Scarlett Huang

Diffusion of Medicine

Introduction

Before the 13the century, Europe and Asia were not aware of each other’s existence due to the lack of cultural, political interaction, until Chingiz Khan’s invasion and creation of the Mongol empire removed the barrier in between. During the 13th and 14th century, the Mongol empire underwent a period known as “Pax Mongolica,” where the peaceful regional interactions through the reopening of the Silk Road allowed cross-cultural pollination and prosperity of medical knowledge within the East and towards the West. This section examines the evidence of the exchange among Chinese, Muslim, Persian, and European medical disciplines and the contribution of prominent figures that fueled this movement, including Kublai Khan, who commissioned the construction of hospitals and invited many foreign physicians to enrich the field of Chinese medicine, and Persian physician Rashid al-Din, who established many medical academies and authored books that made foreign medical knowledge available to the Muslim physicians. The open, receptive nature of Mongol communication and religious system also facilitated the spread of medicine.

The spread of and the motive behind the diffusion of medical knowledge within the East and westwards

The spread and exchange of medicine throughout Eurasia occurred naturally as this field of knowledge was important to keep the army healthy, especially to a militant superpower hungry for continual expansions like the Mongol empire. Another reason for this diffusion of knowledge is an economic one, just like that of the commodities exchange. According to professor Leonardo Brasiliense, Mongols deemed that “drugs cannot be helpful or profitable unless the purchaser knows how to use them. Doctors were therefore also “exchanged” between cultures to disperse such knowledge”[1]. During the reign of Kublai Khan, hospitals and training centers were established to encourage the development of medicine and medical personnel. The Yuan institutions employed doctors from China, India, the Middle East to accumulate and diversify interdisciplinary knowledge within China. In his book 《回回药方考释》published in 1998, Chinese scholar Song-Xian discovered a striking similarity between Hui Hui Yao Fang (《回回药方》), a medical treatise composed near the end of Yuan Dynasty, and Persian physician Avicenna’s book al-Qānūn fī al-Ṭibb (The Canon of Medicine) published in 1025. Firstly, Hui Hui Yao Fang contains many transliterations of the Persian language. For example, Chapter《古阿里失突论只方》in Hui Hui Yao Fang corresponds to “Juwarish al-Ultrujii” in Chapter 5 of al-Qānūn fī al-Ṭibb. “Juwarish” in Persian means “govaresh”,which is the transliteration of “古阿里失”, and “突论只” refers to trujii in Persian [2] .

 
 
 
 

Figure 1

Pages inside Hui Hui Yao Fang

 

There are also resemblances between prescriptions listed in the two books. In chapter 12 of Hui Hui, the prescription for “突论只” is listed as follows:

“沉香 (三钱), 麝香 (西番者二分), 龙脑 (一分半), 肉豆蔻花、 纳尔谟失其 (即麝香门当子)、 香附子、 法兰术谟失其、 扎而拿卜、 广 戎 (各一钱二分), 肉桂、 麻思他其 (即西域云香)、 干姜、 胡椒、 丁 香 (各二钱), 茴香、 可剌福石子、 菖蒲、 甘松 (各三钱), 里撒奴骚 而 (即是羊蹄根五钱)”[3] .

A similar prescription called “San’atu guwarish lana mujjarrab” can also be found in “Juwarish al-Ultrujii” of Avicenna’s book:

“沉香 (‘ūd ) 3 迪尔汗。 樟脑 (龙脑 Kāfūr) 1/4 迪尔汗。 麝香 (Mishk) 1/3 迪尔汗。 肉豆蔻皮 (Basbāsah)、 裂口的小石榴 (Nar⁃ mushki)、 莎草 (Sa‘dah)、 罗勒 (矮糠 Faranjmushki)、 Zarnab 蓬莪 术 (Zurunbād)、 乳香 (Mastaka)、 姜 (Zanjabīl)、 胡椒 (Filfil)、 丁香 (Qaranful) 各 2 迪尔汗。 黄花九轮草 (琉璃苣 Lisānu thawr) 5 迪尔汗。 茴香籽 (Bazar al⁃Rāzyānah)、 芹菜籽 (Bazar al⁃Karafs)、 水 菖蒲 (Wajj)、 甘松 (Sunbul) 各 3 迪尔汗”[4] .

In return, many Chinese medical practices also arrived in South Asia. One frequently cited case, according to Brasiliense, is India’s adaptation of the Chinese practice of pulse diagnosis. By simply touching the wrist, this novel method allows Muslim doctors to “treat female patients without violating the honor of her family”[5]. On the other hand, acupuncture – also of Chinese origin – was not accepted due to excessive skin contact between the practitioner and the patient (Brasiliense p.4). Under the direct order of Kublai Khan, the Chinese texts on pulse diagnosis were translated into Mongolian then Farsi, and the practice was made “a compulsory part of the curriculum of the Chinese Imperial Academy of Medicine in 1305”[6].

Similarly, the diffusion of medical knowledge spread westwards to many European regions. This can be corroborated by the sudden increase of medical luminaries and translated works in Europe throughout the 13th to 15th century. Brasiliense recounts that in 1467, “more than half of the books cataloged in Ferrari’s library (Pavia, Italy) were Arabian commentaries on Greek medicine; Avicenna was quoted more than 3000 times, Rhazes and Galen 1000, and Hippocrates only 140 times”[7].

Despite the positive impacts, the cross-continental interaction allowed the Black Death to travel from western China and Mongolia through the Silk Road. Historical accounts reveal that the bubonic plague indeed originated in Asia, specifically near the Qinghai-Tibet Plateau, the home to many “species of rodent that might carry or serve as intermediary transmitters of the disease”[8](Hymes, p.286). Historical accounts revealed that the Mongols under Chingiz Khan’s leadership bypassed Xia, which was adjacent to the Plateau, and the army might have “unwittingly carried rodent plague hosts and their fleas eastwards into Jin and Song China as passengers in their stores”[9]. The deadliness of the Black Death compelled European physicians and surgeons to focus on Practice more than ever before.

Rashid-al-Din

An indispensable figure to the cross-pollination of medical knowledge between China and Iran was Rashid-al-Din (1247-1318). Rashid-al-Din was born to a Persian Jewish family and later converted to Islam in 1277. He was a statesman, physician, and historian at the same time living in Ilkhanate, Iran. He also authored the monumental Jami’ al-tawarikh, which chronicled the histories of the Mongols, Chinese, Indians, Jews, Armenians, and the Franks, but that is beside the focus of medicine. Under the commission of Ghazan khan, Rashid-al-Din patronized countless Asian scholars and the production of translated books in the scientific field. One significant contribution of his was the establishment of Rabi Rashidi – an academic institution in Tabriz that “featured a research hospital and medical school … and a library containing upwards of 60,000 books”[10] . There Rasid al-Din produced Tansūqnāma‐i Īlkhān dar funūn‐i ‘ulūm‐i Khatā’ī, also known as Treasure Book of the Ilkhans on the Branches of the Chinese Sciences, history’s earliest manuscript on Chinese surgery or medicine ever outside China in 1313[11] . The book is divided into four sections: the first section focuses on principles of Chinese sphygmology, a skill admired in the Mongol word; the second is alleged to be a translation of Wang Weiyi’s (王惟一, c. 987–1067 ce) 銅人腧穴針灸圖經 (Bronze Man Illustrated Chart of the Transporting Points for Acupuncture and Moxibustion) on acupuncture; he third section is a study on Chinese pharmacology of drugs and remedies from the book 本草 (Materia Medica); the fourth section discusses the similarity between physiology and how an empire operates [12] . Tansūqnām also contained a plethora of anatomical drawings on dissections of zang fu, or interior organs, and they are drawn in a manner without the general outlining of bodily contour, which is characteristic of historical Chinese tu of cadaveric dissections. The book made pharmacological and surgical knowledge widely accessible to Muslim physicians.

The recognition of Tansūqnāma, however, was much more limited than Jami’ al-tawarikh in the East; the fact that only one manuscript of Tansūqnāma survived suggests its limited circulation in the Ilkhanate. A lot of Rasid al-Din’s translated works faced questionable receptivity in the succeeding generations. Peter Jackson argued that the growing sense of ‘Iranian-ness’ might have “militated against an openness to extraneous ideas and practices,” especially in medicine, where the Chinese system of Ying/Yang and Five Senses (Wuxing) conflicted with the Galenic system which Muslim physicians abided to [13].

 
 
 
 

Figure 2

Chinese-style illustrations of cadaveric dissection of zang fu inside Tansūqnāma‐i Īlkhān dar funūn‐i ‘ulūm‐i Khatā’ī

 

The role Chinggisids, Trade and Religion

The efficacy and scale of the diffusion of medical knowledge could not have happened without the contributions of the Chinggisid-khans. Many khans were interested in scientific subjects themselves: Hülegü had a particular love of astronomy and geometry and Ghazan developed expertise in philosophy, theology, alchemy, pharmacy, botany, minerals, and astronomy[14]. The passion for science naturally translated to their policies that favored the development of a polyglot culture.

Other than the contribution of several important khans and traveler-physicians, trade and religion also played an integral role by opening up routes and networks across the Mongol Empire as well as to Europe, which the medical personnel can travel through. For example, Marco Polo in Chapter 5 of The Description of the World spent a great number of details describing the merchant ship that could contain up to “200 sailors … carry a good 5,000 basket of pepper and some 6000” suggests the scale, frequency, and the importance of trade beyond the empire, and this necessarily opened up different routes and opportunities for cultural exchange [15]. Similarly, Polo’s account of Princess Kokecin reveals the close affiliation within the interconnected khanates of the Mongol Empire. The story follows that Arghun, the King of Persia, demanded a marriage from Kublai Khan, and three envoys were sent to Yuan Court. The Polos also joined Arghun’s embassy on their return journey through sea routes.

Religion might have influenced the globalization of medicine in two ways. The first reason would be the tolerance intrinsic to Mongol’s religious system, which would have influenced the openness of medicine exchange [16] . The second reason being the interconnection of religion and medicine in China shaped by Buddhism. It is known that from 1278 onwards, Qubilai ordered many Yuan embassies to the Indian subcontinent out of the Mongol government’s interest to “inspect or secure the alms bowl and mortal remains of the Buddha; and the envoys in 1290 were under orders to bring back men of learning and interpreters” [17](Jackson p.94). Many different “strands of medical knowledge are embedded within the Buddhist scriptures imported into China;” for example, the graph of bing, which means illness in Chinese, appears over 40,000 times in the Chinese portion of Taishō Tripiṭaka (Salguero, p.33) [18].

Mongol Medicines

Pax Mongolia brought the Mongol empire under the exposure of a plethora of medical disciplines, yet for the Mongol court in China, medicine usually refers to non-Chinese medicine, such as Tibetan, but most of the time Arabic and Islamic medicine. Islamic medicine later was institutionalized as the official medical practice in the empire, thoroughly becoming “ a part of Chinese medicine and difficult to separate out”[19]. Some evidence listed by Buell, Paul D includes the resemblance between the structure of Yuan-shi 元史 and the institutional structure of Islamic medicine, and the fact that Turkic, largely Uighur physicians were particularly active in Yuan China [20].

Conclusion

In conclusion, Pax Mongolica helped to open up the door that was once closed between different regions within the East and between the West, allowing the collision and interaction between a diverse range of medical science, including Chinese, Indian, Persian, and European disciplines. The exchange was possible and encouraged with a peaceful cultural climate and commissions advocated by Mongolian khans, who harbored a passion for science themselves, as well as the receptive trade-communication system and religiomedical system of Buddhism. The body of medicine was more diverse and interdisciplinary than ever before.

 
 
Footnotes

[1]Brasiliense, The fate of medical knowledge and the neurosciences, p.4

[2]Song, 回回药方考释 , p.181

[3]陆芸, 古代中国与阿拉伯国家的香药交流, p. 115

[4]陆芸, 古代中国与阿拉伯国家的香药交流, p.115

[5]Brasiliense, The fate of medical knowledge and the neuroscience, p.4

[6]Köstenbauer, Surgical wisdom and Genghis Khan’s Pax Mongolica, p.118

[7]Köstenbauer, Surgical wisdom and Genghis Khan’s Pax Mongolica, p.119

[8]Hymes, Epilogue, P.286

[9]Hymes, Epilogue, P.287

[10]Köstenbauer, Surgical wisdom and Genghis Khan’s Pax Mongolica, p.117

[11]Köstenbauer, Surgical wisdom and Genghis Khan’s Pax Mongolica, p.117

[12]Lo, Vivienne. Chasing the Vermilion Bird, p.112

[13]Jackson, Peter. Pax Mongolica, P.239

[14]Jackson, Peter. Pax Mongolica, P.237

[15]Polo, The Description of the World. p. 143

[16]Morgan, David. The Mongols, p.37

[17]Jackson, Peter. Pax Mongolica, p.94

[18]Salguero, Translating Buddhist Medicine in Medieval China, Chapter 1, p.33

[19]Buell, A Look at the Role of Rashid al-Din and Others, p.283

[20]Buell, A Look at the Role of Rashid al-Din and Others, p.283

 
 
References

Berlekamp, Persis. The Limits of Artistic Exchange in Fourteenth-Century Tabriz: The Paradox of Rashid al-Din’s Book on Chinese Medicine, Part I. Brill, 2010.

Brasiliense, Leonardo et al. “The fate of medical knowledge and the neurosciences during the time of Genghis Khan and the Mongolian Empire.” Neurosurgical FOCUS, February 2007.

Buell, Paul D. “How did Persian and Other Western Medical Knowledge Move East, and Chinese West? A Look at the Role of Rashid al-Din and Others.” Asian Medicine 3 (2007), 279-295.

Hamadani, Rashid al-Din, Tansūqnāma‐i Īlkhān dar funūn‐i ‘ulūm‐i Khatā’ī. 1313

Hymes, Robert. “Epilogue: A Hypothesis on the East Asian Beginnings of the Yersinia pestis Polytomy.” The Medieval Globe, 1 (2014): 285-308.

Jackson, Peter. “Pax Mongolica and a Transcontinental Traffic.” In The Mongols and the Islamic World: From Conquest to Conversion, 210-41. New Haven: Yale University

Köstenbauer, Jakob. “Surgical wisdom and Genghis Khan’s Pax Mongolica.” 24 January 2017. https://onlinelibrary.wiley.com/doi/full/10.1111/ans.13813

陆芸, 古代中国与阿拉伯国家的香药交流.

Lo, Vivienne. “Chasing the Vermilion Bird: Late-Medieval Alchemical Transformations in The Treasure Book of Ilkhan on Chinese Science and Techniques.” Imagining Chinese Medicine. Brill, 2018.

Morgan, David. The Mongols. Blackwell, 2008.

Polo, Marco, et al. The Description of the World. Hackett Publishing Company, Inc., 2016

Salguero, C. Pierce Salguero. “CHAPTER 1 The Buddhist Medical Transmission,” Translating Buddhist Medicine in Medieval China. p. 23-43, JSTOR.

Song, Xian. 回回药方考释. 中华书局, 1998.