An Exploration into Life, Body, Materials, Culture of Mediaeval East Asia: Focusing on Emergency Medicine Recipes in Local Medicinals of Koryŏ Dynasty / 의사학

The Emergency Medicine Recipes in Local Medicinals (鄕藥救急方, Hyang'yak Kugŭpbang) (c. 14th century) is known to be one of the oldest Korean medical textbooks that exists in its entirety. This study challenges conventional perceptions that have interpreted this text by using modern concepts, and it seeks to position the medical activities of the late Koryŏ Dynasty 高麗 (918–1392) to the early Chosŏn Dynasty 朝鮮 (1392–1910) in medical history with a focus on this text. According to existing studies, Emergency Medicine Recipes in Local Medicinals is a strategic compromise of the Korean elite in response to the influx of Chinese medical texts and thus a medical text from a “periphery” of the Sinitic world. Other studies have evaluated this text as a medieval publication demonstrating stages of transition to systematic and rational medicine and, as such, a formulary book 方書 that includes primitive elements. By examining past medicine practices through “modern” concepts based on a dichotomous framework of analysis — i.e., modernity vs. tradition, center vs. periphery, science vs. culture — such conventional perceptions have relegated Emergency Medicine Recipes in Local Medicinals to the position of a transitional medieval publication meaningful only for research on hyangchal 鄕札 (Chinese character-based writing system used to record Korean during the Silla Dynasty 新羅 [57 BC–935 AD] to the Koryŏ Dynasty). It is necessary to overcome this dichotomous framework in order to understand the characteristics of East Asian medicine. As such, this study first defines “medicine 醫”, an object of research on medical history, as a “special form of problem-solving activities” and seeks to highlight the problematics and independent medical activities of the relevant actors. Through this strategy (i.e., texts as solutions to problems), this study analyzes Emergency Medicine Recipes in Local Medicinals to determine its characteristics and significance. Ultimately, this study argues that Emergency Medicine Recipes in Local Medicinals was a problem-solving method for the scholar-gentry 士人層 from the late Koryŏ Dynasty to the early Chosŏn Dynasty, who had adopted a new cultural identity, to perform certain roles on the level of medical governance and constitute medical praxis that reflected views of both the body and materials and an orientation distinguished from those of the so-called medicine of Confucian physicians 儒醫, which was the mainstream medicine of the center. Intertwined at the cultural basis of the treatments and medical recipes included in Emergency Medicine Recipes in Local Medicinals were aspects such as correlative thinking, ecological circulation of life force, transformation of materiality through contact, appropriation of analogies, and reasoning of sympathy. Because “local medicinals 鄕藥” is understood in Emergency Medicine Recipes in Local Medicinals as referring to objects easily available from one's surroundings, it signifies locality referring to the ease of acquisition in local areas rather than to the identity of the state of Koryŏ or Chosŏn. As for characteristics revealed by this text's methods of implementing medicine, Korean medicine in terms of this text consisted largely of single-ingredient formulas using diverse medicinal ingredients easily obtainable from one's surroundings rather than making use of general drugs as represented by materia medica 本草 or of multiple-ingredient formulas. In addition, accessible tools, full awareness of the procedures and processes of the guidelines, procedural rituals, and acts of emergency treatment (first aid) were more important than the study of the medical classics, moral cultivation, and coherent explanations emphasized in categorical medical texts. Though Emergency Medicine Recipes in Local Medicinals can be seen as an origin of the tradition of emergency medicine in Korea, it differs from medical texts that followed which specializing in emergency medicine to the extent that it places toxicosis 中毒 before the six climatic factors 六氣 in its classification of diseases.

An Aspect of the History of Medicine in Ancient Korea as Examined through Silla Buddhist Monks'Annotations on the “Chapter on Eliminating Disease (除病品)”in the Sutra of Golden Light (金光明經, Suvarṇabhāsa-sūtra) / 의사학

Nearly nothing is known of medicine in ancient Korea due to insufficient materials. With several extant prescriptions and esoteric methods of treating diseases alone, it is impossible to gauge in depth the management of medicine during this period. If one exception were to be cited, that would be the fact that the annotations for understanding the contents on Indian medicine in the “Chapter on Eliminating Disease” in the Sutra of Golden Light, a Buddhist sutra originating from India, reflected the medical knowledge of Buddhist monks from Silla (新羅, 57 BC-935 AD) who were active immediately after the nation's unification of the two other kingdoms on the Korean Peninsula (668 AD) such as Wonhyo (元曉, 617-686 AD), Gyeongheung (憬興, 620?-700? AD), and Seungjang (勝莊, 684-? AD). Along with those by other monks, these annotations are collected in the Mysterious Pivot of the Sutra of Golden Light (金光明經最勝王經玄樞), which was compiled by Gangyō(願曉, 835-871 AD), a Japanese monk from the Heian era (平安, 794-1185 AD). Representative versions of the “Chapter on Eliminating Disease” in the Sutra of Golden Light include: a classical Chinese translation by the Indian monk Dharmakṣema (曇無讖, 385-433 AD); the eight-volume edition by Chinese monk Baogui (寶貴), which differs little from the preceding work in terms of the contents of the “Chapter on Eliminating Disease”; and the ten-volume edition by Yijing (義淨, 635-713 AD), who had full-fledged knowledge of Indian medicine. When the contents of the annotations thus collected are examined, it seems that Wonhyo had not been aware of the existence of the ten-volume edition, and Gyeongheung and Seungjang most certainly used the ten-volume edition in their annotations as well. Especially noteworthy are Wonhyo's annotations on the Indian medical knowledge found in the “Chapter on Eliminating Disease” in the Sutra of Golden Light. Here, he made a bold attempt to link and understand consistently even discussions on Indian and Buddhist medicine on the basis of the traditional East Asian medical theory centering on the yin-yang (陰陽) and five phases (五行, wuxing). In accordance with East Asia's theory of the seasonal five phases, Wonhyo sought to explain aspects of Indian medicine, e.g., changes in the four great elements (四大, catvāri mahā-bhūtāni) of earth, water, fire, and wind according to seasonal factors and their effect on the internal organs; patterns of diseases such as wind (vāta)-induced disease, bile (pitta)-induced disease, phlegm (śleṣman)-induced disease, and a combination (saṃnipāta) of these three types of diseases; pathogenesis due to the indigestion of food, as pathological mechanisms centering on the theory of the mutual overcoming (相克, xiangke) of the five phases including the five viscera (五藏, wuzang), five flavors (五味, wuwei), and five colors (五色, wuse). They existed in the text contents on Indian medicine, which could not be explicated well with the existing medical knowledge based on the theory of the five phases. Consequently, he boldly modified the theory of the five phases in his own way for such passages, thus attempting a reconciliation, or harmonization of disputes (和諍, hwajaeng), of the two medical systems. Such an attempt was even bolder than those by earlier annotators, and Wonhyo's annotations came to be accepted by later annotators as one persuasive explanation as well. In the case of Gyeongheung and Seungjang, who obtained and examined the ten-volume edition, a new classical Chinese translation produced following Wonhyo's death, annotated the “Chapter on Eliminating Disease” based on their outstanding proficiency in Sanskrit and knowledge of new Indian and Buddhist medicine. This fact signifies that knowledge of the eight arts (八術) of Ayurvedic medicine in India was introduced into Silla around the early 8th century. The medical knowledge of Wonhyo, Gyeongheung, and Seungjang demonstrates that intellectual circles in contemporary Silla were arenas in which not only traditional East Asian medicine as represented by works such as the Inner Canon of the Yellow Emperor (黃帝內經, Huangdi Neijing) but also Indian medicine of Buddhism coexisted in almost real time.

Editing style of Imwon Gyeongjeji / Inje-ji and inclusion of the medicinal knowledge of the late period of Joseon: Comparing mainly with Dongui-Bogam / 의사학

ImwonGyeongjeji which was created by Seo Yu-gu in the first half of the 19th century is a encyclopedia of practical use in rural life. It consists of 113 volumes, 16 fields, and 2.52 million total characters. Of these, the field of medicine comes 11th of the contents covering 28 volumes and 1.1 million characters. Its name is Inje-ji. This paper examines the academic background of Seo Yu-gu and his life work briefly, and investigates the characteristics of medical knowledge of late Joseon period contained in the Imwon Gyeongjeji / Inje-ji. Here, we made key comparisons especially with Dongui-bogam, Joseon's leading medical book. Of the pioneers of medical history studies of Joseon, a Japanese researcher Miki Sakae has made a negative evaluation to Inje-ji. But after concrete investigation we have come to conclude as follows. First, familial ancestors of Seo Yu-gu were engaged in the introduction of foreign-language books, so Seo Yu-gu as a officer of proof-reading and editing of the various books, also had a lot of knowledge on the medical books ever in history. On this background and experience, for over 36 years from 1806 retirement from official position to his death, he had compiled and edited Imwon Gyeongjeji. Second, unlike Dongui-bogam which included improving health skill, Inje-ji focused on curing medicine readily accessible from the major population of that time. Its main features are as follows: i) prescriptions directly linked to the diseases and symptoms, ii) greatly increased medicinal knowledge especially on infectious diseases and trauma, iii) detailed index easy to look up for prescription and iv) his 'own opinions'[an-seol] which can indicate relevant contents within the book and organically combines the whole knowledge in it. Third, "Inje-ji" utilizing medical books in China and Korea even those of Japan, collected more massively almost all the medical knowledge, new illness, herbs of local area, private prescription. Meanwhile Inje-ji modified the errors of the older medical books like Dongui Bogam or Bencao Gangmu, expressed its own subjective views about controversial topics. In summary "Inje-ji" can be the last general medical book which collected and edited almost all the medical knowledge of the period in the East Asia with its own editing format. In addition it is recognized that it pursued an evidence-based medicine and the practical medicine relieving the people, rather than medico-philosophical theories in oriental traditional medicine which was criticized by many critical intellectuals afterwards. Given the scrutiny, it seems that evaluation of the "Inje-ji" by Miki Sakae should be revised by thorough investigations. We are just on the starting line of the Inje-ji research in earnest meaning, and expect this research would give more fruitful and deep perspective in the area of Korea history of medicine.