The Issue of Textual Genres in the Medical Literature Produced in Late Imperial China

Abstract

A great abundance of Chinese medical texts have come down to us since the mid seventeenth century. This is the combined result of the large number of texts written in this period and the fact that the texts were better preserved than earlier. As a matter of fact, the large number of medical texts, coming from various social settings, set historians the quite daunting challenge of understanding what the texts really were and how they should be classified. The idea underlying this article was to go beyond the various modern generic classifications used thus far (“learned”, “popular”, and the like) and to highlight, instead, how medical texts themselves differ from each other. In this aim, I chose to compare a number of excerpts of medical texts written from the eighteenth century to the beginning of the twentieth century in different geographical and social settings. And to compare them, I decided to use some tools created by linguists who have been particularly interested in the issues of genre, notably those used by speech act theoreticians. In this article thus, I analyze these excerpts by paying close attention to the five levels of any discourse act, summarized in the well known formula “Who (says) What (to) Whom (in) What Channel (with) What Effect”, following Harold D. Lasswell’s classic communication paradigm. In other words, I try to shed light on how each of these texts differs from the others from the semantic, syntactic and emotional angles and whether these differences can be linked to the authors’ social, geographical, chronological or intentional settings, and, finally, if we can speak of genres in Chinese medical literature.

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

A great abundance of Chinese medical texts have come down to us since the mid seventeenth century.¹ This is the combined result of the large number of texts written in this period and the fact that the texts were well preserved. As it became more and more difficult to enter the more prestigious imperial bureaucracy, an increasing number of people turned to medicine, in late imperial times. In the resulting acute competition, and in an age of literacy spread, more and more medical practitioners wrote and strove to publish medical writings as proof of their scholarship and legitimacy. At the same time, the development of commercial printing centers, eager to print books that would sell well, allowed a better preservation of books than before.²

As a matter of fact, the large number of medical texts, coming from various social settings, set historians the quite daunting challenge of understanding what the texts really were and how they should be classified. As Charlotte Furth stressed, because of the lack of professionalization, the distinction between a “popular” and a “specialist” work was not great. However, it was possible, according to her, to distinguish between learned and a more popular literature, the latter eschewing “elaborate causal explanations and expositions of complex techniques”.³ Even if the “specialist” vs “popular” or “scholarly” vs “popular” classifications, made by historians and thus exogenous, are not satisfying, it is usually with these terms that historians, most often, qualify medical literature.

The idea underlying this article was to go beyond the various generic classifications used thus far and to highlight, instead, how medical texts themselves differ from each other. In this aim, I chose to compare a number of excerpts of medical texts written from the eighteenth century to the beginning of the twentieth century in different geographical and social settings. And to compare them, I decided to use some tools created by linguists who have been particularly interested in the issues of genre, notably those used by speech act theoreticians. In this article thus, I analyze these excerpts by paying close attention to the five levels of any discourse act, summarized in the well known formula “Who (says) What (to) Whom (in) What Channel (with) What Effect”, following Harold D. Lasswell’s (1948) classic communication paradigm. In other words, I try to shed light on how each of these texts differs from the others from the semantic, syntactic and emotional angles and whether these differences can be linked to the authors’ social, geographical, chronological or intentional settings, and, finally, if, we can speak of genres in Chinese medical literature.⁴

1 Six Texts: Six Discourse Contexts

This article focuses on six excerpts taken from the medical literature produced in the far south of China, between the mid eighteenth and the beginning of the twentieth century. These texts do not belong to an academic corpus which for instance was endorsed by the official central institution of medicine, the 太醫院 (taiyi yuan) Medical Bureau of Medicine.⁵ In fact, all these texts were produced outside the institution, just like the bulk of medical texts written in the period. Moreover, these six texts come from varied social circles that we can reconstruct from two types of source: biographies of the authors, written by local scholars and recorded in local official gazetteers and the books’ prefaces. The information included in the biographies as well as in the very make up of the biographies—their length for instance—,⁶ the information included in the prefaces and in the identity of the preface writers⁷ allow us to deduce the status of an author, his degree of involvement in the practice of medicine, his links with other medical experts and local elites. Last but not least, all this information gives an understanding of the author’s intention and his expected audience. Without getting into a detailed presentation of the life and works of each author of these six excerpts, let us highlight a few points about the status of these texts. They will be of paramount concern for analyzing whether we can find any correlations between an author’s social status, his intention, his target audience and his ways of writing.

The醫碥 (yibian, Stepping-Stone for Medicine hereafter, The Stepping-Stone) was written in 1751 by He Mengyao 何夢瑶 (1693–1764), a native of Nanhai 南海, in the province of Guangdong. The several prefaces attached to his books show him as a polymath who had met the great intellectuals of his time, like Hui Shiqi (1671–1741), an eminent scholar not only in classical culture but also in astronomy and mathematics. He Mengyao subsequently not only mastered classical scholarship but also mathematics, notably spherical trigonometry that had been brought to China by the Jesuits but was then mastered and widely discussed by Chinese mathematicians.⁸ He Mengyao passed the imperial examinations, he was a 進士 (jinshi “presented scholar”, the highest degree taken in metropolitan examinations) and held several posts as a magistrate in the provinces of Guangxi and Guangdong. Despite the prestige associated with officialdom, He Mengyao eventually abandoned his official functions to devote himself to medicine. During his career that thus combined officialdom, teaching and medicine, he wrote 20 or so books in very different fields—poetry, official gazetteers, mathematics and medicine—.⁹ According to He Mengyao’s own preface of The Stepping-Stone, one of his six medical texts, his book has three objectives: firstly, to participate in the knowledge of the Way (Dao 道) that includes medicine; secondly, to enable people to study medicine: “Thus, in writing this book, I brought together the sayings of the physicians that I had learnt by heart when young, I removed the complex and obscure points, I clarified the passages that were not clear and I added my own considerations. We can use it as a stepping-stone to start learning. I don’t dare say that it is a medium that can lead to the Way (dao). I wish only that those who make use of it can rely on it and progress, in the way one uses a stepping-stone. This is why I called my book “stepping-stone”.”; and thirdly, to publicize a criticism of the medical fashion launched by Zhang Jingyue (1563–1640) who underlined the importance of replenishing the Yang in the body and advocated using warming and tonifying drugs.¹⁰

The醫學精要 (Yixue jingyao, The Essentials of Medicine, The Essentials, hereafter) was written in 1800, by Huang Yan 黄岩 (1751–1830), a native of Jiaying嘉應, in Guangdong province. While this man is described by his preface writers as embodying all the distinctive traits of the scholar—good at poetry, literary composition, and classical Chinese—,¹¹ he does not hold an imperial degree. Moreover, his biography recorded in one gazetteer is very short, suggesting that he did not belong to the local elites.¹² However, his book The Essentials received the preface of a scholar of the Hanlin academy, an imperial institution that brought together the most eminent scholars of the time. Like He Mengyao, but to a lesser extent, Huang Yan is a polymath: in addition to his medical book, (The Essentials and the眼科纂要Yanke zuanyao, The Essentials of Ophthalmology, 1867), he wrote several literary books. The first point Huang Yan addresses in his reading guidelines (dufa 讀法) gives an idea of his book’s main objective: “This book was written to teach disciples. This is why it is a compilation of the best of the sages of the past and of what I have obtained from my own work. The language is simple but the intention is completeness. The notions are subtle but the words are clear. Characters and sentences have been chosen after reflection. Rhymes are clear and sound harmonious. One can chant or recite them by rote. He who wants to master this doctrine must read it entirely, and he must be familiar with it”.¹³

The暑症指南 (Shuzheng zhinan, Guide for Summer-Heat diseases, The Guide, hereafter) was written in 1843 by another native of Guangdong, Wang Xueyuan王學淵, about whom we have no information as no biography was recorded in gazetteers and nobody other than the author wrote a preface to his book.¹⁴ In his own preface, however, the author explains why he wrote the book: he wanted to correct the countless errors made about these types of disease he had heard throughout his life, a common topos used by authors, since antiquity, to write a new text: “My heart was full of regrets on hearing so many mistakes. This is why I wanted to gather all the summer-heat diseases into one single book in order to help their study, but I was confused, ignorant and superficial. I did not have good clinical experience until 1830 when a summer drought happened and the diseases then encountered all had the same cause, the summer-heat. I treated them following the techniques of Master Ye Tianshi (1667–1746) and everyone recovered […] In his time, his doctrine was widespread but he had no time to write books, only his Guide with clinical cases is still extant, which is excellent for those who read it. His clinical cases about summer-heat diseases are particularly detailed and clear. I don’t add my own opinion, but, in addition I also collected the good points from the other masters and wrote a book untitled Guide for Summer-heat diseases. It will allow students to know that summer-heat diseases are always caused by hot evil qi and prevent them from believing that some are Yin heat diseases and others Yang.”¹⁵

The 評琴書屋醫略 (Pingqin shuwu yilue, Short guide to medicine of the Pingqin shuwu hereafter, The Short guide) was written in 1865 by Pan Mingxiong潘明熊 (1807–1886). Like the previous authors, he is a native of Guangdong. He passed the first level of the imperial examinations but he did not hold posts in officialdom. As far we can ascertain from his biographies and prefaces, his main employment was medicine even if some preface writers depict him as a good musician as well.¹⁶ Some 20 years after his The Short Guide, in 1873, he wrote another medical book where he gathered together the medical cases of the aforementioned Ye Tianshi. In his Short Guide, Pan Mingxiong aimed to bring together a series of health guidelines for his son and nephews who had left their hometown to study in the provincial capital, Guangzhou. Pan Mingxiong was afraid, he explained, that they would get sick if they were not careful about their health. Hence, he started to write down some basic rules for them. Then, he enlarged the content of his book and his target audience, having in mind the idea that his book could also help people to learn how to cure themselves, thereby avoiding “quacks’” mistakes: “I propose to print (this book) […] in order that people who don’t know anything about medicine can treat their diseases themselves and not be the victims of quacks.”¹⁷

The不知醫必要 (Bu zhi yi biyao, What Someone Ignorant in Medicine Should Know, hereafter, What Someone Ignorant) is a book written in 1881 by Liang Lianfu梁廉夫 (1810–1894), a native of Chengxiang城厢, in the province of Guangxi, a rural province at that time. Liang Lianfu succeeded in the imperial examinations, he was a 附貢生 (fugongsheng, 2nd list of the “recommended man” intermediate degree, taken in provincial examinations). He obtained several posts in officialdom linked to teaching and civil service examinations. He began learning medicine at the middle of his life, at the age of 36, and, afterwards, practiced medicine in addition to his public career.¹⁸ He only wrote one medical book, with the same objective as Pan Mingxiong’s: to help people learn how to self-medicate and avoid quacks: “If you are not a physician, you can have this book, the clinical symptoms are clear to read, it will allow you to avoid quacks’ mistakes.”¹⁹

Finally, the last text, the 經驗良方 (Jingyan liangfang, Tried and Effective Recipes), is an anonymous text, copied in a quasi-similar way in two Guangxi gazetteers, published in 1936 and 1946 respectively: in that of Rongxian and in that of Sanjiang, in the north Guangxi mainly inhabited by the Dong ethnic tribe. It is difficult to date this text. Its title is very common in the history of Chinese medicine. However the fact that this text mentions smallpox vaccination and gives a theoretical overview of hereditary syphilis suggests that this text belongs to the beginning of the twentieth century or, at least, that it was regularly updated. While the origin of this text remains unknown, a short introduction allows us to know why it was copied in these two official sources: to fill the gap of physicians in these remote and poor areas of Guangxi: “In the villages and cantons of our district, people believe in sorcerers and they don’t turn to physicians; some would agree to turn to them, but towns are too far and physicians too few, it is not convenient. Here is a collection of recipes, they have been collected without following any order”.²⁰

This brief overview firstly points to the fact that these six texts, written over a period of two centuries, come from distinct social milieus, from the top of society, as in the case of The Stepping-Stone, written by a scholar who had passed the highest imperial examinations and who received the prefaces of eminent scholars to the quasi-anonymous The Guide which received no allographic preface, and whose author did not deserve an official biography. Secondly, this brief presentation highlights that these texts were written either in Guangdong or Guangxi, that is, in rich and integrated parts of the empire as well as in poor, rural and remote areas. Finally, and maybe even more importantly for the purpose of this analysis, these texts were produced by authors who claimed different statuses as writers: that of teacher for He Mengyao (The Stepping-Stone), Huang Yan (The Essentials), and Wang Xueyuan (The Guide); philanthropic connoisseur for Liang Lianfu (What Someone Ignorant) and Pan Mingxiong (The Short Guide), and physician substitute in the case of the anonymous Tried and Effective Recipes. These texts were written for different recipients as well: apprentice medical practitioners, erudite families, and a populace without physicians. Their commonality lies in their directive function, explicitly announced in the prefaces. According to speech act theory, speech acts or illocutionary acts can be described as follows: “We tell someone how things are (assertive), we try to make someone do something (directive), we engage ourselves in doing something (promissive), we express our feelings (expressive) and we change the world by saying something (declarative)”.²¹ This standard taxonomy of illocutionary acts is usually used at a sentence level. I take the liberty of applying this taxonomy to a text level in order to identify the types of texts I am dealing with as a whole. And, as stressed above, the medical texts under consideration explicitly aim to lead their readers to do something: either to learn how to treat others, in the case of The Stepping-Stone, The Essentials and The Guide, or to learn how to treat oneself in the case of The Short Guide, What Someone Ignorant and Tried and Effective Recipes.

What then do these authors, who come from diverse social, geographical and cultural settings, do to achieve their goal? This is what I will now try to establish by taking sample excerpts from each of these six books—their discourse on huoluan 霍亂etymologically meaning “Sudden Disorder”.²² Now that I have identified the “who” and the “whom”, I will shed light on the semantic (part 3.2) and syntactic (part 3.3) features of these texts (the “what” and the “channel” of the famous formula mentioned above) that mainly deal with the content and the form of a message and, in a fourth part, I will complete my work by analyzing the communicational properties of these texts (the “with what effect” of the same formula).

2 The Sudden Disorders huoluan Analyzed by Six Authors

All these excerpts thus speak of the same thing: huoluan. Today, in the biomedical taxonomy of diseases, this term translates cholera, a disease caused by a specific microbe, the Vibrio cholerae (Kommabacillus) or Koch’s vibrio, discovered in 1883. Yet, the use of the term huoluan does not start with the end of the nineteenth century. Already used in Ban Gu’s History of the Han (1^er CE) and in the first transmitted medical text The Yellow Emperor’s Inner Canon (2nd c. BCE-8th c. CE), this term has a long history. The etymology of the two characters that, once combined, form the term huoluan (huo=quick, sudden) and (luan=disorder) evokes sudden disorders. Since the beginning of the term’s use in a medical context, these sudden disorders were located in the abdomen. Historians who analyzed the different clinical symptoms usually associated with this category of disease in the classical medical literature formulated the first hypothesis that, until the beginning of the nineteenth century this term designated a set of pathological states that included all types of gastroenteritis and alimentary intoxication. As new signs—high contagiousness and high mortality notably—appeared in the medical literature in the early nineteenth century for this category of disease, historians formulated a second hypothesis that the set of pathological states referred to by this term at that time had changed. The heretofore unseen contagiousness and mortality attached to huoluan suggests that true cholera, caused by Vibrio cholerae, had then reached China, an hypothesis which seems plausible as what became known as the ‘first Asiatic cholera pandemic’ broke out in the 1820s.²³ Since the beginning of the nineteenth century, the term huoluan, according to the classic phenomenon of semantic shift, continued to designate all the ancient pathological states usually associated with this term as well as true cholera.²⁴ The texts under discussion, written between 1751 and 1936, were thus written in this period of transition. However, while these six never-before-analyzed texts produced in the far south of China are likely to provide insight into disease history, the object of this article is not to contribute to the history of cholera in China. Therefore, in order to avoid confusion or ill-considered parallels between complex nosological realities that are not always equivalent, I will translate huoluan as “Sudden disorders”. Similarly, one must bear in mind that words like “spleen”, “stomach”, “blood”, and the like do not always refer to the substances or organs of the same name in modern anatomy.

The confrontation of these six excerpts (their semantic features are summarized in Tables 3.1 and 3.2) reveals that with respect to their content, all these texts differ on two principal levels. Firstly, they do not provide the readers with the same types of information. Secondly, the actual information given can differ from one text to the other. The Stepping-Stone, with its 2173 characters, is the furthest from Tried and Effective Recipes, having only 149 characters. The longest text is made up of definitions, clinical descriptions, theoretical explanations, citations, therapeutic recipes and specific diets, clinical cases, advice on how to behave with patients. Tried and Effective Recipes only provides definitions of the disease, short clinical descriptions and therapeutic recipes. Between these two texts that are the most radically different from each other, and which are also the farthest apart chronologically, the four other texts either do not discuss certain points addressed in The Stepping-Stone, or address all its points but much more concisely. But they do not mention anything that was not addressed in the longest text. Thus, between the two texts that differ the most we see variations of a greater or lesser extent in the content, that I will now detail.

Table 3.1 Semantic features shared by all the excerpts

Table 3.2 Semantic features specific to some texts

2.1 Semantic Features Shared by all the Excerpts

Some semantic features are shared by all the excerpts. Not surprisingly due to the nature of the books, all of them provide definitions of the disease including clinical descriptions and therapeutic instructions. Nevertheless, this information is not given in the same way. The clinical descriptions, first, forming the basis of diagnostics are not identical from one text to another and do not require the same competences from the reader: a first group of texts (The Essentials, The Short Guide, What Someone Ignorant, Tried and Effective Recipes) mentions only signs that can be detected through visual or auditory observation of the patients –vomiting, diarrhea, stomach pain, and the like as diagnostic elements; a second group (The Stepping-Stone, The Guide) in addition to these first signs, mentions the state of the pulse—deep and slow, quick, imperceptible, etc.—and mentions the seasonality of the disease.

The number of clinical signs detected by visual and oral observation of a potential patient varies with the texts: around thirty in The Stepping-Stone, fifteen in The Essentials, twenty or so in The Guide, six in The Short Guide, around twenty in What Someone Ignorant in medicine and six in Tried and Effective Recipes. Moreover, this fairly refined inventory of the clinical signs leads to a reasonably detailed diagnosis of the disease: with the exception of The Short Guide, all the texts agree to put two to four forms of the disease under the general heading of huoluan—乾霍亂 gan huoluan “Dry Sudden Disorders”, 濕霍亂shi huoluan “Moist Sudden Disorders”, 霍亂轉筋huoluan zhuanjin “Sudden Disorders with cramps”, 烏沙腸wushachang “Sudden disorders with cyanosis”. The most serious of these, Dry Sudden Disorders, is moreover designated by its “popular” name, 攪腸痧or 絞腸痧 jiaochangsha “disease of the blocked intestines”.

All the texts, then, provide therapeutic advice. Note that the place this therapeutic advice occupies in these excerpts as well as the degree of its specificity differ from one text to the other. The number of prescriptions varies from 1 to 40 and they draw on different therapeutic fields. While all these texts promote hot or cold decoctions made of dried or fresh medicinal herbs or minerals, certain therapies are only mentioned in some of them. Acupuncture, for instance, sometimes combining moxa is only written about in The Stepping-Stone and The Essentials. Tried and Effective Recipes and The Stepping-Stone mention another therapeutic method: 刮痧guasha挑破tiaopo, a technique which involves palpation and cutaneous stimulation where the skin is pressed, in strokes, by a round-edged instrument or needle. Note also that the authors have chosen different formats in which to present their therapeutic advice: either only mentioning the title of the formulas and referring the reader to another part of the book for more information or detailing the composition of the formulas and the ways to make them in the main text. I will come back to this point later which leads to different reading practices.

While all the texts provide readers with clinical and therapeutic information, they do not all contain the same information (Table 3.2).

2.2 Content Features Specific to Certain Texts

Firstly, the texts do not all provide theoretical explanations on the etiology or physiopathology of the diseases. Nothing of that kind can be found in Tried and Effective Recipes neither in The Short Guide, which only recalls the link made by the Ancients between this disease and a wider set of diseases. The other texts include theoretical explanations and strive to classify the Sudden Disorders in a more general theoretical framework: spleen and stomach disease, summer-heat disease, liver disease, spleen disease. The theoretical explanations that are all in keeping with the framework of Yin/Yang and the Five Phase doctrine of systematic correspondence are important to a greater or lesser degree and require a more or a less well refined knowledge of it.²⁵ The Stepping-Stone reserves a lot of space to the presentation of the different causes and the diverse developmental processes of the diseases including obstruction of the medium burner because of something evil 邪xie, separation of Yin and Yang, troubled circulation of the liquids necessary to human activity, condensation of fire in the muscles provoked by the exhaustion of bodily liquids leading sometimes to muscular cramps. The Essentials recalls what the classic The Yellow Emperor’s Inner Canon had said about the development of these diseases, and evokes the dysfunction of the foot-major-yin conduit (Zutaiyin) of the spleen. It also mentions the causes of the diseases: the spleen and stomach being attacked by different types of evil element: abnormal food, abnormal wind or cold, overabundant yin and dampness. The separation of Yin and Yang and the impossibility for the qi to circulate properly in the body are invoked to explain the most serious forms of the diseases. The Guide only evokes the effect of some of the six classic external pathogenic factors: wind, cold, summer-heat, dampness. What Someone Ignorant evokes some of these factors as well—cold wind—, and also abnormal climate, abnormal eating and evokes troubles along the foot-yang-brilliance (Zuyangming) of stomach and foot-ceasing-yin (Zujueyin) of liver conduits.

Secondly some of the texts use citations while others do not: What Someone Ignorant and Tried and Effective Recipes do not cite anyone; the other texts mobilize their peers but not always in the same way and for the same function: The Guide in fact alludes to two masters to highlight the lineage of two of its therapeutic prescriptions (it is the recipe of x and y); The Essentials cites The Yellow Emperor’s Inner Canon to recall some theoretical elements; The Short Guide cites Wang Kentang, a medical author from the sixteenth century, in proposing a therapeutic recipe and he cites the Ancients, to recall what these “sages” used to say about the diseases that happened suddenly and that included, according to him, the Sudden Disorders. In The Stepping-Stone, He Mengyao not only resorts to his peers to teach the reader the different theories developed by some of his forebears but also to include in his text, in two clinical cases cured by Luo Qianfu, another physician, some individualized flesh and blood patients.²⁶ I will develop later what functions the citation can meet but at this stage just note that not all the texts make use of citation.

Thirdly, not all the texts provide advice on how to behave with patients, for making a good diagnosis and adopting an adequate therapeutic strategy. The Stepping-Stone warns its readers against possible misinterpretation, such as, for example, believing that a patient is affected by a cold disease because the cramps are only in his feet. In the clinical encounter, it also recommends to be very cautious in differentiating between hot, cold and damp patho-conditions, and to take care in pulse taking to avoid confusion and to prescribe the suitable treatment. It also advises the reader to question patients in order to get precise information on the food eaten and on the types of emotions felt. We find a piece of advice of this sort in The Short Guide which recalls that in sudden disorders, and contrary to what The Stepping-Stone promotes, pulse diagnosis is not important. The Essentials also advises readers to be calm when facing a certain number of signs that at first could seem serious but that are in fact necessary for the patient’s recovery.

Finally, the extent of the specification or the explanation of the semantic content of these excerpts is not equal in all these texts. The authors assume that their readership already has, to a greater or lesser extent, the capacity to understand these texts. The Stepping-Stone assumes its readers have a command of pharmaceutical knowledge, to the extent of knowing what “antagonist drugs” and “astringent drugs” are, and of being able to elaborate a decoction by only reading the title “Decoction to stop thirst” or “Decoction of the seven qi.” It also supposes the reader knows the acupuncture points, guasha methods and how to read the pulse. The Guide does not assume its readers have deep theoretical medical knowledge; however, it does assume that its readers are able to understand the pulse and have a command of pharmaceutical science to the extent of being able to identify the “warming drugs”. The Essentials assumes that its readership has mastered the elementary theoretical elements (the conduits and the five phases) but has no knowledge of the pulse; it assumes its readership knows a little about therapeutics, as it recommends prescriptions whose ingredients and their utilization are not always explained. By contrast, the authors of the three other texts do not require capabilities other than literacy: Tried and Effective Recipes does not require any knowledge of medical theory, of pulses or pharmaceutical science. In fact, anyone who has mastered literacy can understand the recipes and put them into practice. The Short Guide requires a very basic knowledge of theory, but no capabilities in pulse interpretation or in pharmaceutics, since all the recommended recipes are presented with a description of the quantities of their ingredients. Even someone ignorant in pharmacology could prepare the prescriptions. What Someone Ignorant assumes its readership to have a basic knowledge of the conduits but not necessarily any knowledge in pulse states or in pharmaceutics as, here again, the author always describes, the ingredients, their quantities and how to make each recipe.

To summarize on this first point, the comparison of the semantic features of these excerpts reveals that while all the texts speak about the same thing, they don’t speak about it in exactly the same terms. In fact, we find significant variations on two levels that we must differentiate clearly. On the first level, the type of information the authors provide to their readership can vary. All give descriptions of the disease and therapeutic treatments, but some texts do more than that. Some provide theoretical explanations about the causes and the physiopathology of the disease; some equip the reader with advice on how to be a good medical expert; some give proofs by echoing ancient theories or practices. On a second level, we find significant variations within the information itself: while all these authors agree upon classifying various troubles that all of them found to be quite similar under the category “Sudden Disorder”, their understanding of the causes and development of the disease, their methods for identifying them properly and for treating them, differed substantially. These second-level variations are not surprising for any historian working with Chinese medical texts and well aware that medicine in China has never been a coherent and unified tradition. These variations only attest to the fact that, during the two centuries under consideration and within the different milieus that studied the body and its ailments, there was not a consensus; but rather, that observing patients, understanding the causes and the development of diseases and treating them, were grounded in medical fashions that varied according to either the epoch, the geographical region or social milieu. Whatever the importance of these second-level semantic variations for the history of medicine, they are not, however, of primary concern for the present project which attempts to characterize the different texts and thus pays more attention to the first-level variations (the different types of information provided, or not, by all these texts) and try to understand to what these variations are linked. In Table 3.3, I tried to highlight how the first-level semantic variations (theory, quotations, clinical cases, etc.) are distributed among these texts.

Table 3.3 Content variations within the 6 excerpts

According to this table, the author’s social milieu (deduced from having obtained a high/medium/low degree, holding a post in the bureaucracy, having contact with local elites) does not seem to be a fundamental criterion for explaining the variations in content of these texts: the texts that are the most similar in semantic content—The Stepping-Stone, The Essentials, The Guide on one hand and The Short Guide, What Someone Ignorant, and Tried and Effective Recipes on the other—come in fact from distinct social milieus. Conversely, the texts that come from similar social circles do not have much commonality: The Stepping-Stone and What Someone Ignorant, both coming from high degree-holders, involved in prestigious officialdom, have only one content feature in common. The commonly-used distinction between “scholarly” and “popular” literature thus does not hold. However, the chronology as well as the declared function of the texts (teaching or self-medication) seem to impact on the content of these texts: the texts prior to 1843 have at least three common semantic features: they all include theoretical elements, quotations or citations, and assume the readership to have mastered the rudiments of medicine in order to understand the texts. The Short Guide, What Someone Ignorant, and Tried and Effective Recipes written between 20 and 50 years apart and written for families or patients without physicians, have two common negative features though: they don’t present clinical cases and they don’t expect their readership to have prerequisite knowledge of medicine in order to understand the text.

It is not easy to see, at this point, if it is the chronology or the declared function of the texts that impact on the content of the texts. The books written before 1843 are also those written to teach medicine and thus aim at a specific audience, apprentice medical practitioners; the texts written afterwards and that appear to be the most similar were written for self-medication and aimed at families. However, from this first analysis, the factors that seem to distinguish these texts the most acutely are not the social divide between “low ” or “high” circles, but more chronological or functional. I will now turn to what Schaeffer, in the footsteps of the logicians, calls the syntactic structure of the texts,²⁷ that is, the set of elements that encode the message and investigate whether the proximity found between some of these texts on the content level is confirmed or not at the syntactic level.

3 The “Channel” or the Wide Range of Elements that Encode the Message

Comparison of these six texts reveals that the formal elements that were chosen by the authors to encode their messages are not identical. Let us now highlight these differences.

3.1 Long and Short Texts: The Vade-mecum versus Reference Books?

When we consider these six different excerpts that speak about the same thing, the first obvious difference lies in their different lengths: The Stepping-Stone is the longest, with 2173 characters, while Tried and Effective Recipes with only 138 characters is the shortest. Between these two extremes, we have two groups of quite similar texts: What Someone Ignorant and The Essentials are three times shorter than The Stepping-Stone; The Guide and The Short Guide are seven times shorter. The different lengths that we can observe is in part linked to the various levels of semantic richness of the texts, as we have seen previously. The Stepping-Stone addresses many more different themes than Tried and Effective Recipes that only gives a few clinical descriptions and therapeutic recipes. However, as Tables 3.1 and 3.2 show clearly, some very short texts, such as The Guide, address nearly all the themes developed by The Stepping-Stone, but do so more concisely. The exhaustiveness of the content thus may not be the only factor that plays a part in the length of the texts.

3.2 Simple Language that Uses Textual Connectors and Discourse Markers Frequently or Sparingly

At first glance, all these texts use simple language that does not seem to differ radically from one text to another. But, in fact, a consistent difference does differentiate the language used in these texts: the frequency of the use of textual connectors and discourse markers—that is, particles in the language of sinologists. Among these particles, it is important to distinguish between, on the one hand, the characters that are used to clarify, show cause/result, indicate time, sequence ideas, add information, illustrate, predict and so on and so forth and that are usually called “textual connectors” or “text connectives” and whose function is to contribute to the cohesion of the text (Table 3.5); and on the other hand, the particles that do not change the meaning of an utterance and have a somewhat empty meaning (equivalent to the English “oh”, “well”, “you know”, “I mean”, “right?”) and that are usually called “discourse markers”. For instance, the particles ye 也, yi 矣, hu 乎 (“it’s sure”, “that’s it”, “but why then”) can be labeled “discourse markers”, while you 又, gu 故, ze 則 (“also”, “it is because”, “then”) can be called “textual connectors”. As is often explained by sinologists, one of the functions of these “discourse markers” was to segment the texts which, before the introduction of modern punctuation in the beginning of the twentieth century, were often written continuously.²⁸ It is true that in the sample of texts under consideration, the text that makes the greatest use of these discourse markers was not punctuated. The unpunctuated Stepping-Stone actually used 1 discourse marker every 57 characters, while the punctuated texts rarely used them. However, the use of these discourse markers is not only motivated by the lack of punctuation and a concern of readability. Tried and Effective Recipes does not use punctuation and nor does it use discourse markers. In fact, these particles do more than punctuate and allow writers/speakers to add something other than simple readability to their discourse. But before developing this particular point, let us go back to the question of the different uses of textual connectors and discourse markers in these excerpts.

As Table 3.4 shows (as well as the boxes/circles in figs. 3.1, 3.2, 3.3, 3.4, 3.5 and 3.6 and in translations, at the end of this chapter), not all the texts use these textual connectors and discourse markers in the same frequency. On the one hand, The Stepping-Stone (1 textual connector and discourse markers every 10 characters), The Short Guide (1 every 9 characters) use textual connectors and discourse markers frequently. The Essentials (1 every 20 characters) and What Someone Ignorant (1 every 25 characters) rarely use them. Table 3.4 suggests that chronology does not play a significant role in the differing use of textual connectors and discourse markers: the medical writing before the end of the eighteenth century does not seem to use more textual connectors and discourse markers than the same language at the end of the nineteenth century and beginning of the twentieth century.

Fig. 3.1

Excerpt from He Mengyao 何夢瑤 (ca. 1692–1764), 醫碥 Yibian, The Stepping-Stone for Medicine [1751] second edition, date unknown. Chap. 3. 霍亂 Huoluan, Sudden Disorders. Note the unpunctuated writing, small-size characters for the author’s comments and the frequent use of textual connectors and discourse markers (circles)

Fig. 3.2

Excerpt from Huang Yan 黄岩 (1751–1830), 醫學精要 (Yixue jingyao, The Essentials in Medicine [1800] 1867, Chap. 3, 霍亂 Huoluan, Sudden Disorders. Note the wide range of punctuation markers and the less frequent use of textual connectors and discourse markers (circles)

Fig. 3.3

Excerpt from Wang Xueyuan 王學淵 (active in 1830), 暑症指南 (1838) Shuzheng zhinan, The Guide for Summer-Heat Diseases (no dividing chapter) 霍亂 Huoluan, Sudden Disorders. Note the punctuation markers on the right of the characters and the less frequent use of textual connectors and discourse markers

Fig. 3.4

Excerpt from Pan Mingxiong 潘明熊 (1807–1886), 評琴書屋醫略 (1865) Pinqin shuwu yilue, Short Guide to Medicine of the Pingqin Shuwu (Chap. 2) 霍亂 Fulun huoluan, Added Doctrine on Sudden disorders. Note the punctuation markers and the frequent use of textual connectors and discourse markers

Fig. 3.5

Excerpt from 梁廉夫 (1810-1894), 不知醫必要(1881) Bu zhi yi biyao, What Someone Ignorant in Medicine Should Know (Chap. 2) 霍亂 Huoluan, Sudden Disorders. Note the punctuation markers and the very rare use of textual connectors and discourse markers

Fig. 3.6

Excerpt of an anonymous text 經驗良方 (published in 1936 and1946) Jingyan liangfang, Tried and Effective Recipes, 治霍亂方 Zhi huoluan fang, Recipes for Curing Sudden Disorders. Note the absence of punctuation and the very rare use of textual connectors and discourse markers

Table 3.4 Different uses of textual connectors (t.c.) and discourse markers (d.m.)

As this first analysis pinpoints, the use of discourse markers and textual connectors is not indispensable. We can thus argue that to use or to avoid them is the result of the authors’ choice. The analysis of not only the quantity but also the variety of textual connectors and discourse markers used in all these texts suggests that one reason that may explain this differential use of these characters may be found in the authors’ endeavors to use more or less sophisticated language. The Stepping-Stone not only uses a lot of textual connectors and discourse markers but also resorts to the widest range of this type of words: 37 different often synonymous textual connectors or discourse markers (see Table 3.5). Its author thus seems particularly careful to avoid repetition and uses all the nuances of his language. As I mentioned above, this text was written by a polymath trained in classical studies who moreover wrote a great number of books which received prefaces from members of the top of the elites. The frequent use of textual connectors and discourse markers may thus be linked to the author’s endeavor to adopt a good writing style. On the contrary, sparing particles could be linked to another target: to avoid unnecessary words to have shorter, handier books, easy to carry around when making medical rounds, for instance. And in fact, handiness (便bian) is a concern expressed in two texts: in his introduction, the author of What Someone Ignorant informs us that his book will be convenient for people who move frequently, merchants and bureaucrats.²⁹ The short introduction to Tried and Effective Recipes also underlines that in Guangxi’s rural areas, it was neither easy nor convenient to find a physician. While some authors were keen to use a more sophisticated language, even if it meant having a large cumbersome volume that could only be examined in a medical office (the modern edition of The Stepping-Stone has 797 pages), others wanted to write short, handy, easy-to-carry texts. One way to be more concise was to avoid unnecessary words, such as textual connectors and discourse markers.

The various uses of these textual connectors and discourse markers may finally be linked to what the authors were trying to do when they wrote: convincing by using explanation (causal assertives) and/or prediction (predictive assertives) that need connectives such as “if… then”, “This is why”, “because”; or convincing by using descriptive assertives and directives like in this imaginary utterance “Things are like that. Do this and that” which need few connectives; or convincing by interacting with the readership, through the use of discourse markers such as “right?”, “that’s it”, “for sure”. It is a point which I will come back to later when we compare the different types of speech acts chosen by authors to meet their communicational target. Let us just say, for the moment, that there are different communicational properties behind the frequent or rare use of textual connectors and discourse markers.

Table 3.5 Frequency and diversity of textual connectors and discourse markers

3.3 Texts in Prose and Texts in Verse

Another stylistic feature distinguishes these texts: the use or not of metric constraints. In fact, two texts aimed at different readerships—apprentice medical practitioners for The Essentials and families for What Someone Ignorant—were written under phonetic and metric constraints. The author of The Essentials writes in blank verse and sometimes in rhyme in different places in his text: in the first symptomatic description of Dry Sudden Disorder, and when he enumerates the different etiologies of the disease. What Someone Ignorant is written under even more constraints. Not only does the author choose an identical format to present his message in the first three parts of the first chapter—a symptomatic description of a particular form of the disease, followed by an explanation of the causes, then, an explanation of physiopathology—but also, within this first part, the explanation of the causes is written in five characters, the explanations of the physiopathology that follow are all in seven characters (with the exception of the last two), and all these segments finish with the same sentence: “and then disease occurs”. These constraints give the texts a particular rhythm that surely aimed at facilitating memorization. Memorization has always been highly valued in classical studies in China and this learning method migrated into other fields of knowledge such as medicine.³⁰ Versification facilitated memorization particularly for those who started learning after childhood, as was often the case for those who had decided to learn medicine after successive failures in the imperial examinations.³¹ In his short introduction, the author of The Essentials explains the reasons for his stylistic choice in the following terms: it would help pupils to rote chant his text and learn it by heart.

3.4 A Different Order in the Presentation of Information

The order of presentation of the information and arguments—definitions, etiological and physiopathological explanations, recipes, quotations, etc…—is far from being the same in all these texts and this is worth some consideration. In a field very far from medicine, N. Goodman and J. Virbel have clearly shown that the simple permutation of the episodes in a narrative gives the narrative very different tones and textual statuses.³² Let us now see how all these authors chose to present information.

While What Someone Ignorant, The Stepping-Stone and The Guide, with some nuances though, first describe and define the disease, explain its possible causes and development, reserving the therapeutic section for the end of the chapter, the Short Guide does the contrary: in its first section, it describes the disease and gives therapeutic advice, then, at the end of the chapter, it recalls, in a somewhat accessory way, what the Ancients used to say about these types of diseases that appeared very suddenly. The Essentials chooses another order: it begins with the description of the most serious form of the disease, whose popular name is immediately recalled, and with the therapeutic strategy to adopt urgently in this particular form of the disease. Afterwards, the author recalls some theoretical elements and describes the clinical signs of the common form of the disease. Finally, the author comes back to the most serious form, its clinical signs, its popular name, and the therapeutics suited for acute diseases in general and for which, he says, he has a pill, a family secret, that he agrees to detail. Tried and Effective Recipes first describes three forms of the disease and then gives recipes.

The order in which the information is presented in these texts suggests the idea of a hierarchy of information—what is the most significant information to give my reader first—which, at the same time, suggests that these texts were written for different purposes: the texts which did not leave room for theoretical explanations or that put the theories at the end of the chapter seem to have been written to be consulted in an emergency, in the acute phase of the disease (The Essentials, Tried and Effective Recipes, The Short Guide); the others aim at a readership which is not under the constraint of emergency and can spend time on first reading about the causes and the development of the disease (The Stepping-Stone, What Someone Ignorant and The Guide).

The order in which the therapeutics are presented also varies. Some texts (The Short Guide and The Guide) chose to include their prescription in the general discussion of the disease; others (What Someone Ignorant, The Stepping-Stone, Tried and Effective Recipes and, to a lesser extent, The Essentials) have a clearly distinguished chapter for the theoretical explanations or descriptions of the disease and a different chapter for the therapeutics. Another distinction in the ways of presenting therapeutic advice or recipes can be noted. As already mentioned, while some authors chose to include all the details about the prescribed formulas in the main text, others prefer to send the reader to other parts of the book. What Someone Ignorant, The Essentials and The Short Guide, by indicating the name of the recipes, possibly the type of therapeutics they belong to (invigorating, cooling, etc…), the kind of patho-conditions they cure, the quantities of ingredients and the ways of preparing them in the same place, immediately gives the reader all the indications allowing him to prepare these recipes and to understand them. On the other hand, The Stepping-Stone and The Guide prefer another format: they only mention the name of the recipe and send the reader to another part of the book. What these variations are linked to is not clear. What is sure is that these two different ways of presentation lead to different ways of reading or consulting the texts.

The question of the pagination, of paragraph indents, and of typographical changes would be very interesting to develop in this analysis, even if it is clear that these choices were often in the hands of the editors rather than the authors.³³ Moreover, not all the documents used here are first editions, which, for some of the texts, are no longer available. The editions available to me still show clear contrasts (see Figs. 3.1–3.6). Some authors/editors have chosen to add some paratextual elements in order to make the book easier to read: while The Stepping-Stone, in its second edition, has no punctuation and uses continuous writing, the other texts have clear indents and punctuation markers. The Essentials, in an 1867 edition, uses small and big circles to signal the beginning of paragraphs. It uses rows of circles or mid-commas to the right of the characters in order to emphasize one passage and it uses indents. The Guide and The Short Guide use small circles to mark sentence breaks. What Someone Ignorant uses small and big circles and indents to introduce new chapters or new recipes.

Comparison of these excerpts shows that the authors do not resort to the same formal elements to encode their messages. As summarized in Table 3.6, we have: concise texts versus diluted texts; texts which use connectives widely versus texts that use connectives sparingly; punctuated texts versus unpunctuated texts; texts in verse versus texts in prose; texts that first focus on how to see and do versus texts that first focus on how to see and think; texts that place all the information in one single place versus texts that interrupt the message and send the reader to other parts of the book. Are these different ways of writing linked to chronology, geographical setting, social milieu or the declared function of the book?

Table 3.6 Different encoding of the six excerpts

These differences a priori do not seem to be particularly linked to the chronology, nor to the author’s status, nor to the target audience. They do, however, suggest very different types of reading or consultation: a quick pragmatic reading versus a slower reading for comprehension. On the one hand, we have the highly portable vade-mecum, for those who have no time for etiological or physiopathological explanations, but who must be able to quickly identify the disease and prepare recipes, without wasting time searching in other parts of the book for other information (Tried and Effective Recipes, The Short Guide but also, because of its clear presentation, What Someone Ignorant). On the other hand, we have the reference work, not handy, that first gives the reader all the explanations about the disease, maybe different theories expressed by earlier physicians, before indicating the name of a few formulas that the reader is then required to find in another chapter in order to learn how to prepare. It is the case of The Stepping-Stone, which moreover requires first of all that the reader punctuates and segments the text to get its points.

The analysis of the channels used by the authors to encode their message traces a line between texts written for doing before understanding and texts written for understanding before acting. Let us now finally see what the authors do to guide their readership to follow their first intentions.

4 Communicational Targets: Authors’ Intention and Communicational Properties in the Six Texts

As I mentioned at the beginning, the intention behind these six texts, as explained by the authors themselves, was to teach the reader how to treat people or to self-medicate. From these explicit intentions, we can draw two conclusions about the nature of the texts: firstly, all the texts can be considered as written discourses aimed at a readership (we are thus in a dialogical and not in a note-taking situation, involving a speaker and a hearer); and secondly, the authors did not intend their text to narrate something but rather to engage people do something.

The tools elaborated by speech act theoreticians seemed quite useful in identifying what all the authors did to achieve their communicational target. For these theoreticians, language is not only used to describe or to give some statements; to speak is to act with or against someone to transform our worlds.³⁴ Thus, and always in a comparative perspective, I strove to identify the different types of illocutionary acts (assertive, directive, promissive, etc.), the different illocutionary force markers used in all these texts. A few problems arose from the attempt to apply a theory elaborated within the framework of modern spoken English to ancient written Chinese.

The first problem lies in the difficulty of segmenting pre-modern Chinese texts into utterances and thus into individual illocutionary acts. This problem is linked to the lack of either punctuation or punctuation markers that raise issues. As already mentioned, the first and second editions of The Stepping-Stone was unpunctuated. Punctuation markers were added in later editions. In this case, the punctuation, even though it can vary from one edition to another, corresponds to modern punctuation, a point indicating for instance the end of a sentence.³⁵ Thus segmenting the text into individual sentences is easy for this text. However, the other texts have been printed with punctuation markers that do not always correspond to the modern values of the same markers. For instance, in What Someone Ignorant, the small circle can break a sentence, isolating on the one hand the nominal group, and on the other, the verbal group. As noted earlier, this text was written under heavy metric and rhythmic constraints, and the punctuation in this text is less to indicate semantic or syntactic breaks or pauses, than to give a special rhythm when the text is read aloud. The author strives to write segments of the same length, counting the same number of characters, in order to give a rhythm to facilitate memorization. In order to identify a meaningful sentence in this particular text, I have therefore been obliged to disregard the author’s punctuation.

A second problem arose when I tried to identify the illocutionary force markers and notably those used for translating directives. While the imperative mode is a syntactic force marker easy to locate in French or in English, it is not the same in Chinese because Chinese does not conjugate verbs and does not need personal pronouns, even in what would be the indicative mood (in written Chinese “kan shu 看書” can be interpreted as “I read book” or “Read book!”). We can sometimes find a particle at the end of the sentence that indicates an order. But with the exception of The Stepping-Stone that once uses this type of particle, such particles are rare in these texts. However, the reading of these excerpts shows that the Chinese language uses other resources for translating orders, as we will soon see.

A third problem, not linked specifically to the Chinese language, is that a unique sentence can contain illocutionary acts of different natures, as in this imagined single sentence which contains 3 types of illocutionary act: “If you feel cold you probably have fever (assertive), take rest (directive) and you will feel better (assertive), I promise (promissive)”. In the translations provided at the end of this chapter, I chose to indicate, in front of the translations, the different types of illocutionary acts made in each sentence.

Finally, a speech act can perform different illocutionary acts, according to the context in which it is performed. Take as an example, the sentence “Dinner is served at 8 pm” pronounced in a hotel. It can be assertive in the context of a report on the hotel; it can be promissive if it comes from the mouth of the hotel chef to the hotel manager or clients; it can be directive if it comes from the hotel manager to the chef or to the clients.³⁶ Language is thus not univoqual, and the same sentence, i.e without syntactic or semantic change, can have different communicational values, such as describing, ordering or promising. The second part of the fifth text, What Someone Ignorant, devoted to recipes, in which the author lists and quantifies the different ingredients necessary for a particular decoction illustrates this issue. Are these sentences assertive acts—they describe the composition of the recipe—or directive acts—they implicitly tell the reader what he has to do to prepare the recipe? This question is difficult to settle.

Despite all the difficulties attached to this theory and to its application to Chinese, I found it interesting to use, expecting that it would highlight the communicational properties of these texts and thus give an additional angle of approach for this attempt of systematic comparison.

4.1 Speakers and Hearers: Varying Levels of Personal Authority in the Discourse

All these texts have a common point, they include definition: “If there are x and y signs, it is the Sudden disorder” or “the Sudden disorder is a syndrome where the stomach is painful”. The act of defining introduces a hierarchical distance between the speaker and the hearer: it is the speaker who knows and has the authority to define and the hearer who is unknowing and therefore accepts the definition. We can even think that if this kind of utterance was pronounced in a medical office by the physician with his patient “You have signs x and y, you thus have the disease z”, the illocutionary act would be declarative. Just as a judge who, by his utterance “I sentence you to twenty years imprisonment”, transforms the social situation of the hearer, from free to convicted, the physician transforms the social status of the patient, who, from the simple state of having varied signs is, after the physician’s declaration, a diagnosed sufferer of a disease (with all the social changes, exclusions in particular, that can result in a person’s life from being identified as affected by a particular disease, think of epilepsy or glaucoma for airline pilots, HIV, etc…).

All these texts thus introduce a hierarchical imbalance between speakers and hearers, however, the presence of the speakers is noted differently: The Essentials is the text where the speaker’s presence is the most palpable through the use of different markers. Firstly, the speaker introduces his text by citing himself (“Nai’an says”); secondly, he uses the personal pronoun “I” wo 我 and yu予 which is not necessary in written Chinese; thirdly, he distinguishes himself from his hearers by addressing them directly: “I am teaching it to you (disciples) yi shou ni deng 以授尔等”; finally, he uses many typographical markers, either punctuation markers that are intended to emphasize some particular points, or small size characters for his own comments.³⁷ In the Short Guide, Pan Mingxiong also uses the personal pronoun “I” yu予 and typographical changes for his commentaries. In The Stepping-Stone, He Mengyao does not use personal pronouns, however, he resorts very frequently to small size characters to add personal comments. Moreover, as already noted and as will be developed below, this author often resorts to discourse markers. These markers, in addition to helping the reader to segment unpunctuated texts, also provide metalinguistic indications about the unfolding discourse, such as translating the speaker’s emotion about what he is saying. Interestingly, these three texts that thus bear the presence of the speakers to a higher extent than the others are also the texts that cite other famous masters. Contrastingly, we have some completely impersonal texts. The authors of What Someone Ignorant, The Guide and, not surprisingly, the anonymous Tried and Effective Recipes never use personal pronouns or typographical changes to introduce personal comments. If Liang Lianfu, author of What Someone Ignorant, uses small size characters in the second part of his text devoted to recipes, it is only to specify the general properties and the quantities of the required ingredients, and not to introduce personal comments. Furthermore these writers resort to neither citation nor quotation, that is, do not inscribe their message in a precise individual lineage.

The first impression that arises from the reading of these texts that pay attention to the position of the actors—speaker and hearer—and their ways of including themselves, or not, in the discourse, is that while all these speakers present themselves as more authoritative than their hearers, their endeavor to establish their authority is expressed differently. While some authors ground their authority in individual experience—their own and that of other physicians, by way of quotations or citations—, others prefer to enunciate a discourse where their own presence and that of the famous masters they might refer to remain hidden for the benefit of a general truth, a scientific objectivity. It is also interesting to note, as we will now see, that these latter texts, in comparison to the others, prefer to use descriptive assertives rather than causal or predictive assertives, giving the text an implicit general authority that we could illustrate in this way: things are like that, it is not me who is going to explain to you why.

4.2 Directive Texts Versus Explaining and Predicting Texts

The application of J. Searle’s standard taxonomy on this sample of texts shows that all the texts are made up of directives and assertives that is, of speech acts aimed at leading the reader to do something, and of speech acts aimed at either defining (assertive of definition), describing (descriptive assertive), explaining (causal assertive), predicting (predictive assertive) the state of the world, and, in the present case, the Sudden Disorder. However, if we take into account D. Vernant’s modifications to this standard taxonomy, that notably reintroduced Austin’s idea that some speech acts had metalinguistic functions (“I demonstrate”, “I show” which speak about the speaking activity of the speaker) and should be identified as such, we can say that while all these texts are made up of assertives and directives, only a few of them contain metadiscursive acts, that is, they quote or cite other texts or other sayings.³⁸ Before indicating in which proportions these texts are made up of such illocutionary acts, I shall first underline how the Chinese language translates directives.

As mentioned above, the Chinese language does not conjugate verbs, and there are no morphological changes to indicate tense or mood like the imperative or the infinitive. It does not mean that the Chinese language cannot express injunctions and these texts clearly show it. Firstly, the context makes clear that some verbs could not be translated differently but by the use of an infinitive or imperative (“add this and that”, “refer to the section of the cold damage disease”), which introduce direct directives or conditional directives if the directive speech act is preceded by a conditional proposition introduced by a conditional particle (“if this happens, do that”). Secondly, we have lexical markers including the modal auxiliary verbs “must”, “can”, that introduce indirect directives³⁹. Finally, the authors can express their injunctions without resorting to syntactic markers nor to lexical markers, but by using an implicit formula whose illocutionary force is even more directive, like in this example: “You perspire anytime and in great quantity: Decoction of four colds!”.

As Table 3.7 shows, the proportion of assertives and directives is not equal in all these texts. Tried and Effective Recipes is the only text that gives its readers more orders than descriptions or explanations. In this respect, it is the text that seems the closest to a notice mainly devoted to action. On the contrary, The Essentials and What Someone Ignorant, are made up of more assertives than directives. The other texts are made up of nearly half assertives and half directives. All these texts, therefore, can be considered, to some extent, as texts for action.

Table 3.7 Approximate counting and identification of illocutionary acts in these excerpts

Another feature which seems to distinguish these texts is the types of assertives performed. Assertives, indeed, do not all have the same function: they can describe, define, explain, and predict the state of the world. Behind these different functions, the speaker thus endows himself with different capabilities. As noted above, the act of defining, which can be considered as an assertive (and in some contexts as a declarative) introduces an imbalanced hierarchy between the speaker and the hearer. We can assume that the act of explaining or predicting the unfolding world, that is making causal or predictive assertives, gives the speaker a particularly enlightened intermediate status between the world and the hearer: he presents himself as being able to explain why things happen and how they will happen. Interestingly, these texts do not all refer to the same types of assertives to the same extent. In addition to directing the reader to do something, Tried and Effective Recipes contents itself to defining and describing the disease but not to explaining or to predicting its development. Conversely, He Mengyao, the author of The Stepping-Stone, explains, predicts and describes the disease to the same extent. Finally, between these two contrasting texts, the other books—The Essentials, What Someone Ignorant, The Short Guide and The Guide—give a larger space to description, reserving only one fourth of their assertions to explaining or predicting the disease.

The comparative analysis of the illocutionary acts carried out in these texts reveals three very different communicational targets: the texts that aim to lead the reader to do something (Tried and Effective Recipes), those that want to lead the reader to identify the disease properly and to act (The Essentials, What Someone Ignorant, The Short Guide and The Guide) and one text that wants its readers to be able to identify, to understand, to predict and to act (The Stepping-Stone).

4.3 How do the Speakers Convince Their Readership to Do Something?

Another significant distinction in these texts is the way the authors commit themselves to the results of their advice or instructions Indeed, if these texts are devoted to action, the authors need to convince their readers to do what they say or to think as they want them to do. As we have already noted, the ways these authors grounded their authority is different: some grounded their authority in personal experience while others preferred to refer to a general truth. If we now look at how these authors commit themselves to the results of their advice, we note a difference (see Table 3.8). What Someone Ignorant, which is impersonal, differs from all the others: while all the other texts use sentences like “using this or that is wonderfully efficient shenxiao 神效”, “all these have great effectiveness xie you qi gong 皆有奇功”, formulas that carry in themselves the mark of a personal value judgment, What Someone Ignorant prefers a style that refers to an objective value: instead of saying “this recipe is effective, is excellent, and so on”, the author introduces all his therapeutic recipes with the same utterance: “This recipe cures zhi 治 x, y”.

Table 3.8 How the authors convince their readers to obey their injunctions

In fact, the speakers use different tools to convince their readers to follow their instructions or ways of thinking, or, in other words, to be sure that the perlocutionary effect, which refers to what is commonly called the effect on the receiver, is satisfied. One is quotation or citation. Citation meets very different functions. One of them is to gain authority, as Bhatia clearly underlined: “in order to become acceptable to the community…, one must relate his/her knowledge claims to the accumulated knowledge of others in the discipline”.⁴⁰ Therefore, by referring to prestigious peers, by saying “x and y said that”, the speaker not only relates his knowledge to the prestigious scholars of the past, but he also increases the chances that the perlocutionary effect be satisfied, that is, the reader believes him immediately and acts accordingly. The Stepping-Stone, The Essentials (The Classic says: …), and The Short Guide (Wang Kentang says:…), by using citation and relating their own work to their forebears, use this tool. Only What Someone Ignorant and Tried and Effective Recipes do not use citations.

Another tool, only used by The Stepping-Stone to convince its readership to act and think according to what is written, is the use of discourse markers which have a strong illocutionary force. We had previously noted that this text included a lot of textual connectors and discourse markers, whose function is usually thought to be that of replacing punctuation markers when texts were unpunctuated. But in fact, the author might well have used so many discourse markers for another target. By littering his argument with a lot of discourse markers such as “isn’t it”, “it is sure”, “that’s it”, “I ask you”, the author of The Stepping-Stone interacts with his readership, expecting thereby to strengthen the perlocutionary effects of his writing. By using discourse markers having a strong illocutionary force and other locutions such as “some people believe that… but how is it possible to be so mistaken ….?”, “How is it possible to make such mistakes!”, “to state that is really impossible”, the author’s goal is to produce a complete adhesion to the speaker’s arguments and annihilate any opposition. Interestingly, this text, which uses quotations and interactional discourse markers, was written not only for teaching but also to convince people to stop following a particular medical fashion.

To summarize on this last point, applying different tools from the speech act theories helps to highlight that the communicational properties of these texts are very different (see Table 3.9). We have texts where the speaker’s presence (his ways of thinking, his commitment to results) is highly marked and texts where the speaker and other individualized people are hidden for the benefit of an objective discourse; we have texts that look like simple notices for use and texts that combine instructions for use, explanations and descriptions.

Table 3.9 Communicational properties of these excerpts

5 Conclusion

The issue underlying this analysis was to highlight how medical texts differed from each other. Thus I submitted a small sample of texts dealing with a same issue to a semantic, syntactic, and communicational comparative analysis. This systematic comparison first allows to see that these texts do not share the writing conventions that are usually shared by people who belong to a well-defined professional community.⁴¹

This analysis then allows us to confirm two points highlighted by linguists specializing in the question of genre: the literary act is a complex semiotic act, and, as we multiply the analytical approaches, “we are more likely to find increasing flexibility, fluidity and tentativeness in our understanding of generic integrity”.⁴² Indeed, when we analyze these six excerpts from the single perspective of their semantic content, we find that the texts are informative in varying degrees. When we consider them from the point of view of their encoding, we distinguish verbose versus concise texts, texts that invite action first versus texts that first invite comprehension, texts of differing levels of readability, texts to be learned by heart versus others to be consulted and meditated upon. Finally, if we look at the texts from their communicational properties, we distinguish texts that aim at making the reader follow a series of instructions without explanations versus texts that have the same purpose but by providing the reader with explanations and predictions; we distinguish highly personalized texts versus texts where individual opinions or judgment are hidden for the benefit of a certain objectivity; texts which, in order to convince the readers, interact with them versus texts that do not invite interaction. Some texts seem to be closer to others on the semantic or syntactic or emotional levels. But as soon as we look at these texts from all three perspectives, it becomes quite difficult to establish a particular typology that would distinguish one genre from another. The identification and the delimitation of genres, in whatever field, thus raise difficult problems.⁴³

If firm conclusions cannot be drawn yet, this attempt to make a systematic comparison has led to the establishment of an analysis grid that stresses firstly that texts can be characterized by far more features than simply being “theoretical”, “practical”, “popular” or “scholarly”. Of course, as other historians have already underlined, we can distinguish texts for “doing” from texts for “thinking”. But what this multi-approach analysis shows is that this distinction does not only rely on the presence or lack of theoretical elements but rather on a wider set of criteria: the frequency of directives; the order of presentation of the argument that notably induces very different reading modalities. What this attempt to describe texts from many perspectives stresses, next, and already outlined by linguists working in the field of literature, is the fact that when an author claims, in the paratext (notably in its title and/or preface), generic determination for his text, it does not necessarily imply that the rules he follows are reducible to the rules that are often associated with the generic name chosen.⁴⁴ Let us take as an example the three texts that claim to be pedagogical books: The Stepping-Stone, The Essentials and The Guide. It is true that these three texts share the highest number of semantic features—clinical signs, prescriptions, explanations of causes and the development of the disease and citations. However, if we look at them from the other points of view developed here, we see significant variations: some texts are in prose while others are in verse; some try to be concise and handy while others do not; some ground their authority in individualized opinions while others ground their authority in a neutral objectivity. Note that What Someone Ignorant, announced as a book on self-medication is, to some extents—verse and rhythm constraints, order of information presentation (explaining before acting), clear pagination—closer to some textbooks than to the Short Guide which was also announced as a book on self-medication.

This sample of six excerpts is of course very small. Applying this analysis grid to a larger number of medical texts produced in late imperial China will perhaps help to better highlight the different ways of writing medical texts at that time in China and perhaps distinguish more clearly different types of medical communities.

6 Translations

In order to bring out the discourse characteristics in each text—frequency of textual connectors and of discourse markers, illocutionary force markers, concise or expansive writing styles, etc—I chose to provide a very close translation to the original Chinese. This appeared to be a very difficult challenge which furthermore did not always produce particularly nice results, in terms of readability and style. When I found it really necessary, I have added connectors to the translation, but these connectors are not marked with boxes. I capitalized the names of the five phases (Wood, Fire, etc…) but used small size letters for terms such as “cold”, “warm”, “heat” even if one must bear in mind that these terms, beside corresponding to feelings and to external conditions, are also used as general terms to classify the phenomena and the elements of the universe.

Legend:

• Small characters: comments or indications inserted into the main text in smaller characters by the authors

• Boxes: textual connectors and discourse markers

• Abbreviations for the different types of illocutionary act:

DA:

Descriptive Assertive

CA:

Causal Assertive

PA:

Predictive Assertive

AoD:

Assertive of Definition

CD:

Conditional Directive

DD:

Direct Directive

ID:

Indirect Directive

ImD:

Implicit Directive

CM:

“Citative” Metadiscursive

EM:

“Expositive” Metadiscursive

1st text: The Stepping-Stone for Medicine (Yi bian), by He Mengyao 1751.

1. ⁴⁵Abbreviation for the證治準繩 (Zheng zhi zhunsheng, Rules for diagnosis and treatment), 1602, by Wang Kentang (1549–1613).
2. ⁴⁶Abbreviation for the 伤寒明理論 (shanghan ming lilun, Clear discussion on cold damage) by Cheng Wuji, eleventh–twelfth centuries.

1. ⁴⁷From the千金藥方 (Qianjin yaofang, Essential Prescriptions Worth a Thousand Pieces of Gold), by Sun Simiao (6th–7th) Chap. 20, recipe 14

1. ⁴⁸Same sentence in the 秘傳證治要訣及類方 (Mi zhuan zheng zhi yao jue ji lei fang, Secrets for diagnosis and curing with recipes) by Dai Sigong 戴思恭 (公元1368-1644年), Chap. 1
2. ⁴⁹A physician who lived during the thirteenth and fourteenth centuries
3. ⁵⁰This passage is slightly different in another edition
4. ⁵¹Inspired by (copied from?) the名醫類案 (Mingyi lei'an, Classified Case Records of Celebrated Physicians), by Jiang Guan (1503-1565), Chap. 2, Shu暑
5. ⁵²idem

1. ⁵³Pill promoted in the太平惠民和剂局 (Taiping Huimin he ji ju fang, Formulas of the Bureau of People's Welfare Pharmacy), Chap. 5. 引杜先生方
2. ⁵⁴Entirely similar in秘傳證治要訣及類方 (Mizhuan zhengzhi yaojue ji leifang) by Dai Sigong (1368–1644), chap. 1, itself copied from the 證治準繩 (Zheng zhi zhunsheng, Rules for diagnosis and treatment)of Wang Kentang
3. ⁵⁵A physician whose name appears in the張氏醫通 (Zhangshi yitong, Zhang's Medical Compendium) (1695) by Zhang Lu

2nd text: The Essentials of Medicine, (Yixue jingyao), by Huang Yan, (ca. 1751–1830), 1800, edition of 1867 (Chap. 2, pp.15–16).

1. ⁵⁶Excerpted from the Lingshu, Huangdi neijing, Chap. 10
2. ⁵⁷Translation of Wu Liansheng, Wu Qi, p. 416

3rd text: The Guide for Summer-heat Diseases, (Shuzheng zhinan), by Wang Xueyuan, 1843

1. ⁵⁸Entirely copied from a commentary of the 醫宗金鑒 (Yizong jinjian, Golden Mirror of Medicine), compiled by Wu Qian in 1742

4th text: The Short Guide of Medicine of Pingqin Room (Pingqin shuwu yilue), by Pan Mingxiong, 1865

1. ⁵⁹In the passage that follows “For my part, I respect this method”, there is an ambiguity, due to the fact that Chinese verbs do not conjugate and one does not need personal pronouns in written Chinese either. Therefore, this passage can be understood as a description of what the author does when he faces cases of Sudden Disorder, but also as an injunction aimed at the reader. In both cases, however, the illocutionary target is directive: either the author wants the reader to do as he himself does (I do that, implicitly, do as I do), or the author gives him a series of instructions
2. ⁶⁰According to the belief that in acute forms of any disease, and unlike the other clinical signs, the states of the pulse become confused and cannot provide reliable information about the disease
3. ⁶¹19 This sentence sounds strange as the liver is associated with Wood and by extension with wind

5th text: What Someone Ignorant in Medicine Should Know (Bu zhi yi biyao), by Liang Lianfu, 1881

6th text: Tried and Effective Recipes (jiyan liangfang), anonymous, 1936 and 1946