Doing some quiet reading on the history of Chinese Medicine, I came upon the following areas that medical students were tested on during the Song dynasty in China 800+ years ago.
What fun the practitioners back then would have had learning what we know now about pathophysiology and the human body!
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Although the official history of the Sung gives prominence to three main divisions in medical education, sources closer to the changing curricula reflect 6, 8, 9, 13 and 14. The 13 areas examined in AD1212 became the usual number in later eras:
(1)Internal and general medicine(ta fang mo)
(2)Miscellaneous medicine (tsa i )
(3)Paediatrics (hsiao fang mo )
(4)Convulsive and paralytic diseases (fêng)
(5)Gynaecology and obstetrics (chhan)
(6)Ophthalmology (yen)
(7)Stomatology and dentistry (khou chhih)
(8)Laryngology (yen hou)
(9)Orthopaedics (chêng ku)
(10)Apotropaics (chu yu )
(11)External medicine (chin chhuang chung)
(12)Acupuncture and moxibustion (chen chiu )
(23)Interdiction (chin)
As late as the 20th century, examinations in traditional medicine followed a somewhat similar division into categories, with the addition of physiotherapy and history of medicine, and of course minus the last two categories.
(1)The so-called ‘black-ink purport’(mo i ), in which the examinee was given a sentence such as ‘those who treat illness must have a clear understanding of the way of Heaven and the patterns of the Earth’. The object was not to explain or interpret it, but to quote exactly from memory the long passage from the Nei chingin which it occurs.
(2)The ‘large purport’, also called ‘purport of the classic’ (ta i , ching i ). The examinee was expected to explain a canonical passage chosen to test mastery of the foundations of medicine, such as ‘the chhiof the liver flows to the eyes; when there is concord in the eye [functions], one can distinguish black and white’. To answer this question satisfactorily required ability to apply yin–yang and Five Elements reasoning.
(3)The ‘pulse purport’ (mo i ), which called for comment on a passage about pulse diagnosis from the Nei ching.
(4)The ‘discussion of a medicinal formula’ (fang lun ), taken from acanonical source such as the Shang han tsa ping lunor the Thai-phing shêng hui fang (Imperial grace formulary of the Thai-phing-hsing-kuo era, +). The object was to explain the physiological activity of each ingredient, as well as the results of their synergy.
(5)The ‘hypothetical instance’ (chia ling ) of diagnosis or therapy, meant to test the ability to apply learning to patients. One instance asked the student to explain a formula recommended for given symptoms by a standard source, containing ingredients that according to standard principles ought not to be combined.
(6)The question on ‘phase energetics’ (yün chhi ), which required the student to determine what effect the cosmic dispensation of a given year would have on therapy. This practice was not altogether unlike the astrology that was a routine part of medical practice in early modern Europe. In China no astronomical computation was involved, merely simple arithmetic.
Although it was essential to memorise many volumes of medical classics before one could cope with an examination of this sort, it also evaluated a command of abstract concepts and the ability to apply this learning to diagnosis and therapy. On the other hand, it did not presuppose clinical experience. One may not conclude that practical knowledge was never relevant to the evaluation of medical students.
When pupils in the National University, the Law School, and the Military School, as well as officers in the military garrison, fall ill, the students are to be sent in rotation to treat them. A printed form(yin chih) is to be issued to the student for each instance. The officials of the school or garrison are to write down the diagnosis and manifestations, and whether the illness ended or [the patient] died. The report is to be certified by officials of the Service. If after examining the patient [the student declares that the illness] is incurable, someone else is to be dispatched to treat it, and determine whether [the patient] dies or recovers. The details are to be written down as a basis for adding points to, or deducting them from, the student’s score. At the end of the year [the scores] are compared, and the [100 most successful] students divided amongst three levels. The ranking determined not only the student’s standing but his salary for the next year. The document adds that those who rank below the top 100 might be punished or expelled. After the Sung period, there were many minor modifications but little in the way of significant innovation. The Yüan and its successors tended to recruit students from medical families, although the Chhing relaxed this policy. Local practitioners could apply to fill teaching vacancies in the Yüan provincial system. The Imperial Directorate of Medicine(Shang i chien ) demanded that applications contain the details of the doctor’s social standing as well as of the medical cases he had treated. From AD1285 on the State periodically tested provincial medical teachers. The Directorate graded their examination papers as well as those of their students.
The Ming–Chhing system relied upon quarterly local examinations and a triennial central examination. Both were oral as well as written. The government used grade rankings to promote and demote incumbents, and to appoint neophytes Physician or, if the grade were lower, Student of General Medicine.
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Hmm, so there we have it. The different purports taken together equal a fairly badass examination system and I guess that medical students then were just as typically stressed and under-pressure as they are these days too. Thats good to know! heheh… studying medicine has never been particularly easy thing to do. For me I appreciate seeing what the standards were back then as it gives me something to reach for and the impetus to keep on at it. There is always more to know huh?
– From Science and Civilization in China Volume 6
