounting to thousands of volumes, only to find in old age that it was all in vain. They then conclude that there truly are no methods of immortality in the world." [39] Moreover, the texts on immortality often conveyed teachings that were not written down. As stated in *Baopuzi·Mingben*: "The profound and distant teachings, even if one obtains the books without receiving instruction from a master, are like looking up without seeing the head or looking down without knowing the feet. How could you possibly understand them in detail?" [40] In other words, the master-disciple relationship was far more important than the texts themselves. [41] Books were merely the dregs of the sages.
In the Han dynasty, the broad category of "medicine" included practices related to immortality and sexual techniques. The *Hanshu·Yiwenzhi* classified books on life and medicine into four branches: medical classics, classical formulas, sexual techniques, and immortality. However, with the establishment of hereditary medicine and Daoist medicine, there was a significant shift in the classification of knowledge. In the Liang dynasty, Ruan Xiaoxu's *Qilu* categorized "medical classics" and "medical formulas" under "techniques and skills," while the "Daoist records" separately included "scriptures and precepts," "ingestion of elixirs," "sexual techniques," and "talismans and diagrams." Ruan Xiaoxu stated: "Since sexual techniques and immortality are already part of the Daoist path, there is no need to create a separate category for medical classics and formulas." This effectively divided the Han dynasty's "techniques and skills" into two distinct branches. After the formation of Daoist medicine, it refined practices related to sexual techniques and immortality, giving rise to more specialized disciplines. The *Suishu·Jingjizhi* classified "medical formulas" under the category of philosophical schools, while the "Daoist scriptures" section, corresponding to the establishment of Daoism, included books on sexual techniques, precepts, elixirs, and talismans. [42] The general trend in the history of medicine was the gradual exclusion of immortality and sexual techniques from the category of "medicine."
From the perspective of historical bibliography, another significant change during this period was the emergence of a large number of medical texts, which were dozens of times more numerous than those from before the Han dynasty. This was reflected in a shift in the form of authorship, with many medical texts no longer attributing their authorship to sages but instead being written by scholar-officials. For example, works such as *Yin Jingzhou's Essential Formulas*, *Fan Dongyang's Formulas*, *Ruan Henan's Prescriptions*, *Qin Chengzu's Prescriptions*, *Hu Qia's Formulas for a Hundred Diseases*, *Yang Zhongsan's Prescriptions*, *Kong Zhonglang's Miscellaneous Prescriptions*, *Xu Wenbo's Prescriptions*, *Xiahou's Prescriptions*, *Wang Jiyan's Prescriptions*, *Wang Shirong's Single Formulas*, *Yao Dafu's Collected Proven Formulas*, *Lingqiu Gong's Discussions*, and *Wu Shanjü's Formulas* appeared. [43] Compared to the pre-Han period, when medical knowledge was primarily held by fangshi (masters of esoteric arts) and Daoists, the involvement of scholar-officials from the Wei-Jin period onward undoubtedly prompted subtle adjustments in the self-awareness of "medicine."
In the form of knowledge transmission, family physicians value inherited experience, while Daoist physicians rely on the guidance of enlightened masters. This phase of medicine made significant contributions to the reorganization of ancient texts. In the history of Chinese medicine, the "Medical Classics" lineage underwent several critical periods of reorganization. Apart from the medical text corrections by the North Song imperial government, the first was the work of Li Zhuguo (33-29 BCE) during the Western Han, and the second was the work of Huang-fu Mi (215-282 CE) [44]. The significance of the canonization of the Medical Classics between the Han and Wei periods, as scholars have pointed out, is that the emergence of a "canon" is always closely related to a crisis within the discipline itself, stemming from anxiety over the disintegration of established authoritative discourses and in response to challenges and impacts from other disciplines [45]. As mentioned earlier, the decline of classical medical book rituals and the rise of new medical branches were the historical context for Huang-fu Mi's recompilation of the Medical Classics.

　　　　＊　　　　　　　＊　　　　　　　　＊　　　　　　　　＊

At the end of the first century BCE, the court physician Li Zhuguo organized medical texts into four categories: Medical Classics, classical formulas, sexual cultivation, and immortality, totaling thirty-six schools. Apart from what is now known as the Huangdi Neijing, the rest of the books have completely disappeared. It is noteworthy that the "Medical Classics" lineage, through successive generations of physicians adding, deleting, recompiling, and annotating based on the same materials, gradually formed exemplary texts. Therefore, the texts of Jiayi Jing, Taisu, Suwen, and Lingshu often overlap and can be cross-referenced [46].
The "Han Shu‧Yi Wen Zhi" records seven schools of Medical Classics: (1) Huangdi Neijing in 18 volumes; (2) "Huangdi Waijing" in 37 volumes; (3) "Bian Que Neijing" in 9 volumes; (4) "Bian Que Waijing" in 12 volumes; (5) "Baishi Waijing" in 38 volumes; (6) "Baishi Waijing" in 36 volumes; (7) "Baishi Pangjing" in 25 volumes. The "normative" canonical medicine in China began after the first century CE. Interestingly, apart from being recorded in official catalogs, these books were never cited by anyone nor appeared in other texts. Yun Tie-qiao's "Qun Jing Jian Zhi Lu" states:
　　　Before the "Han Shu," the name Neijing was not seen, yet the "Han Shu" lists up to three types of Neijing. Considering the time from the compilation of the "Han
　　　Shu" to the era of Zhongjing, it was only a hundred years, yet the so-called "Huangdi Waijing," Bian Que, and the five types of "Nei, Waijing" by Baishi
　　　are not seen in any writings, and subsequently, there is no trace of them. They appear suddenly and disappear suddenly, which is quite inexplicable [47].
In fact, the "Han Shu‧Yi Wen Zhi" already mentions the obscure nature of medical transmission techniques; considering the secretive style of book transmission, the process of how these books were circulated is hard to trace, which should not be difficult to understand.
Compared to the ancient secretive and non-disclosing methods of book transmission, the significance of Huang-fu Mi's reorganization work lies in making the secretive texts public [48].The Jiayi Jing he authored is primarily based on the transmitted versions of three medical classics:
　　　According to the Qilue and the Yiwenzhi: Huangdi Neijing consists of 18 volumes, now there are Zhenjing in 9 volumes, Suwen
　　　in 9 volumes, totaling 18 volumes, which is the Neijing. Some parts have been lost. Its discussions are far-reaching, yet it contains more narratives and
　　　fewer practical details, and some parts are not systematically arranged. Comparing with the biography of Canggong, his learning all stems from this. Suwen discusses diseases with precision, the "Nine
　　　Volumes" originally discuss the Benjing pulse, its meanings are profound and not easily understood. There is also the "Nose Acupuncture and Moxibustion Essentials," all remnants of Huang
　　　Di and Qibo. The three parts converge, with much repetition and numerous inconsistencies[49].
Huang-fu Mi reclassified the deeply hidden texts of the three medical classics, removing redundancies and providing chapter headings, making Jiayi Jing the first medical classic with clearly defined chapter headings. That is to say, the texts of the Neijing lineage were unclear in their chapter headings before this, and there were even texts without systematic arrangement. Huang-fu Mi's work of revising old texts and reclassifying them had a normative effect, inspiring later works of medical classics in the genres of "classified compilation," "classified extracts," and "combined classifications"[50]. Although there are many works, they are essentially adaptations based on the same set of classical texts.
　　 The historical process of the canonization of medical classics is not a snowballing accumulation but follows the principle of elimination. Medical books are mostly manuals (technical operation manuals) of prescriptions, increasing in number, but what remains are the theoretical and normative "classics" from the Qin and Han medical practitioners and later additions. The work of Li Zhuguo, Huang-fu Mi, or later Yang Shang-shan, Wang Bing, and Song officials was not to confer canonical status and authority on any medical texts, but to continuously uncover the canonical nature of existing medical classics, borrowing Huang-fu Mi's words, "removing the superficial, eliminating the redundant, and discussing the essentials." That is, through re-editing, renaming, and annotating old texts to reconstruct the order and authority of the discipline.


　　　　　　　　　　　　　　　　V,

　　 This is an outline of research involving the core concept groups of forbidden prescription books, reliance, and canon. Although the time is limited to around the 3rd century AD as a period, it attempts to trace the formation and evolution of the prototype of classical Chinese medical knowledge.
　　 Ancient medicine transmitted knowledge through book-receiving rituals, where books served to establish master-disciple relationships and distinguish between in-groups and out-groups. The book-receiving rituals probably declined between the Han and Wei dynasties, and the previously inseparable qualities of ancient texts, teachers, and experience began to differentiate. Taoist medicine can be said to be a knowledge form of the "enlightened master" type, while aristocratic medicine is marked by bloodline transmission and ancestral prescription experience. The Wei and Jin medical practitioners redefined the boundaries of "medicine" by organizing old medical classics and shaping the orthodoxy of medical knowledge. Xiao Guan once said that Chinese medicine has a "Confucian proportion" trait[51], and from the attitude towards texts, medical practitioners indeed gradually leaned towards Confucianism and away from Taoism (or Taoist religion). Song official Shi Song in the preface to "Huangdi Suwen Lingshujing" even said: "To be a doctor, one must read medical books. There are those who read but cannot be doctors, but there are none who do not read and can be doctors. Those who do not read medical books are not of the profession, and killing people is more poisonous than wielding a knife."
　　 The sacredness of ancient medical books originates from reliance.Relying on the historical knowledge of medical practitioners themselves, it is used both to trace the lineage of their techniques and to shape the academic tradition. The format of the dialogues of sages, from the Neijing to the Nan Jing, shows a tendency towards standardization and formulaic expression. Closely related to this is the historical research on the recitation and copying of medical texts, topics that can only break through the existing achievements of medical history by further integrating with the history of thought and cultural history.
I have also pointed out two threads in the development of Chinese "canonical" medicine: one is the mainstream of the Neijing lineage, based on the continuous recompilation of the same set of texts, and the other is the formation of the tradition of annotating these medical classics. How the medical "canon" has been maintained and changed over time undoubtedly requires more solid and in-depth research, and related topics also require the joint efforts of my peers.
Chinese medicine is a text-centered canonical medicine. The Neijing, the "Treatise on Cold Damage Diseases," and other classics can be said to be the ancestral sources of Chinese medicine. Even now, as Chinese medicine moves towards modernization and scientization, it still continuously emphasizes reading the "Four Great Classics" and the "Eight Great Classics," which can be said to be a revival of the old to establish a new school. However, why must modern Chinese medicine rely on several texts formed around the third century AD? The knowledge forms and cultural mentality reflected in this are worthy of further reflection.

＊ ＊ ＊ ＊

During my tenure as a visiting scholar at the University of Tokyo, I often took the Marunouchi Line train to Yushima Seido in Bunkyo Ward. In the colorful alleys, this private school with a history of several hundred years still teaches Chinese culture. Standing outside the Sibu Hall, I was deeply moved to see the bulletin board listing courses on the "Analects," the "Book of Changes," Shiji, and others. In addition to the regular ceremonies for Confucius and ancient scholars, this place holds an "Acupuncture and Moxibustion Festival" on the third Sunday of May each year. I occasionally engage in written conversations with a Japanese Kampo doctor here. Through his introduction, I began reading the Suwen annotations by the late Edo period medical scholar Mori Tatsuyuki. This doctor believes that modern Chinese medicine has already been "Westernized." Once, I couldn't help but ask him what the Chinese classics he studied had to do with clinical practice. He smiled without answering and wrote, "I am an old hand at the wheel."
That is a story from the "Zhuangzi·Heavenly Dao." For a moment, I seemed to understand something, and at the same time, I gained a deeper appreciation for the "easy words of the sages."


[1] Wang Ming, Baopuzi Neipian Jiaoshi (Beijing: Zhonghua Book Company, 1980), p. 322.
[2] Yin Huihe, ed., Basic Theory of Chinese Medicine (Shanghai: Shanghai Scientific and Technical Publishers, 2001, 30th printing).
[3] "Will There Still Be Chinese Medicine in a Hundred Years?" Modern Education News, September 21, 2001; "Where Is the Root of the Disease in Chinese Medicine That Has Entered the Cardiodiaphragmatic Interspace?" Modern Education News, September 28, 2001; "Is There Still Medicine for Chinese Medicine?" Modern Education News, October 19, 2001.
[4] For example, the research of Okinai Tamehito, Watanabe Kozo, Miyashita Saburo, and others.
[5] See Simon Schaffer, "Contextualizing the Canon," in Peter Galison and David J. Stump (eds.), The Disunity of Science (Stanford: Stanford University Press, 1996), pp. 207-230.
[6] Liao Yuqun, "Research on Ancient Chinese Incantation Therapy," Studies in the History of Natural Sciences 12, no. 4 (1993), pp. 373-383.
[7] Hanshu‧Yiwen Zhi‧Fangji Lue, Shenxian‧Fangzhong Lei.
[8] Li Jianmin, The Realm of Life and Death: The Origins of Zhou-Qin-Han Pulse Studies (Taipei: Institute of History and Philology, Academia Sinica, 2000), pp. 120-139.
[9] Zhouli‧Jiyi: "For those among the people who have diseases, they are treated separately, and upon death, the reasons are recorded and submitted to the physician."
[10] See Shiji‧Bian Que Canggong Liezhuan. Morita Denichiro, Shiji Bian Que Canggong Zhuan Translation and Annotation (Tokyo: Yuzankaku, 1986), pp. 23-27.
[11] Liao Yuqun, The Medical Way of Qi and Huang (Shenyang: Liaoning Education Press, 1992), pp. 56-64.
[12] Mr. Ma Jixing said: The questions and answers in Nan Jing "are found in 9 places in the existing Suwen; and in 38 places in the existing Lingshu. In addition, there are 17 quotations not found in the existing Huangdi Neijing, which are probably lost texts of Huangdi Neijing or include some lost texts of medical classics outside Huangdi Neijing." See Ma Jixing, Chinese Medical Literature (Shanghai: Shanghai Scientific and Technical Publishers, 1990), p. 102.
[13] Xiao Guan, On the Origins of Chinese Medicine (Taipei: Xinwenfeng Publishing Co., 1997), p. 29.
[14] Suwen-Zhengsishi Lun chapter.
[15] Suwen-Shicongrong Lun chapter.
[16] Yoshimi Murakami, "The Immortals of China: The Thought of Baopuzi" (Kyoto: Heirakuji Shoten, 1991), pp. 9-11.
[17] Shiji‧Canggong Biography states: "The ancient sages established the method of pulse diagnosis, setting standards, establishing rules, balancing weights, and regulating yin-yang." The Mawangdui Silk Manuscript "Mai Fa" states: "The pulse is also valued by the sages."
[18] Li Ling, "A Study of Chinese Occult Arts" (Beijing: People's China Publishing House, 1993), p. 27.
[19] Li Ling, "On Huang-Lao," included in his "Selected Works of Li Ling" (Guilin: Guangxi Normal University Press, 1998), pp. 278-280.
[20] Suwen-Yinyang Yingxiang Da Lun chapter.
[21] Hu Huaichen, "On the Art of Ruling," included in his "Theories of Ancient Chinese Sages" (Nanjing: Zhengzhong Book Company, 1935), pp. 1-26.
[22] Liu Cunren, "Daoism and Daoist Techniques," included in his "Daoism and Daoist Techniques" (Shanghai: Shanghai Ancient Books Publishing House, 1999), pp. 5-7.
[23] Suwen-Zhuzhijiao Lun chapter.
[24] Zhang Jie-bin: "The sage understands emotions through sounds and is omniscient." See Cheng Shide, "Collected Annotations on Suwen" (Beijing: People's Medical Publishing House, 1982), p. 50; also, Wei Qipeng, "Annotations on the Mawangdui Han Tomb Silk Manuscript 'De Xing'" (Chengdu: Bashu Publishing House, 1991), p. 17.
[25] Li Jianmin, "The Realm of Life and Death," pp. 83-84.
[26] See George E. Marcus, “A Broad(er)side to the Canon: Being a Partial Account of a Year of Travel among Textual Communities in the Realm of Humanities Centers and Including a Collection of Artificial Curiosities,” Cultural Anthropology 6.3 (1991), pp. 385–405.
[27] Xu Fuguan, History of Han Dynasty Thought, vol. 2.
[28] He Lintian, Revised and Newly Collated Collected Works of Wang Zi’an (Taiyuan: Shanxi People’s Publishing House, 1990), pp. 75–76.
[29] Yu Jiaxi, General Principles of Ancient Books (Taipei: Danqing Books, 1987), p. 79.
[30] Zhang Jie-bin, Preface to Leijing.
[31] Xiao Guan, On the Origins of Chinese Medicine, p. 57.
[32] Fan Xingzhun, A Brief History of Chinese Medicine (Beijing: Chinese Medicine Ancient Texts Publishing House, 1986), pp. 59–63.
[33] Yoshimoto Shoji, Taoism and the Medicine of Longevity (Tokyo: Hirakawa Shuppansha, 1989).
[34] Fan Xingzhun, A Brief History of Chinese Medicine, pp. 60–63.
[35] Guo Aichun and Zhang Hailing, Collation, Annotation, and Translation of the Treatise on Cold Damage Diseases (Tianjin: Tianjin Science and Technology Publishing House, 1996), p. 3.
[36] Jiang Sheng and Tang Weixia, eds., History of Science and Technology in Chinese Taoism: Han, Wei, and Two Jin Dynasties (Beijing: Science Press, 2002), pp. 617–634.
[37] Wang Ming, Collation and Annotation of the Inner Chapters of Baopuzi, p. 248.
[38] Baopuzi‧Yellow and White: "The medicines of the medical family are very superficial, but their (Taoist) commonly used effective prescriptions are kept secret again."
[39] Wang Ming, "Collation and Interpretation of the Inner Chapters of Baopuzi," p. 233.
[40] Wang Ming, "Collation and Interpretation of the Inner Chapters of Baopuzi," p. 172.
[41] Murakami Yoshimi, "Chinese Immortals," p. 10.
[42] Matsuki Kika, "The Scope and Evaluation of Medical Books in Historical Bibliographies," "Journal of the Japanese Sinological Society" 50th Collection (1998), pp. 92～107.
[43] Okanishi Ijin, "Examination of Medical Books Before the Song Dynasty" (Taipei: Guting Book House, 1969), pp. 503～586.
[44] Okanishi Ijin, "The History of the Revival of Ancient Medicine," included in Koyama Kanji's "The Origins of Chinese Medicine" (Tokyo: Mainichi Shimbun, 1974), pp. 71～94.
[45] Marcus, "A Broad(er)side to the Canon."
[46] Mayanagi Makoto, "The 'Neijing' Series of Medical Books and Their Research," Tokyo: Japan Kampo Association Academic Department, 1985, pp. 1～39.
[47] Yun Shu-jue, "Records of Wisdom from the Classics," included in Lu Zhen's "Collection of Rare Books on Modern Chinese Medicine‧Medical Classics" (Zhejiang Science and Technology Press, 1990), p. 520.
[48] James Scott, "Domination and the Arts of Resistance: Hidden Transcripts" (New Haven: Yale University, 1990), p. 202.
[49] Huang-fu Mi, Preface to Jiayi Jing. Yamada Keiji, "How Chinese Medicine Was Created" (Tokyo: Iwanami Shoten, 1999), pp. 86～188.
[50] Fan Xingzhun, "A Brief History of Chinese Medicine," p. 52.
[51] Xiao Guan, "On the Origins of Chinese Medicine," pp. 29-32.