Understanding Case Records Pt. 1

YTS_01Further thoughts on understanding Ye Tian-Shi’s case records.

By: Jason Blalack

Ye Tian-Shi is quite arguably one of the most important clinicians in Chinese medical history. His most important contribution, Case Records as a Guide to Clinical Practice (lin zheng zhi nan), is a compilation of case records by his students. It should be noted that, for a period of time in the Qing Dynasty that doctors/students would only study this book while ignoring the “classics.” Although criticized for this by their teachers, it definitely demonstrates the impact that Ye’s case records had on medicine.

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Understanding Ye Tian Shi’s Cases

Charles Chace recently brought this following passage to my attention. We both found it interesting in helping to understand Ye Tian-Shi’s case studies and putting into context the shorthand style that his cases are presented in. It is an excerpt from Thinking with Cases — Specialist Knowledge and Chinese Cultural History(2007) by Charlotte Furth. A great read.

“… the admirers of Ye Gui (1666-1745) saw to it that after his death some of this legendary doctor’s personal clinical records found their way into best-selling collections. Of these, Medical Cases as a Guide to Clinical Practice (Lin zheng zhinan yi’an), published in 1768, was the most authoritative and enduringly popular (there survive thirty-nine editions printed before tlIe end of the imperial era). A clinically oriented innovator from a hereditary medical family in Suzhou, Ye established a model style of case history that continues to be admired and imitated even today. Stripped of storytelling flourishes or social detail concerning the patients’ identities, Ye’s cases offered a laconic narrative that cut through the presenting symptoms to an underlying diagnostic pattern and concentrated on a customized prescription formula. The “Organizing Principles” (Fanli) that introduced the first edition of the collection help explain its thinking. They warn of the limitations of the nosological categories that constitute the surface organization of the section headings. By the selection and arrangement of cases within each category, the reader is being taught to distinguish between easily recognizable symptoms and syndromes (zheng, clusters of symptoms) and the more subtle “diagnostic patterns” (zhenghou) that identify the disorder at the most fundamental level.

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