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American Academy of Political and Social Science
Remodeling the Arsenal of Chinese Medicine: Shared Pasts, Alternative Futures Author(s): Volker Scheid Source: Annals of the American Academy of Political and Social Science, Vol. 583, Global Perspectives on Complementary and Alternative Medicine (Sep., 2002), pp. 136-159 Published by: Sage Publications, Inc. in association with the American Academy of Political and Social Science Stable URL: http://www.jstor.org/stable/1049693 . Accessed: 30/09/2013 05:36
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ANNALS, AAPSS, 583, September 2002
Remodeling the Arsenal of Chinese Medicine: Shared Pasts, Alternative Futures

By VOLKERSCHEID ABSTRACT: The discourse on alternative medicine assumes that medical practices exist as distinctive medical systems that compete with each other in plural health care systems. Anthropological and historical research clearly demonstrates, however, that this is not so. Many so-called traditional medicines are revealed as inventions of distinctly modern regimes of knowledge and institutional practice, while the political needs of healers and the epistemological desires of researchers converge in the construction of distinctive medical practices for description, classification, and comparison. This article draws on genealogy as a possible way out of this impasse. It shows how different generations of physicians of Chinese medicine employed the same four core concepts to reflect on their practice, imbuing them with ever new meanings to relate them to the changing demands of clinical and political practice. Examining these core concepts reveals something about the essence of Chinese medicine without reducing our analysis to a misguided search for cultural essences.
Volker Scheid studied social psychology (B.A., University of Sussex) and medical anthropology (Ph.D., University of Cambridge) and is currently a Wellcome Trust Research Fellow in the history of medicine at the School of Oriental and African Studies, London. He has studied Chinese medicine in London, Beijing, and Shanghai and has practiced in the United Kingdom since 1983. His research interests focus on the development of Chinese medicine in late imperial and modern China. He is the author of ChiUniversity Press.
nese Medicine in ContemporaryChina: Plurality and Synthesis, published by Duke

NOTE:The research on which this article is based was enabled by a WellcomeTrust Postdoctoral Research Fellowship in the history of medicine. I wish to thank Dan Bensky, Christopher Cullen, Judith Farquhar,Thomas Quehl, Cinzia Scorzon,and Wu Boping for their comments on earlier drafts of this article. I am also indebted to Ding Yi'e,Fei Jixiang, and YuXin for aiding me with my research on the Ding, Fei, and Yu families in China.
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THE ARSENALOF CHINESE MEDICINE REMODELING
137
ESPITE the sentiments of tradition, ethnicity, and cultural singularity evoked by its name, Chinese medicine in the twenty-first century is not local, static, or backward looking. Rather, it is a global medical practice employed worldwide by physicians in more than 120 countries. In the United States alone, an estimated twenty thousand people practice some form of acupuncture. In excess of seventeen thousand foreigners traveled to China between 1949 and 1998 to study Chinese medicine, while some of the most famous Chinese physicians now practice outside of China. The Chinese government has envisaged earnings from the sale of Chinese medicines abroad in 2000 to exceed U.S.$80 million and is actively promotinga strategy to increase these revenues in the future (Meng Qingyun 2000, 719-30; Wang Zhipu and Cai Jingfeng 1999,67-69). Internally, Chinese medicine has always been immensely diverse, heterogeneous, and by implication, constantly evolving (Sivin 1987; Unschuld 1985). It thus should be imagined as an adaptive system (Dunn 1976) that actively assimilates and transforms concepts, models, and practices from other medical and nonmedical traditions, just as it constitutes itself a resource of techniques and ideas for appropriationby other cultural formations (Baer, Hays, et al. 1998; Baer, Jen, et al. 1998; Barnes 1998; Cassidy 1998; Hsu 1991; Scheid 2002; White 1998,
1999).1
Auricular acupuncture, invented in France in the 1950s, for instance, quickly traveled to China where it stimulated the extension of older
body-centered practices. These are taught today in modern university classrooms as aspects of traditional medical practice (Hsu 1996). Cybernetics, systems theory, black and white boxes, inferential statistics, dialectical materialism, and the Enlightenment teleology of scientific progress have become integral to how Chinese medicine physicians define what they do (Meng Qingyun 2000, 539-88; Zhu Shina and Sun Guilian 1990). Positron-emission tomograpy and CT scanners, blood pressure readings, and notions of mind borrowed from Western psychology constitute routine practices in modern Chinese medicine hospitals, where they are used side by side with older tools and technologies such as pulse and tongue diagnosis and strategies of formula composition (Ots 1990; Scheid 2002). In the West, meanwhile, Chinese medicine is indigenized through a process of synthesis that reconfigures it as simultaneously fulfilling medical, psychological, and religious functions (Barnes 1998). Yet the discourse on alternative medicine through which Chinese medicine is commonly apprehended in the West remains tied to an oppositional rhetoric that configures medical practices as discrete systems offering competing frameworks for relating to health and disease. Usually, the goals of this rhetoric are polemical: when the dynamic nature of biomedical science is contrasted with "a static historical tradition" underpinning "complementarymedical techniques"(Vickers2000), when two thousand years of Chinese medical history are condensed into a
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THE ANNALS OF THE AMERICAN ACADEMY
single "essential underpinning paradigm" (Heptonstall 2000) that can more easily be defended against criticism on the grounds of cultural incommensurability, or when Chinese medicine is promoted as a synthetic science irreconcilablydifferent from the analytic orientation of biomedicine (Porkert 1978, 1983). In other contexts, the creation of essential difference proceeds by subtler routes. Anthropologists and historians, for instance, readily acknowledge the historical plurality of Chinese medicine and the openness of medical systems and thereby have greatly advanced not only our understanding of Chinese medicine but also the polemical nature of the discourses that construct it as homogeneous. Unfortunately, heterogeneity on the level of description is all too often homogenized once more on the level of explanation through notions of distinctive cultural practices 1994), aesthetics (Farquhar (Unschuld 1990, 1992), or forms of reasoning (Hsu 1999). Here, the problem tends to be conceptual: a profound difficulty reconciling an analytical demand for essences with the dynamic complexity of actual living systems (Moore 1987; Turner
attached to each other to achieve effects. This will enable me to discover the fault lines that must invariably appear in all such syntheses but also the continuities that tie the past to the present across many apparent ruptures and discontinuities and that, in the manner in which they are remembered, offer different potentialities for the future (Duara 1995). In doing so, I hope to discover what is essential to any understanding of Chinese medicine in the contemporary era without losing myself in the vain search for cultural essences.
CHINESE MEDICINE: 1840-1935
The method I have chosen for my investigation is that of genealogy. I shall examine transformations in meaning and usage of a complex of
four concepts-principles (li), strategies (fa), formulas or methods (fang), and medicinals (yao)-that have long
been used by Chinese physicians to define their identity. In doing so, I follow in the footsteps of Raymond Williams rather than Michel Foucault. Foucault's (1972, 1974, 1976) critical genealogy was concerned with understanding how subjects are cre1994).2 As a consequence, rather ated through and within the operathan providing a critical perspective tion of distinctive regimes of power/ on the discourse of alternative medi- knowledge. Although such a stance cine, such research is easily co-opted opens up a horizon of inquiry that by the former'spolitically motivated seeks to grasp how the past is desire for rhetorical opposition.3 instantiated within the historical In this article, I seek to move present, its structuralist orientatoward a more critical form of analy- tions tend to fix discursive regimes to sis. My intention is to understand distinct geographic and temporal how heterogeneous ideas, practices, fields-the very temptation from institutions, and values-all with which I seek to escape.4 Williams's their own histories-become ([1976] 1983) project of historical
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semantics, on the other hand, sought to emphasize precisely the complex tensions within the present that are of by "communities" generated "keywords," which all carry with them their own diverse histories of meaning. In Williams's view, therefore, the present is neither homogeneous nor well structured but is a complex site of tensions characterized by continuity with the pastestablished in the domain of semantics through continuity of word usage-but also by the discontinuity and conflict that attach to struggles over meaning. The singular importance within the discourse of contemporary Chinese medicine of the four key terms I shall examine has been well captured by Judith Farquhar (1994), who referred to them as the "arsenal medicine" of Chinese (p. 20). Although the individual bricks of this arsenal had long been used by Chinese physicians, they were joined together for the first time in 1935 set by the into a distinguishable Xie Guan (1880scholar-physician 1950).5 Xie, an important writer, educator, and activist for the cause of Chinese medicine during the Republican era, stated in the conclusion to an influential history of Chinese medicine, "To sum up [one can say that the] essentials [of Chinese medicine] do not lie outside four single characters: principles, methods, formulas and medicinals" (Xie Guan 1935, 62b). Xie came from a lineage of scholars and physicians from the small in Wujin hamlet of Luoshuwan County, Jiangsu Province. He was thereby related by proximity (and
also perhaps apprenticeship) to a group of well-known literati physicians from the nearby town of Menghe, an influential local and national center of medicine during the late nineteenth century (Chen Daojin 1981; Huang Huang 1984). In their discussions about the nature of medicine, Menghe physicians consistently drew attention to the same concepts later picked up by Xie. Most important of these was the notion of li, or principle, an important term in neo-Confucian philosophy where it refers to that which makes things the way they are and thereby constitutes the prime object and source of knowledge (Fung 1953). For literati physicians in late imperial China-who came from or aspired to membership conin elite society-Confucianism stituted an obvious point of reference (Chao 1995; Wu 1998). Not surprisingly, only those who understood for the doprinciples-explicated main of medicine in the canonical works of the medical archive-could hope to become proficient physicians. Examining clinical formulas is exactly like examining [other] pieces of contemporary scholarship. Where one's understanding of sagely principles goes all the way back to ancient literature, one's knowledge and learning have deep roots, while in the clinic one's selection of strategies and use of medicinals will have the marvel of always being able to achieve success. (YuJinghe [1891] 1996, 1358) The author of this passage is Yu Jinghe (1847-1907), who studied and worked in Menghe for twenty years. His daughter was married to one of the sons of his close friend Ding Ganren (1865-1926), another physi-
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cian from Menghe who practiced in Shanghai, where in 1916 he had founded the enormously influential Shanghai Technical College of Chinese Medicine (Shanghai zhongyi zhuanmen xuexiao). The first academic dean employed at the college was Xie Guan, whose grandfather is said to have studied with the same as family of Menghe physicians Ding.6 Li, principles, also had an important social function, as Yu Jinghe ([1891] 1996) made clear in another section of the book cited above. For membership in the community of literati physicians, including the right to evaluate and pass judgment on each other, was conditional on their mastery of principles. My friends asked, "Howcan you be sure that later readers will believe the case recordsyou have edited [in this book]?They do not know whether [the treatment administered at the time] was effective or not."I replied, "Themyriad things do not go beyond principles. If one knows the principles of medicine, one can naturally [follow]the differentiation [ofsymptoms] and one will naturally believe [in the results]. Those who do not know the principles of medicine not only are unable to differentiate [symptoms]but whether or not they trust me is also of no consequence."(YuJinghe [1891] 1996, 1358) Such understanding of universal principles was grounded, above all, in book learning.7 The importance of such scholarly knowledge was, however, considered insufficient on its own to guarantee clinical success.8 Rather, it required a practical supplement, as explained by Fei Boxiong
(1800-1879), the chief ideologue of the Menghe medical style: The terms pulse, symptoms and treatment-by which I mean first inspecting the pulse, then differentiating symptoms and signs and finally applying treatment-these three constitute the three principle rubrics [of medicine]. With regard to the term "treatment"one can furthermore distinguish between three levels. These are called principles, strategies and orientations (yi). Medicine [reflects] medical principles, treatment [embodies] treatment strategies. Adaptive decision making responsive to changes in the disorder, however, must also follow orientations that lie outside of [established] strategies. (Fei Boxiong [1863] 1984, 6) Fei Boxiong here supplements an understanding of principles (defined as the doctrines that constitute the explicit framework of medical knowledge) and strategies (the formalized techniques and technologies of curing) with a third and crucially important aspect of medical practice: the reading and bestowal of significations and one's reaction to them that are context specific and mediated by subjective understanding. Chinese physicians had long employed the notion of yi-a term that can also be translated as attention, intention, thought, meaning, and will-to point to those aspects of medicine that can be apprehended but are difficult to explain in words (keyi yihui, nan yu yanchuan). Yi was therefore used whenever one wished to refer to a physician's ability to grasp the everchanging (bian) transformations of illness in clinical practice that lie be-
THE ARSENALOF CHINESE MEDICINE REMODELING 1 FIGURE BETWEEN INTEXT RELATIONSHIP PHYSICIANS CITED
"GOLDEN MIRROR MEDICAL
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YU CHANG
(15851664)
OF THE
LINEAGE"
(1742) Background Knowledae
Influenced by Doctrines
Teacher and
Lineage
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ACADEMY THE ANNALS OF THE AMERICAN CHINESE MEDICINE:1935-1966
yond the regular (chang) manifestations described in books. It also signaled the difficulty of passing on through the medium of language those kinds of knowledge that following Polanyi (1958), we nowadays refer to as implicit and link to artistry and craft.9 The essential tension between the regular and the changing is mirrored in Fei Boxiong's ([1863] 1984) separation of pulse diagnosis and symptom differentiation. This is strikingly different to contemporary usage, where the pulse is simply classified as one of the four methods of diagnosis (si zhen). In practice, therefore, many contemporary physicians feel entitled to downgrade the importance of pulse diagnosis or to disregard it For Fei Boxiong, completely.10 instead, pulse diagnosis was essential. If pulse and symptoms pointed to the same pathomechanism, a corresponding treatment strategy was easily devised. If, on the other hand, pulse and symptom differentiation indicated contrary pathomechanisms, a more judicial form of decision making was required that drew on the physician's ability to relate the regular and changing manifestations of a disorder to one another. This difference gains in significance if we consider that due to the difficulty of transmitting pulse diagnosis through verbal instruction alone, it had long enjoyed an emblematic association with the notion ofyi. For the modern Chinese physicians who perceive themselves as scientists, on the other hand, anything that cannot be put into words has become an extremely suspect entity.1l
To literati physicians such as Fei Boxiong and Yu Jinghe, the principles and strategies of medicine embodied enduring truths transmitted since antiquity, even if in practice they required supplementation by the local intelligence of yi. Such claims to the universal validity of Chinese medical knowledge had become much less self-evident by the time Xie Guan wrote his history. During the intervening half century, China had become enchanted by modernity and the construction of a new society that in its very definition had little time for the old (Lee 2000). Exploitation of nationalistic sentiment was one avenue open to scholars like Xie who wished to preserve aspects of tradition in a society gripped by scientism (Kwok 1965). The modernization and scientization of tradition itself was another. In practice, both routes were usually joined into a single project (Andrews 1996; Croizier 1968; Lei 1998; Zhao Hongjun 1989). Qin Bowei (1901-1970), a student of both Xie Guan and Ding Ganren and an influential writer and teacher of Chinese medicine in Republican Shanghai and later Beijing, laid out this route with exemplary clarity.12 How to reformChinese medicine?How to develop Chinese medicine? [Answering these questions] should be informedby a penetrating knowledge of China's medicine itself. Here I cannot forget that I myself am a Chinese person and I can even less forget that those people I treat are also Chinese people. (Qin Bowei, cited in Huang Shuze 1985, 174)
143
The successful completion of this project, as Qin Bowei spelled out, demanded intimate familiarity with Chinese medicine itself and could therefore only be accomplished by the Chinese working from within their culture and tradition rather than bending to pressure from without. This project of reform had to accommodate to the historical plurality of Chinese medicine-encompassing not merely the universal principles of the original classics but also their continual adjustment to contextual circumstance by later physicians-to remain loyal to the idea of a national culture. It also had to satisfy the demands for systematization and regularization that were by then identified as the hallmarks of science in China (Hui 1997). Xie Guan's condensation of the many weapons accumulated during Chinese medicine's long history into a single arsenal fulfilled these needs.
propriate to each given case. One cannot [just]follow a given precedent. (Xie Guan 1935, 62b) Xie here takes up key themes discussed by his medical ancestors but adjusts them to the changed intellectual milieu of his time. We can note, first, that the tension between universal principles and the local orientations has been replaced by a new dialectic between general knowledge and concrete application. If the former accords an important place in medical practice to nonverbal reasoning and insight, the latter de-emphasizes these tacit dimensions because in theory, rules of practice might be specified for both general and specific contexts. At the same time, the principles that ground Chinese medical thinking are explicitly placed on an equal epistemic footing with those of Western knowledge.
The Changes state: [things taken to the] The human body may tend towards de- extreme change. Throughtheir changing pletion or repletion, heat or cold. In each they connect with each other and mutu[respectivecase] one decides upon warm- ally change into each other.Hence in realing or cooling, attacking or supplement- ity what mutually causes each other also ing [strategies] and administers [corre- mutually produces each other. This is sponding]formulas to return it to a [state clearly evident in the principles of evoluof]balance.All these principles and strat- tion (tuihua zhi li zhe). Even less must egies can be used throughout all prov- one therefore remain bound by views of inces and [also] all other countries.A per- the past. It is the same with medicine. son's body may be strong or weak, old or (Xie Guan 1935, 3a) young. Disorders may be recent or longstanding, light or serious. Climates may Medical history is translated here [vary between] cold and warm, dry and into the Darwinian idiom of evolumoist. The environment may be hard or tion in vogue throughout Asia at the soft, gentle or demanding. All these fac- time (Dikoetter 1997), and a space tors [can be classed] as changes of [local] for reform. Yet opened up progressive situations that [can be responded to] by in to accord to Evolution of refusing medicinals and comcollecting [different] a different in Species formulas. For epistemological [different] [composing status than to the Book of Changes, posing] formulas and combining medicinals one should follow what is ap- the universality of principle is as-
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In paradigmatic serted in the very same move. If Darfashion, win had a place in China, then Chi- bianzheng lunzhi constitutes medinese medicine also had a place in the cal problems as kinds of disorders West. Hence, the cover of Chinese (bing) that manifest in the form of illMedicine World (Zhongyi shijie), a ness patterns (zheng). These patjournal published between 1929 and terns reflect distinctive patho1937 by Qin Bowei, depicted a globe mechanisms (bingji) that can be across which was written in large let- understood and analyzed with the ters: "Transforming Chinese Medi- help of the principles embodied in cine into a World Medicine" (Hua Chinese medical theory. Once a zhongyi wei shijie yi). pathomechanism has been correctly Xie's formula circulated widely understood, it opens the way for the among Chinese physicians, helped discussion of treatment strategies, along by the many new networks by means of which it may be corthat were created during the first rected. One or more such strategies phase of institutionalization and are combined into the composition of professionalization of Chinese medi- a formula or treatment method that cine in Republican China. However, is realized in the clinic through the given that this labor was largely pri- application of specific medicinals vately organized and lacked a strong (Farquhar 1994). One of the chief architects of this unifying center, its networks remained highly volatile and frac- paradigm was Shi Jinmo (1881tured along various dimensions 1969), an influential scholar-physician from Beijing. Shi occupied a Croizier Zhao (Andrews 1996; 1968; Hongjun 1989).13 Scholar-physicians leading position in the National succeeded in Institute of Medicine (Guoyiguan) Chinese only centering medicine on a common core para- during the 1930s, an organization for digm during a second phase of state- which Xie Guan worked as an advimediated regularization. A para- sor. In 1930, Shi founded the Northdigm, in Thomas Kuhn's (1970) defi- ern School of National Medicine nition of the term, specifies a model (Huabei guoyi xueyuan) in Beijing, for solving problems that practitio- where he taught one of the first ners of a given science bring to bear courses on bianzheng lunzhi. In on the puzzles confronting them in class, Shi employed the case records their life worlds. For contemporary of Ding Ganren, which he edited and Chinese medicine, this paradigm is reprinted for the purpose, as exemthe practice of "pattern differentia- plary models for teaching students tion and treatment determination" the practice of Chinese medicine.14 (bianzheng lunzhi), which was conDing Ganren (1960) had earlier structed during the 1950s and 1960s presented a systematization of Chiand has been accepted ever since as nese medicine by condensing his clinthe "pivot" of medical practice ical approach into 113 treatment (Farquhar 1994; Scheid 2002). strategies. Each of these strategies
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was represented by a model formula. Students might use these formulas in practice by adjusting their constituent medicinals to the concrete presentation of an individual case. More often, however, they would use other formulas from the medical archive or even compose their own, while drawing on the principles of disease mechanisms and treatment strategies embodied in each of Ding's formulas (Huang Wendong 1962; Zhang Baiyu 1985). Shi Jinmo advocated a more radically modern approach. Disorders were to be diagnosed on the basis of biomedical disease nosologies but treated on the basis of pattern differentiation. The foundation of this paradigm remained firmly rooted, however, in classical precedent. Confronting [clinical] patterns is similar to confronting [enemy]battle formations. Using medicinals is similar to deploying soldiers. One must follow a clear differentiation of patterns and symptoms, be minutely familiar with the composition of formulas and [be able to] effectively and flexibly employ medicinals. If one does not know the principles of medicine, it is difficult to differentiate patterns. If one's differentiation of patterns is unclear,one has nothing from where to establish a strategy [for treatment]. One may still pile up medicinals [into a prescription, though it is bound] to be confused and disorderly.(Zhu Shenyu 1996) In rooting the paradigm of pattern differentiation in the understanding of principles, Shi Jinmo's views deviated little from those of the editors of the Golden Mirror of the Medical Lineage (Yizongjinjian), a compendium of medicine published under the aus-
pices of the Qing court in 1742 and used as a manual at its Imperial Academy (Taiyi yuan).
A physician who is not intimately familiar with bookswill not understand principles. If he does not understand principles,
he will not understand what is essential. Clinical patterns are [constantly] shifting and changing. If, [in response] one roams about without a definite view, then medicinals and patterns will not be matched and it will be difficult to obtain results. (Wu Qian et al. [1742] 1987, 17)
The similarity in content and style between these two passages throws into relief the idea that the systematization of medicine advocated by Ding Ganren, Xie Guan, Shi Qinmo, Qin Bowei, and their peers was motivated by the same goals that had inspired previous generations of physicians. Like in other established traditions of knowledge that base themselves on written texts that do not disappear with the death of their authors, the growth of knowledge within Chinese medicine had long presented a problem of social epistemology for its practitioners (Fuller 1988; Goody 1987). Influential literati physicians like Yu Chang (15851664) had advocated, therefore, that physicians needed to develop an understanding of what was essential and what was not. "[Regarding] the art of medicine [one can say] that if one does not [grasp its] essence one cannot understand its principles. If one does not [possess] a wide knowledge one cannot penetrate to the limits [of the discipline]" (Yu Chang [1658] 1999, 214).
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The change accomplished during the Republican period nevertheless was profound. Previous generations of physicians had searched for essences and principles within the canons of the past but also argued to extend their relevance to the present by means of the local intelligence of yi. Xie Guan, his peers, and his students, on the other hand, sought to systematize the principles of the past into universally valid knowledge or procedure. This project depended much more than before on shared effort and the institutional infrastructures that are preconditions for establishing a paradigm and therefore a science in the modern sense of the term. Mindful, however, of the limits of formalized knowledge and generalized principles in a shifting and changing world, the demand for flexibility and the emphasis on individual skill and insight-despite a generalized rejection of idealism and metanever physical speculation-was entirely surrendered. As a consequence, the curricula of Chinese medicine schools at the time included not merely classes in medical theory and practice but also classes in literature, poetry, and calligraphy to educate scholars who might accomplish for Chinese medicine the goals stipulated by Yu (Qiu Peiran 1998, 2000; Yang Xinglin and Tang Xiaohong 1991). Education at the newly established Colleges of Chinese Medicine in Maoist China would build on these transformations but channel them toward different objectives: efficient health care for the masses, the development of knowledge under the
guidance of dialectical materialism and the party, and an emphasis on practical knowledge. In the pursuit of these goals, classical texts were replaced with modern textbooks, the study of principles (li) with that of basic theory (jichu lilun), and the understanding that comes from careful exegesis with the comprehension of explicit facts (Hsu 1999; Taylor 2000). For the older generation of physicians who established these courses and compiled their textbooks, the difference between principle and theory remained one of terminology rather than meaning. Ren Yingqiu, the most preeminent academic in the field of Chinese medicine during the Maoist period, for instance, described the study of theory in terms that are at least as close to the Golden Mirror as they are to Mao Zedong's (1968 [1937]) On Practice (Shijian lun). All academic labor is characterized by a dialectical relationship between essential and wide knowledge. With regard to basic theory (jichulilun), it is essential to achieve proficiency and succinct understanding in this area. With regard to what does not belong to the basics but constitutes general knowledge that has a direct or indirect relationship to the subject, this must be followed up through extensive reading [of key texts] and then widened though more cursory readings [ofother material]. (ZhouFengwu, Zhang Qiwen, and Cong Lin 1981-1985, 1) The students educated in basic theory, however, were often lacking in the wide reading and scholarship deemed essential by Ren Yingqiu and his peers and found it increasingly difficult to cut through the ever-
MEDICINE OFCHINESE THEARSENAL REMODELING changing manifestations of illness on the basis of their grasp of principles alone.'5 They demanded rules of practice that resembled more closely the straightforward connection between diagnosis and treatment perceived to be characteristic of Western medicine, a subject that now constituted a significant part of the curriculum at Chinese medicine colleges.
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MEDICINE: CHINESE
1966-2001
These tendencies were accelerated during the Cultural Revolution. Demands for a practice-based medicine and a tighter integration of Chinese and Western medicine further downgraded the importance of principles and their locus in classical scholarship. What had previously required a lifetime of study could now be summarized in a 133-page manual (Beijing Zhongyiyuan geming weiyuanhui 1971). These transformations-but conversely also the power of tradition to conbe read off from strain them-can what happened to Xie Guan's essential concepts. Pattern differentiation and treatment application represent the concrete clinical usage of Chinese medicine's principles, methods, formulas and medicinals. These [concepts]constitute the theoretical tenets (lilun yuanze) of Chinese medicine's clinical work, but [simultaneously] also concretemethods for decidingpractical questions in diagnosis and treatment. (Beijing zhongyiyuan geming weiyuanhui 1971, 1)
The context in which this discussion occurs shows that an explicit effort is made here to align the paradigm of pattern differentiation with the practice orientation of Maoism. Hence, even though principles are now equated with theoretical tenets, the productive tension between theory and practice is emphasized most of all. Rather than thinking of practice as derived from and dependent on doctrine, theory is now reduced (or lifted up) to the status of a practice. Any reference to individuality, however, has completely disappeared. Medicine no longer emerges at the interface of individual scholarship and insight but within the dialectic between theory and practice of medicine as a social system.16 This narrowly Maoist reinterpretation of Chinese medicine was relatively short-lived even if its effects endured. The cultural and economic reorientations that followed the fall of the Gang of Four in 1976 created a social space in which the acknowledgment of individual achievement became possible once more. This space was rapidly filled by a literature that drew on classical genres but imbued these with novel significance: individual biographies; case records and anthologies of medical essays published by individual physicians, their students, their colleagues, or their work units; and histories of local medical traditions at the sponsored by institutions regional, provincial, or national level. If initially this literature reflected a striving for and acknowledgment of individual merit, economic liberalization increasingly is adding to such
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motivations the need for self-promotion in the pursuit of monetary gain. At no time, however, did this literature seek to challenge the vision of Chinese medicine as a unitary tradition institutionalized at the level of the state through the creation of an officially plural medical system in the early 1980s (Farquhar 1992a, 1992b,1996). This synergy between private and social goals emerges from the particular relationship between past, present, and future inscribed into the constitution of contemporary Chinese medicine through the concept of inheriting and developing (jicheng fayang). Whereas the Kuhnian model of scientific revolution that underpins biomedicine's historical self-image visualizes science as a social system stratified by a few big men who create the breakthroughs and set the terms for the masses of normal scientists, the development model of contemporary Chinese medicine necessitates a quite different configuration between individual and collective achievement. Socially, Chinese medicine is perceived to be a transcendental object realized a through process of gradual accumulation and systematization that accepts from individuals that which it finds useful and rejects the rest. Individually, however, any given treatment episode embodies the reverse process: physicians utilize from the accumulated archive of the tradition that which they find useful and discard what they do not need (Jia 1997; Scheid 2001). Within the discourse of pattern differentiation, this difference between biomedicine and Chinese med-
icine is clearly expressed in a contribution to Methodology in Chinese Medicine (Zhongyi fangfa lun), part of a series of influential self-reflective texts published in the early 1990s (Xiao Dexin 1992). The authors began by noting that "everyone knows that pattern differentiation and treatment determination embodies in its totality the four separate aspects of principles, strategies, formulas and medicinals" (p. 246). They then determined that principles correspond to pattern differentiation, while strategies, formulas, and medicinals can be subsumed under the heading of treatment determination. Next, pattern differentiation is defined as constituting a process of diagnostic reasoning (zhenduan tuili) that embodies universal reason and transcends individual experience. Treatment determination, instead, is the product of contextually emergent process. In Western medicine, once one has diagnostically defined the name of the disease, the method of treatment down to the use of medicinals [follows]relatively straightforwardand clearly.Having diagnosed "disease" and "pattern",Chinese medicine must still formulate what is appropriate in terms of "the individual patient, the season and the environment" [before] selecting the appropriate treatment method and mode of application.... Therefore, Chinese medicine treatment is a selective process [demanding] flexibility and careful deliberation. (Xiao Dexin 1992, 248) Other contemporary writers reach similar conclusions. Summing up the development of pattern differentiation as a paradigm of Chinese medi-
REMODELING THE ARSENALOF CHINESE MEDICINE
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cine during the past half century, the and historian Meng physician Qingyun (2000), for instance, was led back to the dialectic between regularized models and methods referred to as exemplars (xiao) and contextual, subjective, and intuitive orientations (yi). "Exemplars"and "orientations"refer to two different models of thinking. The former is employed in context of standard situations and [concernedwith what] is regular and constant. The latter, in contrast, is employed in the context of nonstandard situations and [concernedwith what] is changing and different. (P. 89) Such statements may lead us to presume that in spite of a century of regularization, standardization, and scientization, hospitalization, institutionalization and in spite of consistent subjugation to the combined discourses of modernization, scientism and dialectical materialism, the essence of Chinese medicine, have survived not only intact but also unchanged and that in spite of the claims I made in the introduction, such an essence does exist after all. That, however, would be an illusion. Although Meng Qingyun and the authors of Methodology accord a place to subjectivity in the practice of Chinese medicine, it is subjugated to the primacy of regularized exemplars and universal reason. The latter are always discussed first and at length, while subjectivity is called on to fill in the cracks in a paradigm that hankers after the prestige of regularized science but continues to draw its legitimacy from the individual experiences stored in the archives of tradition. This represents a distinctive
step away from the estimation of the previous generation of physicians such as Qin Bowei, who explicitly accorded equal value to regularized patterns and treatment methods and subjective processes of differentiation and determination. It is more than two steps removed from physicians such as Fei Boxiong, who not only estimated the subjectivity of yi to be necessary to check the knowledge of li but also perceived principles not as self-evident facts but rather as awakenings (wu) of the mind in the process of exegetical study and scholarly self-cultivation. And it represents an entirely different conception of medicine to that of writers such as Zhao Xuemin (17191805), who accorded value not merely to the scholarly medical tradition but also to the itinerant physicians and herb peddlers, the barefoot doctors of his day, for whom li andyi, knowledge and experience, appear not to have been distinct categories of mind. Medicine is yi. It is not as good to use medicinals, as it is to use yi. Whether or not a treatment works is based onyi. Ifyi can enter the fundamental subtleties [of the illness], one can achieve a penetrating understanding. After this, when one uses medicinals, none will not work as expected. (ZhaoXuemin [1759] 1998, 12) Hence, I argue that the place accorded to subjectivity in contemporary Chinese medicine-acknowledged but simultaneously subjugated to a more powerful universal reasonrepresents a tactic judiciously employed to negotiate a set of acute problems. It succeeds to differentiate Chinese medicine from biomedicine without overtly challenging the fun-
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damental principles of modernism; and it allows Chinese medicine physicians to regularize their medicine in the spirit of science yet also fall back on personal experience when the former turns out not to be effective.17 However,the global market toward which the Chinese state is now orienting the national economy (and of which Chinese medicine is an important part) may be less accommodating of such tactics in the future. On 4 June 1997, the State Council of the People's Republic of China decided on a national research program to be implemented in the period from 1998 to 2010. The program was conceived with the explicit goal of guiding economic and social development by finding solutions to important issues confronting China in the twenty-first century. Research into Chinese medicine formulas was listed as one of forty-two projects in the program and was allocated funding of approximately U.S.$7 million, the largest grant for Chinese medicine research ever awarded at the national level (Anonymous 2001). Xie Guan's arsenal of principles, strategies, formulas, and medicinals is mobilized in the program'soutline description to anchor individual research projects.A continuity of tradition is thereby suggested when, in fact, the programengages in a fundamental transformation of traditional values shared across previous periods in spite of much apparent change. During the Republican era and also in Maoist China, the goal of modernization (xiandaihua) in Chinese medicine was the regularization
(guifanhua),scientization (kexuehua), and sorting out (zhengli) of its theoretical framework. Except for the brief period of the Cultural Revolution, this enterprise was guided by elite physicians, many of whom were connected through direct lineages of descent to literati physicians in late imperial China.18 Hence, even though this process of modernization drew on novel forms of social and intellectual organization, its emphasis on principles resonated with the orientation of previous generations of physicians and left sufficient space, too, for their flexible application in clinical practice.19 The explicit objectives of new research, however, are no longer primarily intellectual but increasingly motivated by economic considerations. The research program outlined above, for instance, has as its main objective the enhancement of the understanding of formula composition and efficacy with the intention of advancing technologies of production for traditional pharmaceutical products and introducing them into the mainstream of international pharmaceutical markets (Anonymous 2001). This marks a radical remodeling of Xie Guan's arsenal. The value of principles and strategies-difficult to insert into global networks and even more difficult to do so at a profit-is downgraded. Drugs, as history demonstrates and Chinese physicians very well know, can easily be poached by biomedicine and thereby removed from its arsenal altogether.20 Only formulas-distinctly Chinese, derived from theories and strategies, and composed of
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to condense medicinals-promise into a marketable commodity the treasure house of Chinese medicine in such a manner that its arsenal remains intact, preserved by calculations of economic advantage rather than as to date, by nationalist pride or humanist concerns for the welfare of others.21
CONCLUSIONS
The philosopher DelkescampHayes (1993) summed up a recent symposium on the nature of medicine in the West by noting that it "can only be described in terms of a network of relations between various aspects of activities denoted by the terms 'science', 'technology' and 'art'" (p. 271). The recent history of Chinese medicine, described and analyzed in terms of the ongoing restructuring of its arsenal, can easily be accommodated to this view if we assimilate principles and strategies to science; formulas and medicinals to technology; and the subjectivities of orientations, intentions, attention, will, and understanding to art. In doing so, we remove any categorical distinction between Eastern and Western, conventional and alternative, medicines and open up, instead, a horizon of inquiry that retains a scope for comparison but does not insist on unwarranted reductions. This allows me to make the following observations relevant to the place of Chinese medicine in relation to the discourse on alternative medicine in the West. First, identity, knowledge, and practice in Chinese medicine are shown to be intrinsically
interrelated. It thus does not make sense to think of Chinese medicine other than with reference to the concrete contexts in which it is being employed and to those who employ it. Second, although individual physicians will continue to deploy the tools available within the arsenal of Chinese medicine as they see fit, other agents have an important influence on their freedom to do so. Medical careers in contemporary China, for instance, are increasingly dependent of physicians' active contribution to the kind of research efforts outlined above, while bureaucratically determined standards constrain the content of principles, the nature of strategies, the classifications of formulas, and the application of medicinals.22 Third, the goal of integrating Chinese medicine into global technoscientific networks actively pursued by the Chinese government with the explicit support of practitioners in East and West involves a profound shift in emphasis from medicine practiced in the pursuit of knowledge, merit, and the beautiful (He Yumin 1987, 1-17) to medicine as an economic activity.23 The result will be a novel articulation between the domains of science, technology, and art and of perceptions of what it means to be ill and what it means to be healed. This reevaluation is bound to reduce the value accorded to subjectivity in medicine while emphasizing those elements that can be more easily administered, packaged, and transferred between different locations. Chinese medicine may still be different from biomedicine, but different in different ways.
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This implies that those serious about their commitment to Chinese medicine as an alternative medicine will have to question whether they are searching for alternatives in the right places. I have shown that it is easy to leave concepts intact while profoundly changing their meaning, practical usage, and articulation. Greater sensitivity to the manner in which Chinese medicine has historically configured itself as a practiceand here in particular the role accorded to the articulation between science, technology, and art-may produce a different sense of what is essential, different, or important and open up a space for diverse and alternative futures. Notes
1. Technological borrowing has made possible large-scale social and cultural change since prehistoric times (Ricklis 1992) and continues to do so as theories, technologies, and those who make and implement them travel increasingly faster in a postmodern world (Perry 1995; Said 1982). Hybridity and syncretism, mediated and structured by competition and power differentials rather than the coexistence of clearly demarcated medical systems, appear to be the norm where different medical practices coexist in the same sociocultural 2000; space (Ayora-Diaz Brodwin 1996; Craig 2000; Flint 2001; Lock 1980; Obbo 1996). 2. Unschuld (1990), for instance, attributed the plurality of Chinese medicine to a greater willingness of members of Chinese culture to tolerate cognitive dissonance. Such explanations remain circular (and therefore meaningless) unless they can specify the factors and mechanisms that would generate and maintain such stabilities across changing sociohistorical contexts and populations. As a consequence, the true effect of such attributions is to hide the heterogeneity, plurality, and disorder in biomedical science, which is the contextual other in this discourse.
3. Recent attempts to move toward a single integrated medicine that would combine conventional and alternative medicines (Goldsmith 1999, 2287; Vickers 2000) do not undercut this argument. First, their desire for synthesis proceeds from a classical model of dialectical opposition. Second, integration most commonly implies subjugation and assimilation of alternative medicines to the dominant framework of biomedicine. Irrespective of the political economies that motivate such efforts, they proceed from an epistemology that views medicine in terms of a hierarchy of systems with biomedicine at the top (Baer 1995; Lock 1990). 4. Knauf (1996, 157), following Feher (1990), argued that as a genealogist, Foucault was always concerned with the structure of regimes of knowledge/power rather than the complex processes that generated, stabilized, or changed them. 5. This, at least, is the first occurrence I have been able to make out and to which contemporary discussions attach. The vastness of the archive of Chinese medicine does not permit me to pronounce with absolute certainty that Xie Guan did not, in fact, copy from someone else. 6. For a biography of Yu Jinghe, see Dai Zuming and Yu Xin (1997). For biographical material on Ding Ganren, see He Shixi (1991). For a biography of Xie, see Chen Cunren (1954). I discuss the social relations between these physicians in greater detail in Scheid (forthcoming) but mention them here to underline the close interconnection between the formation of social networks and the development of knowledge in Chinese medicine. 7. The concepts of learning held by literati physicians such as Yu and Fei can be traced back to those advocated by paragons of neoConfucian learning such as Zhu Xi (cf. Fung 1953, 651-52). 8. For a more detailed discussion of the tension between empirical efficacy and scholarly learning in Chinese medicine in late imperial China, see Wu (1998). My own research, however, cautions against simply conflating this tension with the social difference between family and scholarly medical traditions. Many of the scholar-physicians I mention in this article also stem from family medical traditions. 9. For a summary of these debates, see Ma Boying (1993, 778-85), He Yumin (1987, 15-
THE ARSENALOF CHINESE MEDICINE REMODELING 16), and Liao Yujun (1999). In these discussions, the notion ofyi is used not only to signal the difficulty of teaching the craft-like aspects of medical knowledge but as a constitutive aspect of the medical habitus that is the foundation of clinical success and medicalinnovation. Polanyi's assimilation of scientific inquiry to implicit and therefore personal knowledge is derived from a quite different context of debate, as shown by Fuller (2000, 139-53). 10. Taking the pulse (qie mai) remains to this day the archetype of Chinese medical diagnostics (Kuriyama 1987, 1999), althoughlike anything else in Chinese medicine-it is intrinsically plural and has undergonesignificant changes since its developmentin the Han (ZhaoEnjian 1990).The other main categories of diagnosis besides palpation(qie)are interrogation (wen),listening and smelling (wen),and visual inspection (wang). For a general discussion of diagnosis in contemporary Chinese medicine, see (Deng Tietao 1987, 211-68). 11. We can take as exemplary the Encyclopedia of Chinese Medicine, edited by eminent
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historians at the Academy of Chinese Medicine. In its entry on the Han dynasty physician Guo Yu, the first physician to explicitly discussed the notion ofyi in the context of medical
practice, the Encyclopedic Dictionary notes
that if GuoYuthinks that "medicineembodies the idea of yi" and that the hows and whys of treatment "cannot be put into words, [then] these are aspects of his limited thinking"(Li Jingwei and Deng Tietao 1995). 12. For biographies of Qin Bowei, see Wu Boping (1981) and Wu Dazhen and Wang Fengqi (1984). 13. Economiccompetition,older systems of social organizationthat tied students to teachers through bonds of loyalty but also patronage, and the effects of war and civil war ensured that physicians of Chinese medicine only mobilized effectively as a group when they were forced to do so, as in the struggle against moves to abolish Chinese medicine in 1929. 14. For biographiesof Shi, see Zhu Chenyu (1985) and Su Yanchang (2000, 54-57). The foundationof his school and its curriculumare discussed by Deng Tietao (1999,204-5) and Su Yanchang(2000, 239-44). 15. This was the case for most students but especially so for the Western medicine physi-
cians envisaged by Mao Zedong to form the avant-garde of a new revolutionary medicine and orderedto study Chinese medicine in the mid-1950s. The compilationof teaching materials for these physicians had a major influence on the development of Chinese medical education in subsequent periods (Taylor1999, 2000) 16. For the importanceof Maoist dialectics and its philosophyof practiceon the shaping of Chinese medicine in Maoist China, see Farquhar (1987), Gibson (1972), Hsu (1999), Scheid (2002), and Unschuld (1992). 17. Explaining in this manner the historical context in which contradictions are tolerated appears to me to be more meaningful than attributing them to enduring aspects of a Chinese cultural aesthetics (Unschuld 1990, 1992). 18. I have tried to underline this fact by outlining the linkages between the physicians cited in this article. I will discuss these at length in a forthcomingmonograph. 19. In practice, therefore, leading physicians in contemporary China occupy plural roles in the transmission of medical knowledge. They are professorsat modernuniversities but also masters to disciples within personal relationships of learning (Scheid 2002, chap. 6). 20. Once an active constituent has been identified in a traditional medicinal,for example, Ephedrin in the drug Ephedra sinensis (ma huang), it ceases to be part of the arsenal of Chinese medicine. This kind of poaching was a key strategy pursued by opponents of traditional medicine during the Republican period, who accepted the efficacy but not the principles of Chinese medicine (Lei 1998). 21. Interestingly, the very same development is currently taking place in the West, where the most prominentteachers of Chinese medicine are creating their own pharmacological lines of ready-made formulas, whose use they teach in Chinese medical textbooks and seminars. 22. There is a strong tendency among contemporary Chinese physicians-undoubtedly followingin the footsteps of their teachers who saw in regularization the hallmark of science-to welcome regulation as a sign of modernization. Meng Qingyun (2000, preface),for instance, declared proudly that the "nearly
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THE ANNALS OF THE AMERICAN ACADEMY ment: An outline). Beijing, China: Renmin weisheng chubanshe. Brodwin, Paul. 1996. Medicine and morality in Haiti: The contest for healing power. Cambridge, UK: Cambridge University Press. Cassidy, C. M. 1998. Chinese medicine users in the United States part I: Utilization, satisfaction, medical plurality. Journal of Alternative and Complementary Medicine 4 (1): 17-27. Chao, Yuan-Ling. 1995. Medicine and society in late Imperial China: A study of physicians in Suzhou. Ph.D. diss., University of California at Los Angeles. Chen Cunren. 1954. Guoyi Qisu Xie Liheng Xiansheng Zhuanji (Biography of the esteemed physician of national medicine Mr. Xie Liheng). In Zhongguo Lidai Yixue Shilue (Sketch history of Chinese medicine through the ages), 2d ed., edited by Zhang Zanchen, 51-56. Shanghai, China: Shanghai zhongyi shuju. Chen Daojin. 1981. Luetan Menghe Si Mingjia (A brief account of Menghe's four famous families). Jiangsu zhongyi zazhi 1:42-45. Craig, D. 2000. Practical logics: The shapes and lessons of popular medical knowledge and practice-Examples from Vietnam and indigenous Australia. Social Science & Medicine 51 (5): 703-11. Croizier, Ralph C. 1968. Traditional medicine in modern China. Cambridge, MA: Harvard University Press. Dai Zuming and Yu Xin. 1997. Yu Jinghe Nianbiao (A chronicle of Yu Jinghe's life). Zhonghua yishi zazhi 27 (1): 5254. Corinna. 1993. Is Delkescamp-Hayes, medicine special, and if so, what? An attempt at rational reconstruction. In Science, technology, and the art of medicine: European American dialogues, edited by Corinna Delkescamp-Hayes and Mary Ann Gordell Cutter, 271-
two hundred documents concerningthe rules, regulations, [and] technical standards [that] have been stipulated" up to the end of 1998 have laid a solid foundation for the regulated development of Chinese medicine. 23. The importanceof benevolence (ren) in the practice of medicine is not an abstract concept but was impressed to me by many physicians in China. CompareHua (1995), who argues for the importance of humanism in understandingcontinuities in Chinese culture beyond outward transformation.
References
Andrews, Bridie J. 1996. The making of modern Chinese medicine, 1895-1937. Ph.D. diss., Cambridge University, UK. Anonymous. 2001. Basic research program for Chinese medicine formulae. Medical China Update 1 (1): 30. Ayora-Diaz, S. I. 2000. Imagining authenof ticity in the local medicines Chiapas, Mexico. Critique of Anthropology 20 (2): 173-90. Baer, H. A., J. Hays, N. McClendon, N. McGoldrick, and R. Vespucci. 1998. The holistic health movement in the San Francisco Bay Area: Some preliminary observations. Social Science & Medicine 47 (10): 1495-501. Baer, H. A., C. Jen, L. M. Tanassi, C. Tsia, and H. Wahbeh. 1998. The drive for professionalization in acupuncture: A preliminary view from the San Francisco Bay Area. Social Science & Medicine 46 (4/5): 533-37. Baer, Hans A. 1995. Medical pluralism in the United States: A review. Medical Anthropology Quarterly 9 (4): 493-502. Barnes, L. L. 1998. The psychologizing of Chinese healing practices in the United States. Culture Medicine and Psychiatry 22 (4): 413-43. Beijing zhongyiyuan geming weiyuanhui (Beijing Hospital of Chinese Medicine 1971. Committee). Revolutionary Bianzheng Shizhi Gangyao (Differentiating symptoms and applying treat-
THE ARSENALOF CHINESE MEDICINE REMODELING 320. Dordrecht, the Netherlands: Kluwer. Deng Tietao, ed. 1999. Zhongyi Jindai Shi (A history of Chinese medicine in the modern era). Guangzhou, China: jiaoyu gaodeng Guangdong chubanshe. Dik6tter, Frank. 1997. The construction of racial identities in China and Japan: Historical and contemporary perspectives. London: Hurst. Ding Ganren. 1960. Ding Ganren Yong Yao 113 Fa (Ding Ganren's 113 methods of employing drugs). Shanghai, kexue China: jishu Shanghai chubanshe. Duara, Prasenjit. 1995. Rescuing history from the nation: Questioning narratives of Modern China. Chicago: University of Chicago Press. Dunn, Fred L. 1976. Traditional Asian medicine and cosmopolitan medicine as adaptive systems. In Asian medical systems: A comparative study, edited by Charles Leslie, 133-58. Berkeley: University of California Press. Farquhar, Judith. 1987. Problems of knowledge in contemporary Chinese medical discourse. Social Science & Medicine 24:1013-21. .1992a. Objects, processes and female infertility in Chinese medicine. Medical Anthropology Quarterly 14:370-99. . 1992b. Time and text: Approaching Chinese medical practice through analysis of a published case. In Paths to Asian medical knowledge, edited by Charles Leslie and Allan Young, 62-71. Berkeley: University of California Press. .1994. Knowingpractice: The clinical encounter in Chinese medicine, studies in the ethnographic imagination. Boulder, CO: Westview. . 1996. Market magic: Getting rich and getting personal in medicine after Mao. American Ethnologist 23 (2): 239-57.
155
Feher, Michel. 1990. Carmelo Bene and Michel Foucault: Nominalism, body and subjectivity. Paper presented at the annual meetings of the American Ethnological Society,Atlanta, GA. Fei Boxiong. [1863] 1984. Yichun Shengyi (The refined in medicine remembered). In Menghe Sijia Yiji, edited by Zhang Yuan-Kai, 3-87. Nanjing, kexue jishu China: Jiangsu chubanshe. Flint, K. 2001. Competition, race, and professionalization: African healers and white medical practitioners in Natal, South Africa in the early twentieth century. Social History of Medicine 14 (2): 199-221. Foucault, Michel. 1972. The archaeology of knowledge.London:Tavistock. .1974. Theorderof things. London: Tavistock. . 1976. The birth of the clinic: An archeologyof medical perception.London: Tavistock. Fuller, Steve. 1988. Social epistemology. Bloomington: University of Indiana Press. .2000. ThomasKuhn:Aphilosophical history for our times. Chicago: University of Chicago Press. Fung, Yu-lan. 1953. A history of Chinese philosophy: The period of classical learning, Vol. 2, translated by Derk Bodde. Princeton, NJ: Princeton University Press. Gibson,Geoffrey.1972. Chinese medicine and the thoughts of Chairman Mao. Social Science & Medicine 6: 67-93. Goldsmith, Marsha S. 1999. 2020 vision: NIH heads foresee the future. Journal of the American Medical Association 282:2287-90. Goody,Jack. 1987. The interface between the written and the oral. Cambridge, UK: CambridgeUniversity Press. He Shixi. 1991. Menghe Dingshi Sandai Mingyi (Three generations of famous physicians in the Menghe Ding family). In Hdishang Yilin (Physicians of
156
THE ANNALS OF THE AMERICAN ACADEMY Hui, Wang. 1997. The fate of"Mr Science" in China: The concept of science and its application in modern Chinese thought. In Formations of colonial modernity in East Asia, edited by Tani E. Barlow, 21-81. Durham, NC: Duke University Press. Jia, Huanguang. 1997. Chinese medicine in post-Mao China: Standardization and the context of modern science. Ph.D. diss., University of North Carolina. Knauf, Bruce M. 1996. Genealogies of the present in cultural anthropology. New York: Routledge. Kuhn, Thomas S. 1970. The structure of scientific revolutions. 2d Rev. ed. Chicago: University of Chicago Press. Kwok, Daniel W. Y. 1965. Scientism in Chinese thought 1900-1950. New Haven, CT: Yale University Press. Lee, Lee Ou-fan. 2000. The cultural construction of modernity in urban Shanghai: Some preliminary explorations. In Becoming Chinese: Passages to modernity and beyond, edited by Wen-Hsin Yeh, 31-61. Berkeley: University of California Press. Lei, Sean Hsianglin. 1998. When Chinese medicine encountered the state: 19101949. Ph.D. diss., Morris Fishbein Centre, University of Chicago. Li Jingwei and Deng Tietao, eds. 1995. Zhongyi Dacidian (Encyclopaedic dictionary of Chinese medicine). Beijing, China: Renmin weisheng chubanshe. Liao Yujun. 1999. Guanyu Zhongguo Chuantong Yixue De Yige Chuantong Guannian (On a traditional concept of traditional Chinese medicine-Medicine is signification). Paper presented at the Chinese Academy of Social Sciences, 24 June, Beijing, China. Lock, Margaret. 1980. East Asian medicine in urban Japan: Varieties of medical experience. Berkeley: University of California Press. .1990. Rationalization of Japanese herbal medicine: The hegemony of or-
Shanghai), edited by Shanghaishi wenshi ziliaohui (Shanghai Literary and Historical Materials Committee), 1-11. Shanghai, China: Shanghai renmin chubanshe. He Yumin. 1987. Zhongyixue Daolun (Guide to Chinese medicine). Shanghai, China: Shanghai zhongyi xueyuan chubanshe. Heptonstall, John P. 2000. A comment from the author-Rebutted. Reply to Andrew Vickers' "Recent advances: Complementary medicine." British Medical Journal. Electronic responses. Retrieved from http:// BMJ. com/cgi/eletters/3 21/7262/ 683#EL7. Hsu, Elisabeth. 1991. The reception of Westernmedicine in China:Examples
from Yunnan. In Science and empires, edited by P. Petitjean et al., 89-101. Amsterdam: Kluwer. . 1996. Innovations in Acumoxa: Analgesia, scalp and ear acupuncture in the People's Republic of China. Social Science & Medicine 42 (3): 421-30. . 1999. The transmission of Chinese medicine. Cambridge, UK: Cambridge University Press. Hua, Shiping. 1995. Scientism and humanism: Two cultures in post-Mao China. Albany: State University of New York Press. Huang Huang. 1984. Jiangsu Menghe Yipai De Xingcheng He Fazhan (The formation and development of the Jiangsu Mengh6 medical lineage). Zhonguo yixueshi 14 (2): 65-71. Huang Shuze, ed. 1985. Zhongguo Xiandai Mingyi Zhuan (Biographies of China's famous physicians of modern times). Beijing, China: Kexue puji chubanshe. Huang Wendong. 1962. Dingshi Xueshu Liupai De Xingcheng He Fazhan (The formation and development of Mr. Ding's learning and stream). Shanghai zhongyiyao zazhi 1:5-9.
THE ARSENALOF CHINESE MEDICINE REMODELING chestrated pluralism. Human Organization 49 (1): 41-47. Ma Boying. 1993. Zhongguo Yixue Wenhua Shi (A history of Chinese medicine in Chinese culture). Shanghai, China: Shanghai People's. Mao Zedong ([1937]1968) Shijian lun (On practice). In Mao zhuxi xuanji (Selected works by Chairman Mao), pp. 259-73. Beijing, China: Renmin chubanshe, Meng Qingyun, ed. 2000. Zhongguo Zhongyiyao Fazhan Wushi Nian: 1949-1999 (Fifty years of development of Chinese medicine and pharmacology in China: 1949-1999). Zhengzhou, China: Henan yike daxue chubanshe. Moore, Sally Falk. 1987. Explaining the present: Theoretical dilemmas in processual ethnography. American Ethnologist 14 (4): 727-36. fundaObbo, C. 1996. Healing-Cultural mentalism and syncreticism in Buganda. Africa 66 (2): 183-201. Ots, Thomas. 1990. Medizin Und Heilung in China (2. Auflage). Berlin, Germany: Dietrich Reimer Verlag. Perry, N. 1995. Traveling theory nomadic theorizing. Organization 2 (1): 35-54. Polanyi, Michael. 1958. Personal knowledge. Chicago: University of Chicago Press. Porkert, Manfred. 1978. The theoretical foundations of Chinese medicine: Systems of correspondence, edited by Nathan Sivin. MIT East Asian Science Series. Cambridge, MA: MIT Press. .1983. The essentials of Chinese diagnostics. Zurich, Switzerland: Acta Medicinae Sinensis. Qiu Peiran, ed. 1998. Mingyi Yaolan: Shanghai Zhongyi Xueyuan (Shanghai Zhongyi Zhuanmen Xuexiao) Xiaoshi (Cradle of famous physicians: The history of the Shanghai College of Chinese Medicine and the Shanghai Technical College of Chinese Medicine). Shanghai, China: Shanghai zhongyiyao daxue chubanshe.
157
, ed. 2000. Xingyuan Heyi: Shanghai Xinzhongguo Yixueyuan Yuanshi (A blossoming garden of virtuous scholars: The history of the Shanghai New China Medical College). Shanghai, China: Shanghai zhongyiyao daxue chubanshe. Ricklis, R. A. 1992. The spread of a late prehistoric bison hunting complexEvidence from the south-central coastal prairie of Texas. Plains Anthropologist 37 (140): 261-73. Said, E. W. 1982. Traveling theory + the movement of ideas from one culture to another.Raritan-a QuarterlyReview 1 (3): 41-67. Scheid, Volker. 2001. Shaping Chinese medicine: Two case studies from contemporary China. In Innovation in Chinese medicine, edited by Elisabeth Hsu, 370-404. Cambridge, UK: Cambridge University Press. . 2002. Contemporary Chinese medicine: Plurality and synthesis. Durham, NC: Duke University Press. Sivin, Nathan. 1987. Traditional medicine in contemporary China. In Science, medicine and technologyin East Asia, edited by Nathan Sivin. Ann Arbor: Centre for Chinese Studies, University of Michigan. Su Yanchang, ed. 2000. Beicheng Guoyi Pu (Genealogyof national medicine in Beijing). Beijing, China: Zhongguo yiyao keji chubanshe. Taylor, Kim. 1999. Paving the way for TCM textbooks:The Chinese medical improvement schools. Paper presented at the Ninth International Conference on the History of Science in East Asia, 23-27 August, East Asian Institute, National University of Singapore. .2000. Medicineof revolution:Chinese medicine in early Communist China 1945-1963. Cambridge, UK: University of Cambridge. Turner,Stephen. 1994. The social theory ofpractices:Tradition,tacit knowledge
158
THE ANNALS OF THE AMERICAN ACADEMY Qin [Bowei]). In Qin Bowei Yiwen Ji (A collection of essays on medicine by Qin Bowei), edited by Wu Dazhen and Wang Fengqi, 1-10. Changsha, China: Hunan kexue jishu chubanshe. Wu Qian et al., eds. [1742] 1987. Yizong Jinjian (The golden mirror of the medical lineage). 2 vols. Beijing, China: Renmin weisheng chubanshe. Xiao Dexin, ed. 1992. Zhongyi Fangfa Lun (On the methodology of Chinese medicine). Chongqing, China: Chongqingchubanshe. Xie Guan. 1935. Zhongguo Yixue Yuanliu Lun (On the source and course of Chinese medicine). Shanghai, China: Shanghai chengzhai yishe. Yang Xinglin and Tang Xiaohong, eds. 1991. Shanghai Zhongguo Yixueyuan Yuanshi (History of the Shanghai China Medicine College). Shanghai, China: Shanghai kexue jishu wenxian chubanshe. Yu Chang. [1658] 1999. Yimen Falii (Precepts for physicians). In Yu Jiayan Yixue Quanshu (The complete medical works of Yu Jiayan), edited by Chen Yi, 175-368. Beijing, China: Zhongguo zhongyiyao chubanshe. Yu Jinghe. [1891] 1996. Waizheng Yi'an Huibian (A compilation of case records of external patterns). In Ming Qing Shiba Mingyi Yi'an (Case records by eighteen famous physicians from the Ming and Qing dynasties), edited by Yi Guang, 1351-444. Beijing, China: Zhongguo zhongyiyao chubanshe. Zhang Baiyu. 1985. Taoli Wuyan, Xiazi Chengxi (Disciples too numerous to name, providing a path for subsequent generations). Shanghai zhongyiyao zazhi 9:3-4. Zhao Hongjun. 1989. Jindai Zhong-Xiyi Lunzheng Shi (History of the polemics between Chinese and Western medicine in modern times). Hefei, China: Anhui kexue jishu chubanshe. Zhao Xuemin. [1759] 1998. Chuanya Neibian (The penetrator improved: In-
and presuppositions. Cambridge, UK: Polity. Unschuld, Paul U. 1985. Medicine in China: A history of ideas. Berkeley: University of California Press. . 1990. Gedanken Zur Kognitiven Asthetik Europas Und Ostasiens. GWU 12:735-44. . 1992. Epistemological issues and changing legitimation: Traditional Chinese medicine in the twentieth century. In Paths to Asian medical knowledge, edited by Charles Leslie and Allan Young, 44-63. Berkeley: University of California Press. Vickers, Andrew. 2000. Recent advances: medicine. British Complementary Medical Journal 321:683-86. Wang Zhipu and Cai Jingfeng, eds. 1999. Zhongguo Zhongyiyao Wushi Nian (Fifty years of Chinese medicine and pharmacology in China). Fuzhou, China: Fujian kexuejishu chubanshe. White, Sidney D. 1998. From "barefoot doctor" to "village doctor":A case study of health care transformation in socialist China. Human Organization 57 (4): 480-90. . 1999. Deciphering "integrated Chinese and Western medicine" in the rural Lijiang basin: State policy and local practice(s) in socialist China. Social Science & Medicine 49:1333-47. Williams, Raymond. [1976] 1983. Keywords: A vocabulary of culture and society. Rev. and expanded ed. London: Fontana. Wu, Yi-Li. 1998. Transmitted secrets: The doctors of the lower Yangzi region and popular gynecology in late Imperial China. Ph.D. diss., Yale University. Wu Boping. 1981. Yi Qin Bowei Laoshi De Zhi Xue Jingshen (A recollection of the vigour of Teacher Qin Bowei's research). Shandong zhongyi zazhi 1: 1-5. Wu Dazhen and Wang Fengqi. 1984. Yi Qinlao (Remembering the Honourable
159
ner volume). In Chuanya Quanshu nese physicians), edited by Zhou (The penetrator improved: Complete Fengwu, Zhang Qiwen, and Cong Lin, 71-76. Jinan, China: Shandong kexue volumes), edited by He Yuan. Beijing, China: Zhongguo zhongyiyao jishu chubanshe. chubanshe. Zhu Shenyu. 1996. Foreword to Shi Zhou Fengwu, Zhang Qiwen, and Cong Jinmo Duiyao (Shi Jinmo on synergistic medicinals) Lin, eds. 1981-1985. Ming Laozhongyi by Lu Jingshan. Zhi Lu (Paths of renowned senior ChiChina: Renmin Beijing, yunyi nese physicians). Vol. 1. Jinan, China: chubanshe. Zhu Shina and Sun Guilian. 1990. Shandong kexue jishu chubanshe. Zhu Chenyu. 1985. Yi Dai Ming Yi-Shi Zhongyi Xitonglun (Chinese medicine Jinmo (A famous physician of our systems theory). Chongqing, China: time: Shi Jinmo). In Ming Laozhongyi Chongqingchubanshe. Zhi Lu (Paths of renowned senior Chi-

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American Academy of Political and Social Science

ANNALS, AAPSS, 583, September 2002

Remodeling the Arsenal of Chinese Medicine: Shared Pasts, Alternative Futures

nese Medicine in ContemporaryChina: Plurality and Synthesis, published by Duke

THE ARSENALOF CHINESE MEDICINE REMODELING

THE ANNALS OF THE AMERICAN ACADEMY

THE ARSENALOF CHINESE MEDICINE REMODELING

THE ANNALS OF THE AMERICAN ACADEMY

(1742) Background Knowledae

ACADEMY THE ANNALS OF THE AMERICAN CHINESE MEDICINE:1935-1966

THE ARSENALOF CHINESE MEDICINE REMODELING

THE ANNALS OF THE AMERICAN ACADEMY

THE ARSENALOF CHINESE MEDICINE REMODELING

THE ANNALS OF THE AMERICAN ACADEMY

THE ANNALS OF THE AMERICAN ACADEMY

REMODELING THE ARSENALOF CHINESE MEDICINE

THE ANNALS OF THE AMERICAN ACADEMY

REMODELING THE ARSENALOF CHINESE MEDICINE

THE ANNALS OF THE AMERICAN ACADEMY

REMODELING THE ARSENALOF CHINESE MEDICINE

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