By Dr. James Flowers PhD
Research fellow at the Kyung Hee University in Seoul. He obtained his PhD in History of Medicinefrom the Johns Hopkins University School of Medicine. He is also a Chinese Medicine Physician.
The TCM community thanks Dr. Flowers for this article as a follow up of his interview on world acupuncture day 2023, contributed especially to our ever growing global TCM Community.
King Injo (仁祖 1595-1649; reign 1623-1649), the sixteenth monarch of the Chosŏn Dynasty (朝鮮 1392-1910), found enemies all around besieging and then attacking him. Almost immediately upon his ascent to the throne, taken by force in a coup, he faced a military rebellion. War with the Jurchens proved even more devastating. Injo is most well-known for provoking the Jurchen forces to attack his Kingdom twice, in 1627 and 1636, with the Chosŏn armies suffering terrible defeats. The coup de grâce was his ritualized humiliating formal surrender in 1636 to the Manchu Khan, Hong Taiji himself. Nevertheless, Injo was preoccupied with another more sinister threat to his existence, as he firmly believed that a black magic death spell had been ritually performed to kill him.
Much of the historiography of the mid-Chosŏn highlights the central role of Confucianism as the state ideology and its vigorous pursuit by scholar-officials. The primary sources suggest that this characterization, while reasonable, may be limited. Court officials generally accepted that a death curse had been cast and that this was a matter for concern. Controversy in the Injo court did not hinge on believing or not in black magic but rather centred on how to deal with this terrible curse. Beneath the official state rhetoric of Confucianism sat more primal beliefs, the native world of spirits and magic powers. For Injo, his most dangerous enemy was not without but within his court using the weapon of a hex placed upon his royal body.
Injo and Sadae (事大) “Serving the Great”
Injo overthrew his predecessor Kwanghaegun (光海君 1574-1641; reign 1608-1623), justifying this with indignation at the policy of maintaining equally friendly relations with the Jurchens and the Ming Empire (1368-1644). The Jurchens, inhabiting the lands we know as Manchuria or Northeast China, were threatening Ming China. Injo represented the faction within Chosŏn that advocated total loyalty to the Ming Empire, which also meant shunning the Jurchens. This was in line with the traditional sadae policy of supposed loyalty to China. Injo’s faction argued that it was immoral of Chosŏn to prevaricate in loyalty to Ming, as only thirty-one years previously Ming forces had intervened in repelling the massive Toyotomi Hideyoshi-led (豊臣 秀吉 1537－1598) Japanese invasions of Korea from 1592-1598. The Jurchen response to King Injo’s implementation of the sadae policy was to launch two invasions of the Chosŏn Kingdom.
Notes on Injo’s medical consultations consist of recording of his symptoms, the disease patterns and the treatments administered. Many of the prescriptions administered can be found in the state-sanctioned text Tongǔi Pogam (東醫寶鑒Treasured Mirror of Eastern Medicine 1613) compiled by the court doctor Hŏ Chun (許浚 1537-1615). Injo’s records give detailed descriptions of herbal medicines prescribed for him. For example, we find that palace physicans frequently prescribed for Injo, ginseng or In Sam. This is not surprising, as ginseng is well known as a common herb for supplementation in Korea as well as in China. Injo’s conditions mainly concerned deficiency and weakness of ki (氣). He also commonly suffered from dampness, a condition that may be understood as an excess of retained fluids in the body. This type of diagnosis, as a commonly seen condition, is also not remarkable.
Most notably, Injo suffered terribly from heat thought to be caused by vexation and irritability. Surprisingly, he did not attribute this continual spiritual turmoil and worry to his terrible humiliations at the hands of the Manchus with the kidnapping of his two sons and the subsequent devastation of the Chosŏn economy.Instead, he attributed his debilitated health and anxiety to a black magic death curse. The primary suspects were the Queen Mother Inmok (仁穆 1584-1632), and her daughter Princess Ch’ŏngmy’ŏng. Evidence was found in 1632 on a scrap of written text on a piece of silk in the palace.
Whatever the cause, Injo suffered very poor health from the tenth year of his reign until his death at the age of fifty-four. He continually suffered from frequent diarrhea, colds, and general weakness. The palace scribe emphasises Injo’s exertions causing exhaustion and even emaciation while performing his obligatory funerary rituals for Queen Mother Inmok in 1632.
The orthodox doctors of the Palace Medical Bureau Naeǔiwon (內醫院) attended to Injo’s health , but with little success. This included dietary advice, herbal prescriptions, acupuncture, and moxibustion treatment strategies sharing much in conceptual approach with medical practice in Ming China.
In response to the impasse in this health crisis, the Royal Palace brought acupuncturist Yi Hyǒng-ik (李馨益 dates unknown) from his countryside base to work in the Naeǔiwon. At first, Injo was sceptical but was persuaded to give physician Yi and his unique style of acupuncture a chance. After the initial course of treatment, Injo came to fully trust Yi and received his acupuncture at intermittent periods for the rest of his life. For Injo, Yi was the only healer who could give him some relief and comfort from his constant pain, both spiritual and physical.
Remarkably, in a court framed by Confucian ritual and protocol, the King’s most trusted healer sat squarely as a heterodox individual. Not fashioned as a Confucian physician trained in the official system, Yi’s special talent was an acupuncture technique that could deal with spirit possession. Unfortunately, the records do not give us Yi’s words or thoughts. Nor do the Palace Records elaborate on the details of the alleged curse. We only have a scrap of circumstantial evidence on a piece of silk and the firm conviction of Injo and those around him that he had been hexed. We learn that while Injo felt that Yi was his only effective healer, this aroused outrage and indignation from the orthodox healers in the Palace Medical Bureau. They protested that Yi’s treatments were not sanctified by any textual evidence and that to try unproven methods on the royal body was sacrilegious and also dangerous. Injo protected Yi and managed this concern that he was violating orthodox medical protocols by continuing to receive treatment from a range of Palace doctors, apparently with no result, while often receiving acupuncture treatment from Yi in secret in the middle of night.
Yi’s expertise lay in dealing with ghostly possession with his secret, unique style of hot needle acupuncture. The needles were immersed in flame before insertion into the patient’s body. Injo reported feeling much better from Yi’s acupuncture sessions, which also included moxibustion. This technique involved burning mugwort, a herb believed to contain therapeutic qualities, and which Yi believed to have magical properties. Moxibustion may be compared to cauterization in the Western medical tradition with the major difference that the emphasis in moxibustion is on the healing property of the mugwort plant.
Not only was Yi’s technique heterodox but also his choice of acupuncture points defied the conventions of the Palace Medical Bureau. The records list his choice of acupuncture points, which from a historical perspective bear a remarkable resemblance to Sun Simiao’s (孫思邈581-682) Thirteen Ghost Points. The approach of the doctors of the Palace Medical Bureau was in line with the naturalistic principles of balancing ǔm (陰) and yang (陽), and regulating ki and blood. The court doctors disapproved of Yi’s presence in the Palace, as his style sat outside the definition of accepted standards of medical practice. Yi represented theOther, the native Korean countryside, the residence of folk beliefs in ghosts and demons. Ironically, Injo had taken the throne arguing for adherence to Confucianism, as shared in common by both the Ming and the Chosǒn scholar-official class, and expressing horror at fostering relations with the “barbarian” Jurchens, people ignorant of Confucian norms and who practised shamanism.
Mostly absent from standard medical histories of the period, the Injo records provide rich primary evidence for beliefs in spirits and ghosts, central to understandings of health and disease, at the heart of the Royal court. To gain a richer understanding of Chosǒn medicine, accounts of spiritual healers, dealing in the occult and the numinous, help us to better understand the range of healing available. This is to accept Yi and the folk healers in general he may be taken to represent on their own terms.
Causes of Injo’s Illness
The secondary sources that discuss the Injo records argue that rather than being affected by the curse, his illness was instead caused by worry and stress at being defeated by the Jurchens and by the unexplained murder of his son, the Crown Prince, following his return from Qing China. We cannot retrospectively decide that Injo’s illness was not caused by the curse because this approach applies modern standards at the expense of actors’ categories. The world of spirits not only continued to exist for the Chosǒn people after the adoption of Confucianism, but also helped explain for King Injo and those in his inner court his mental and physical health.
Working in the Korean language, four scholars have written articles on the Injo case, but none have sought to inquire further into the question of magic in the Palace. While acknowledging that it was a significant phenomenon for Injo, each writer chose to analyse other concerns. Kim Hun argues that Injo’s illness lay in internal weakness of his spleen and stomach, rather than in any external cause such as a curse. Kim In Sook argues that Injo’s illness was caused by his participation in the Queen Mother’s funeral rites and his frustration at being defeated by the Jurchens. He refers to the magic in the palace as psychological suspicion. Oh Jun-Ho, et al., focus more on Lee’s acupuncture style and even concede that the hex caused Injo agony, but do not go so far as to link this torment to his illness. Finally, Kim Hyuk Kyu, et al., go furthest in conceding that the curse had a significant influence on Injo’s health. Having made this concession Kim, et al., then go on to argue strongly that the king’s illness was mainly brought on by his psychological torment on being defeated by the Jurchens with the added crucial factor of his son’s death.
Rather than applying modern standards of medical diagnosis, a more comprehensive understanding of healing in the Chosǒn period requires further investigation into such magical healing practices. Injo responded to his illness by receiving acupuncture, against the advice of some doctors, by a healer who specialised in breaking spells and exorcising noxious materials from the human body. This suggests a potent tension between court-mandated orthodox medicine and an alternative multifaceted world of folk and religious healers.
Correcting the one-sided picture of a Neo-Confucian Chosun society and medical practice requires further study of comparable unofficial religious practices both within and outside the court. Laurel Kendall’s anthropological studies of shamanism in contemporary Korea provide a good example of accepting exorcist practices on their own terms without seeking to find modernist explanations. Although his area of study is China, I also draw on Philip Cho’s research in which he argues that scholar physicians of the late imperial period, critical of religious healing practices involving exorcism, or zhuyou 祝由, reinterpreted these techniques as a secular therapy to treat emotional disorders. I believe this analysis can be applied to King Injo’s case, though argue that the operating categories of the historical actors must also be understood on their own terms. Thus, I both accept that Injo’s curse was a real problem for him and Yi’s treatments were grounded in the desire to quell dark matter caused by black magic, and consider modern interpretations that argue that Injo was somehow emotionally unstable.
The Qing Court
As a point of comparison with the Qing court, records of a later period show the Qianlong Emperor (乾隆1711-1799; reign 1735-1796) performing daily lengthy shamanic rituals including sacrifice of animals such as pigs to plea for protection from disease. This shamanic practice resonates with the Injo court with religious healing practices as central beliefs even though they are not featured as official state discourse.
Acupuncture is widely known as a Chinese practice but it is clear that acupuncture was practised much more extensively in the Chosŏn court than its Qing counterpart. The Qing emperors disliked acupuncture while the records show clearly that the Chosŏn emperors, Injo as one example, enjoyed acupuncture regularly. Acupuncture in the primary records of the Chosŏn Palace is seen as both a standardized system, in common with Ming practices, and also a native variant closely in tune with the world of the Korean village, abounding with ghosts and spirits. Orthodox acupuncture and Yi’s hot needle technique shared common features such as the same tools and a shared terminology. However, Yi’s focus was on exorcising noxious matter caused by external forces while the scholar-official doctors emphasised balancing energies inside the body.
For Injo, and presumably large numbers of people in the Chosun Kingdom, enemies in the form of practitioners of the dark arts and their associated noxious matter were as real as political and military enemies. Strategies were implemented to combat such malevolent forces. In Injo’s case, it was exorcism in the form of esoteric acupuncture. Rather, than seeing medical practice in the Chosun court as dichotomised between official scholarly physicians and religious healers, however, the records provide evidence of diversity and overlap in healing since Injo did not exclusively use Lee as his physician. Although religious healing does not appear in official texts, such as the royally sanctioned Tongǔi Pogam, the primary sources show it had a central role in practice. A localised practice such as Yi’s hot needle acupuncture provides just one example of complex layers of belief beneath the official rhetoric of Confucianism, even within the Royal court.
The Daily Records of Royal Secretariat of Chosun Dynasty, 承政院日記， http://sjw.history.go.kr/main/main.jsp
Cha, Wung Seok, ed 2012, “Medical Records of Palace Medical Bureau of Chosun Dynasty,” unpublished.
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Kim, Hun, 2005, “Examination of the Diseases of Chosun Dynasty’s Injo,” The Journal of Korean Medical History, 18:2. P. 15-37. 金勳， 朝鮮時代 仁祖의 疾病 관한 考察，한국의사학회지
Kim, Hyuk-Kyu; Kim, Nam-Il; Kang Do-Hyun; Cha Wung-Seok, 2012, “A review on disease records of King Injo of Chosun Dynasty-based on the records from the Daily Records of Royal Secretariat of Chosun Dynasty,” The Journal of Korean Medical History, vol. 25, no. 1. P. 23-41. 김혁규; 김남일; 강도현; 차용석, 조선 仁祖 질병기록을 중심으로, 한국의사학희지.
Kim, In-sook, 2004, “Homeopathic magic cases in the royal palace and its Political meaning in King Injo’s reign,” Chosun Journal of Medical History, p.79-111. 김인선, 인조대의 궁중저주사건과 그 정치적 의미, 朝鮮時代史學報。
Kim, In-sook, 2004, “King Injo’s Disease and Burnt Needle Therapy,” Korean Journal of Medical History, 13: 198-218. 김인석, 인조의 질병과 번짐술, 醫學史
Oh, Jun-Ho; Kang Yeon-Seok; Cha Wung-Seok; Kim Nam-Il, 2009, “The Lineage and Characteristic of Lee HyungYik ‘s Burnchim,” Journal of Korean Oriental Medicine, 30 (2): 46-55. 오준호; 강연석; 차옹석; 김남일, 李馨益 燔鍼의 계통과 성격, 대한한의학회지.
 Yi Kwal’s (李适) rebellion of 1624.  The Jurchen Later Jin Khan, Hong Taiji, reinvented the Jurchens as Manchus in 1635. Some modern-day Koreans, even scholars, routinely refer to the Manchu invasions as “Chinese”. This interpretation would have been surprising to Hong Taiji and his followers.  For example, Lee, 1984; Eckert et al, 1990; Deuchler, 1995; Pratt, 2006; Seth 2011.  The Daily Records of Royal Secretariat of Chosun Dynasty, (承政院日記1392-1910).  Injo’s two eldest sons, Sohyǒn (1612-1645) and Bongrim (1619-1659; reign as king, 1649-1659, as the king he was known as Hyojong 孝宗) were captured as hostages by the invading Manchu forces in 1636.  Inmok was queen to Sǒnjo (宣祖 1552-1608; reign 1557-1608) the fourteenth Chosŏn king. Injo was a grandson of Sǒnjo, but not descended from Inmok. There was no proof, but Injo suspected Inmok of involvement in undermining him, in the context of the acute factional struggles in Chosŏn politics. She was also known to surround herself with shamans.  Kim Kwang Hyun, representing this group in the palace argued that the king’s body must not be penetrated.  The renowned physician, Sun, as did many others, wrote of acupuncture as a method to deal with harm caused by ghosts. See Yu, 1995, “The Song of the Thirteen Ghost Points,” in Pacific Journal of Oriental Medicine, pp.9-19.  Kim, 2005  Kim, 2004  Oh, 2009,  Kim, 2012  Kendall, 1987  Cho, 2005  Wu, 2006 or Barme 2008, pp. 72-75.