Global Histories of Health

For centuries, China has been regarded as a global superpower of economy, culture, and civilization. Despite its “Century of Humiliation” lasting from the First Opium War in 1839 until the emergence of the People’s Republic of China in 1945, China’s worldwide influence cannot be denied. However, although this prosperity has spanned ages, many consider its Golden Age to be over 1,000 years ago, during the rule of the Song Dynasty.

The empire was the center of the global economy, trading its sought-after goods of silk, porcelain, lacquerware, gunpowder, and paper on the Silk Road and Indian Ocean Exchange. This commerciality led to diasporic and cosmopolitan communities across its Eastern Coast, such as the port city of Quanzhou, where Arabic, Indian, and Southeast Asian merchants spread their Islamic, Hindu, and Buddhist traditions. This cultural assimilation would also be vital in spreading new medicine and medical techniques. But the Song additionally experienced great internal economic growth through the creation of the Grand Canal, allowing farmers to trade Champa rice, contributing to a population boom and the rise of even more cities, like the capital of Hangzhou. Yet what set the empire apart from the rest of the world in this time was not its economy, not its culture, but rather its political power. The Song used a Confucian-based civil service exam to identify China’s best men to run their government. These men made up the highest social class, and they helped the empire rule for over 300 years. This strong bureaucracy would also contribute to medical policy change and interact with medical institutions, transforming the public health of its population. As such, the Song Dynasty was at the worldwide center of global commerce and civilization, shaping the early trends of globalization.

The purpose of this essay is to understand how and why medical policy changed in the Song Dynasty. It will delve into the political, economic, and cultural factors that contributed to such change, analyzing how consolidation of power, the urbanization and overpopulation effects of economic prosperity, and cultural exchanges on the Silk Road and in diasporic communities led to public health transformations in the Song Dynasty.

To legitimize imperial rule, Song emperors would utilize the ancient concept of the “Mandate of Heaven” – an ideology that a divine power gave the ruler the power to govern as long as he made decisions in their best interests. But in 1045, increasing epidemics throughout the empire would challenge this philosophy. Due to increasing urbanization and trade, disease spread throughout the Chinese population, creating tensions among them and the ruling class, as epidemics were seen as a symbol of Heaven’s disapproval towards the emperor’s rule. So, the bureaucracy began to make specific, direct changes in medical policy to show to their people and higher powers that they indeed were beneficially contributing to society. Such changes included the creation of new governmental public health departments, like The Bureau for Revising Medical Texts (校正醫書局), which revised and released medical texts to the public. They also updated their Treatise on Cold Damage Disorders (傷寒論), which offered a systematic framework for treating epidemics.¹ What is important about these examples is that they all portray how attempts to legitimize political rule caused medical policy to change in the Song Dynasty. During this time period, the most important aspect of an emperor’s rule was to maintain the governing power over his people. Because the spread of diseases challenged the direct tool of legitimation – The Mandate of Heaven – the emperor standardized public health practices to display his benevolence to the people. Medical policy change in China was largely spurred by state-driven attempts for maintenance of power. But what complicates this argument is the evidence of state-led standardization of medical education in the Song Dynasty. For instance, the bureaucracy began to include medicine in the imperial examination system, indicating that it recognized doctors as professionals in society. It also established a state-mandated curriculum for medical practitioners and founded dedicated medical departments, such as the Imperial Medical Bureau, which implemented detailed medical training and evaluations by professionals to ensure competence.² It must be noted that these creations were not a result of widespread epidemics, pointing towards the idea that although political ambitions were a driving factor for medical policy change, the general welfare of the population was considered. The enhancement of doctors and medical care would have only benefited the people, and unlike before, was not prompted by a threat of political stability. So, by taking direct measures to improve the well-being of the population, the bureaucracy reveals that its motivations to shift medical policy were not entirely political, but also took into account humanitarian causes. Yet political desires still proved to be most dominant above all. For instance, in 1076, the Song bureaucracy established the Imperial Pharmacy (太醫局), selling drugs at state-regulated prices. This was an attempt to control the economy and centralize medical practices, enforcing imperial authority.³ As shown, the Song government had the exterior motive of consolidation of power, common with political desires discussed earlier. Because they regulated medical prices due to such motives, they reveal that in general, although the bureaucracy showed genuine concern for human lives in their empire, drives for legitimization and consolidation of power were the most prominent political causes for changes in medical policy in the Song Dynasty.

But although the creation of the Imperial Pharmacy helped the empire exert political authority, the underlying cause was entirely economic. In 1076, the Song Dynasty underwent a series of institutional reforms, establishing new acts to benefit the general population. These were the New Policies (新法). Pushed by Wang Anshi, a Chinese economist serving as a chancellor under Emperor Shenzong, Anshi was outraged at wealthy, monopolistic merchants who manipulated medicinal drug markets for personal gain. He argued that the state should intervene and regulate the economy, and the bureaucracy listened. They established the Imperial Pharmacy as a result, selling medicine at a price locals could afford.⁴ Here, the Song Dynasty shows that they valued the well-being of their population as much as economic control. Although the new department aided their overall means of achieving centralization, the fact that the creation occurred because their people were harmed reveals that medical policy change in the Song Dynasty was fueled by the desire to reduce economic strain on their population. What further illustrates this idea can be seen in the public health changes from rapid population growth and urbanization throughout the empire. As detailed earlier, increased trade and commerce from the Silk Road, Indian Ocean Exchange, and Grand Canal led to massive economic growth and increased spread of goods, especially rice. As such, the population boomed in a short period of time, resulting in the growth of major cities. But along with this rapid urbanization came overcrowding, and most importantly, increased disease transmission. Populations suffered, and one Song scientist – Shen Kuo – detailed the grueling conditions of the cities in Dream Pool Essays (夢溪筆談), in which he made observations about societies throughout the empire (author’s translation):

In the capital’s wards and alleys, with tens of thousands of households, waste accumulates, and the drains are clogged. During the summer months, the stench fills the air, epidemics spread, and the people suffer greatly.⁵

This account displays why economic factors caused the Song Dynasty to alter medical policy. Increased economic output by the empire allowed them to participate in trade, increasing their population and leading to urban development. But this process also created devastating effects on their own population, so they adopted new medical standards, such as creating the Imperial Bureau of Medicine, Imperial Pharmacy, and training doctors in a professional method. Thus, by responding to the epidemics, air pollution, and drainage through offering more effective medical solutions to locals, the Song Dynasty illustrated that medical policy change in their empire did not occur because of an increased desire for wealth; rather, to adapt to the effects of their existing economic prosperity.

Yet perhaps the most influential factor altering medical policy in the Song Dynasty was the Silk Road. This transcontinental trade route had an important medical impact on the empire because it served as a conduit for medical exchange, allowing for the transfer of new medical goods. For instance, China came into contact with the Abbasid Caliphate, a Middle Eastern Islamic empire which was a mecca for medical knowledge at the time. The caliphate traded extensively with the Song, transferring goods including saffron, pomegranate, benzoin resin, patchouli, asafetida, and galls. Upon arrival, these products were traded by Muslim merchants and assessed by Song medical officials and integrated into formularies – published books listing medicinal substances, recipes, and treatments considered safe and effective.⁶ However, not only did Islam merchants bring new medicine to the region, but so did Buddhist missionaries from Central Asia, bringing unique medical knowledge and exotic herbs which were implemented in formularies as well.⁷ These written texts illustrate how culture caused medical policy to change in the Song Dynasty. As shown, the Silk Road allowed for interactions between groups of distinct identities and religions to share knowledge and goods to benefit one another, displaying that a cultural exchange of ideas took place. Then, the fact that this cultural exchange led not only to the availability of new goods but also the integration of them into standardized medical practices reveals that the Song believed in an openness and willingness to accept new cultures, ultimately influencing medical policy throughout the empire. But not only did the cultural interactions that grew from commerce influence medical policy; so did the cities that trade created. For example, cities like Chang’an, Quanzhou, and Guangzhou grew as they were temporary homes and residences of Persian and Arab traders. These men would bring new plants, such as myrrh and frankincense, remedies, and medical texts, altering medicinal drugs and medical methods in the Song Dynasty.⁸ One example of this mixing of culture was depicted by Du Zheng, a 13th-century poet describing the autumn medicine fair in Chengdu:

Coming in a palanquin to visit the medicine fair, our bearers’ knees are caught in the press of the crowd… there is such a profusion it cannot be detailed… Mica and frankincense the colour of sparkling crystal, aloe, and sandalwood wafting their fragrant scents… Some things are costly… others are bitter … Many are produced in barbarian tribes… merchants have buffeted the sea-winds and the waves and foreign merchants crossed over towering crags drawn onwards by the profit to be made.⁹

The existence of Arab goods reveals that the merchants described most likely were Arab and Persian merchants. Therefore, this description of a Chinese medicine fair reveals how hybrid culture affected medicine in Song cities, as interactions between two groups of people – Arab merchants and Chinese purchasers – allowed for new techniques, treatments, and knowledge of medicine to be discovered by the Song. This would not have been likely to happen if no such trade or cosmopolitan cities existed, thus showing that Arab interactions in diasporic communities helped the Song Dynasty improve public health and medical policy in their empire.

All in all, changes to medical policy occurred because of unique reasons in the Song Dynasty. Politically, alterations occurred to centralize and consolidate the power of the emperor, yet the humanitarian needs of the population were still considered. As such, rulers of the empire were not greatly economically motivated to change medical policy, but rather shifted public health systems to adapt to the effects of overpopulation and urbanization resulting from their wealth and prosperity. Finally, culture was arguably the most important factor in changing medical policy in the Song Dynasty because it allowed for Chinese-Arab interactions, spreading new goods along the Silk Road and within cosmopolitan cities, expanding the Song’s knowledge of medical knowledge and techniques.

Now, why should one study the history of medical policy in the Song Dynasty? The answer is simple. During the reign of this dynasty and long after, empires remained a common theme throughout the world. Nearly every region on Earth had some monarchy, or some elite ruler where the ideas of democracy remained centuries away. If we take a look at a small part of these systems, such as medical policy, we can characterize what life was like in these societies. The true importance of studying nuanced history, like the topic of this essay, is not to document facts, display evidence, or draw conclusions some may never understand. Instead, the significance lies in understanding what truly mattered to people from long ago, and how their actions have shaped our lives today. Doing so will not only explain the world around us, but also reveal the timeless truths about who we are and what we value.

Notes

1. Asaf Goldschmidt, “Epidemics and Medicine during the Northern Song Dynasty: The Revival of Cold Damage Disorders (Shanghan),” T’oung Pao 93, no. 1/3 (2007): 53–109, http://www.jstor.org/stable/40376304.
   
2. Lingbai Hu and Xuedan Zhang, “Insights on Song Dynasty Medical Exams from Tai Yi Ju Zhu Ke Cheng Wen Ge (《太医局诸科程文格》 Examination Answers and Standards of the Imperial Medical Bureau),” Chinese Medicine and Culture 8, no. 1 (March 2025): 68–77, https://doi.org/10.1097/MC9.0000000000000129.
   
3. Ibid.
   
4. Asaf Goldschmidt, “Commercializing Medicine or Benefiting the People – The First Public Pharmacy in China,” Science in Context 21 (October 2008): 311–350, https://doi.org/10.1017/S0269889708001816.
   
5. Shen Kuo, 夢溪筆談 [Mengxi Bitan], produced by Jun-Bi Lai, Project Gutenberg, November 18, 2008, https://www.gutenberg.org/cache/epub/27292/pg27292-images.html.
   
6. Ali Mollahassani, Aoyu Cheng, Weidong Zhang, and Ye Wu, “The Transmission of Herbal Medicine to China via the Silk Road in Medieval Ages,” Chinese Medicine and Culture 8, no. 1 (March 2025): 13–23, https://doi.org/10.1097/MC9.0000000000000130.
   
7. Sean Bradley, “The Silk Road and Sources of Chinese Medicine Expansion: Part 2 – Formularies,” Chinese Medicine and Culture 1, no. 2 (July–September 2018): 68–70, https://doi.org/10.4103/CMAC.CMAC_20_18.
   
8. Mollahassani, Cheng, Zhang, and Wu, “The Transmission of Herbal Medicine to China via the Silk Road in Medieval Ages,” 13–23.
   
9. Du Zheng, quoted in Ann Paludan, Chronicle of the Chinese Emperors: The Reign-by-Reign Record of the Rulers of Imperial China (London: Thames & Hudson, 1998), 142.

Bibliography

Bradley, Sean. “The Silk Road and Sources of Chinese Medicine Expansion: Part 2 – Formularies.” Chinese Medicine and Culture 1, no. 2 (July–September 2018): 68–70. https://doi.org/10.4103/CMAC.CMAC_20_18.

Du Zheng. Quoted in Ann Paludan, Chronicle of the Chinese Emperors: The Reign-by-Reign Record of the Rulers of Imperial China. London: Thames & Hudson, 1998, p. 142.

Goldschmidt, Asaf. “Epidemics and Medicine during the Northern Song Dynasty: The Revival of Cold Damage Disorders (Shanghan).” T’oung Pao 93, no. 1/3 (2007): 53–109. http://www.jstor.org/stable/40376304.

Goldschmidt, Asaf. “Commercializing Medicine or Benefiting the People – The First Public Pharmacy in China.” Science in Context 21 (October 2008): 311–350. https://doi.org/10.1017/S0269889708001816.

Hu, Lingbai, and Xuedan Zhang. “Insights on Song Dynasty Medical Exams from Tai Yi Ju Zhu Ke Cheng Wen Ge (《太医局诸科程文格》 Examination Answers and Standards of the Imperial Medical Bureau).” Chinese Medicine and Culture 8, no. 1 (March 2025): 68–77. https://doi.org/10.1097/MC9.0000000000000129.

Mollahassani, Ali, Aoyu Cheng, Weidong Zhang, and Ye Wu. “The Transmission of Herbal Medicine to China via the Silk Road in Medieval Ages.” Chinese Medicine and Culture 8, no. 1 (March 2025): 13–23. https://doi.org/10.1097/MC9.0000000000000130.

Shen, Kuo. 夢溪筆談 [Mengxi Bitan]. Produced by Jun-Bi Lai. Project Gutenberg, November 18, 2008. https://www.gutenberg.org/cache/epub/27292/pg27292-images.html.