Transforming Emotions

with Chinese Medicine
SUNY scrics in Chincsc Philosophy and Culturc
Rogcr T. Amcs, cditor
Transforming Emotions
with Chinese Medicine
An Ethnographic Account from Contemporary China
Yanhua Zhang
STATE UNIVERSITY OF NEW YORK PRESS
Publishcd by
STATE UNIVERSITY OF NEW YORK PRESS,
ALBANY
© acc, Statc Univcrsity ol Ncw York
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For inlormation, addrcss
Statc Univcrsity ol Ncw York Prcss
.µ¡ Vashington Avcnuc, Suitc ¸c¸, Albany, NY .aa.ca¸·¡
Production by Christinc Hamcl
Markcting by Michacl Campochiaro
Library of Congress Cataloging-in-Publication Data
Zhang, Yanhua.
Translorming cmotions with Chincsc mcdicinc : an cthnographic account lrom
contcmporary China / Yanhua Zhang.
p. cm. (SUNY scrics in Chincsc philosophy and culturc)
!ncludcs bibliographical rclcrcnccs and indcx.
!S8N.¸: µ,·c,µ.¡6µµµ6 (hardcovcr : alk. papcr)
!S8N.¸: µ,·c,µ.¡,ccc· (pbk. : alk. papcr)
.. Mcdical anthropologyChina. a. Mcdicinc, Chincsc. ¸. Traditional
mcdicincChina. ¡. ¡thnopsychologyChina. ¸. ¡motionsSocial aspccts
China. !. Titlc. !!. Scrics.
GNaµ6.¸.C6Z¸¸ acc,
¸c6.¡´6.cµ¸.dcaa
acc6c.aµ¡.
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For my parents.
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vi i
Contents
Tablcs ix
!llustrations xi
Acknowlcdgmcnts xiii
!. !x:vobuc:iox .
!!. Cnixvsv Mvbicixv: Cox:ixui:v ~xb Mobvvx
Tv~xsvov:~:ioxs .,
!!!. Tnv Cnixvsv Vovib ov SHENTI (8obvPvvsox) ¸.
!\. Cox:vx:u~iizixc QINGZHI 情志 (¡:o:ioxs) ¸¸
\. Uxbvvs:~xbixc ZHONGYI Ciixic~i Ci~ssivic~:iox ,¸
\!. M~xivvs:~:ioxs ov YU (S:~cx~:ioxs) ·,
\!!. Ciixic~i Pvocvss ov TIAO (A::uxixc) .c¸
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Appcndix: Transcription Convcntions .¡¸
Notcs .¡,
8ibliography .6µ
!ndcx .·,
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i x
Tables
¡.. Summary ol thc lunctions ol thc fivc visccral systcms 6·
¡.a Wuxing and thc fivczang systcms ,c
¡.¸ ¡motions and countcrcmotions ,¸
6.. Zheng (syndromcs) and qingzhi disordcrs µ.
6.a Ðistribution ol qingzhi disordcrs according to zheng (Pattcrns) µa
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xi
Illustrations
¡.. Tc Scqucncc ol Production and Rcstriction ,c
Tv~xscviv: Svc:vx:s
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xi i i
Acknowledgments
Tis book has bcncfitcd lrom thc gcncrous assistancc and support ol many indi
viduals and institutions. Tc study lcading to this book bcgan at thc Univcrsity
ol Hawaii at Manoa whcn ! was a graduatc studcnt. ! havc had wondcrlul tcach
crs: Rogcr Amcs, Jack 8ilmcs, Frcd 8lakc, Nina ¡tkin, Allcn Howard, Tomas
Marctzki, Anthony Marsclla, Grcgory Maskarincc, and Gcoffrcy Vhitc. Tcy
havc dircctly and indircctly contributcd to thc lormation ol many idcas in this
book. ! owc spccial thanks to Frcd 8lakc, thc chair ol my disscrtation commit
tcc, whosc guidancc and cncouragcmcnt saw mc through thc arduous proccss ol
disscrtation writing, and to Rogcr Amcs, who rcad thc manuscript scvcral timcs
and whosc critical commcnts arc largcly rcsponsiblc lor thc improvcmcnt ol thc
prcscnt book lrom thc original disscrtation. Scvcral othcr pcoplc havc rcad thc
cntirc or parts ol thc manuscript at its diffcrcnt stagcs. John ÐcFrancis mcticu
lously wcnt ovcr my bilingual transcript ol thc clinical intcraction and offcrcd
dctailcd corrcctions and suggcstions, Judith Farquhar rcad and commcntcd on
an carlicr vcrsion ol thc chaptcr on zhongyi clinical classifications, and Louis
8rcggcr at Clcmson Univcrsity proolrcad thc cntirc manuscript at lcast twicc.
My collcaguc, Joan 8ridgwood, hclpcd with thc final proolrcading ol thc book.
! am thanklul lor thcir assistancc.
Ðuring thc long proccss ol thc rcscarch and writing ol this book, ! lcarncd
a lot lrom my lcllow graduatc studcnts and collcagucs through convcrsations
and discussions. ! bcncfitcd lrom thc insights, criticism, and camaradcric ol
Vcirong Cai, Nancy Coopcr, Ðphrosinc Ðaniggclis, 8ingzhong Gao, Mclissa
Schrilt, Chcnshan Tian, Yanyin Zhang, Ðcborah Zvoscc, and many othcrs.
My ficld rcscarch bcncfitcd grcatly lrom thc hclp and support ol many
lricnds and collcagucs in 8cijing, China. ! want to thank my affiliatcd institu
tion in 8cijing, thc School ol ¡thnology and Sociology at Ccntral Univcrsity
lor Nationalitics, lor hospitality and institutional support. ! want cspccially to
thank Yang Shcngmin and Tcng Xing lor introducing mc to thcir nctwork ol
social rclations and hclping arrangc my ficldwork sitc. ! thank all thc studcnts
and practitioncrs ol Chincsc mcdicinc ! mct and intcractcd with in 8cijing,
xi v TRANSFORMI NG EMOTI ONS
particularly Vang Xiuzhcn and Cao Pci. Tcy gcncrously sharcd thcir knowl
cdgc and cxpcricncc ol Chincsc mcdicinc with mc and paticntly answcrcd my
qucstions. Ðircctor Zhou Shaohua ol Xiyuan hospital providcd mc with thc
bcst ficldwork cnvironmcnt ! could cvcr hopc lor. Hc was not only thc bcst
zhongyi tcachcr to mc, but also my most knowlcdgcablc rcsourcc in Chincsc
mcdicinc. ! am also dccply gratclul to thc paticnts involvcd in my rcscarch lor
thcir trust and gcncrosity. My rcsponsibility to protcct thcir anonymity prcvcnts
mc lrom naming thcm individually, but my dccpcst gratitudc gocs to thcm.
My ficld rcscarch was lundcd by a grant (Grant No. ¸66·) lrom thc
VcnncrGrcn Foundation. ! would also likc to acknowlcdgc thc assistancc and
support lrom thc Ccntcr lor Chincsc Studics at thc Univcrsity ol Hawaii at
Manoa. Tc opportunitics to work in thcir various Chinarclatcd projccts and
acccss to thcir rcsourccs lacilitatcd thc complction ol thc original disscrtation.
For this, ! am particularly thanklul to Cynthia Ning, thc associatc dircctor ol
thc Ccntcr, and Ðanicl Tschudi. Coursc rclicl providcd by thc Ðcpartmcnt ol
Languagcs ol Clcmson Univcrsity hclpcd spccd up thc writing ol thc final vcr
sion ol this book.
My thanks also go to cvcryonc at SUNY prcss whosc hard work hclpcd to
turn my manuscript into this book.
My parcnts supportcd my prolcssional pursuit in cvcry way thcy could.
Tcy actcd as surrogatc parcnts to my daughtcr lor many ycars whilc ! was away
doing my graduatc studics in thc U.S., and thcy houscd mc whilc ! was doing
ficldwork in 8cijing.
Covcr Calligraphy by Michacl M. Chcn.
1
I .
Introduction
Tis book offcrs an cthnographic account ol cmotionrclatcd disordcrs as thcy
arc undcrstood, cxpcricnccd, and trcatcd in thc clinics ol Chincsc mcdicinc
or zhongyi 中医 in contcmporary China. Ccntral to this cnquiry is a zhon-
gyi catcgory ol illncss, qingzhi bing 情志病 or qingzhi lei jibing 情志类疾病
(cmotionrclatcd disordcrs),' attributablc to disordcrcd cmotions and trcatablc
with ordinary Chincsc mcdical thcrapics. Vhat nccds to bc cmphasizcd lrom
thc vcry bcginning is that qingzhi bing is not a dircct translation ol thc Vcstcrn
psychiatric conccpt ol “cmotional disordcr” or “mcntal disordcr.” Not a strictly
dcfincd discrctc illncss cntity in a biomcdical scnsc, thc zhongyi construct is
uscd somcwhat looscly to includc a group ol illncss pattcrns, originating lrom
“intcrnal damagcs attributablc to cxccssivc cmotions” (qingzhi neishang 情志内
伤) and markcd with ccrtain configurations ol physical, cmotional, and bchav
ioral symptoms. Vhilc to group disordcrs prcdominantly involving cmotions
and thoughts undcr thc hcading ol qingzhi is nothing modcrn,´ thc mcaning ol
qingzhi disordcrs cncountcrcd in today’s zhongyi clinics rcflccts ongoing social
and political dynamics in contcmporary Chincsc socicty and changcs in thc
prolcssion ol Chincsc mcdicinc itscll through dccadcs ol thc statcsponsorcd
zhongyi modcrnization undcr thc guidancc ol scicncc. 8iomcdical tcrminology
and tcchnology arc commonly prcscnt in contcmporary zhongyi practiccs, yct
thc way in which a qingzhi disordcr is conccptualizcd, cxpcricnccd, diagnoscd,
and trcatcd rcmains rcmarkably “Chincsc.” !t is not “culturally bound,” but ccr
tainly “pcrmcatcd with culturc.”`
THEORETI CAL ORI ENTATI ONS
!t is quitc common lor a mcdical anthropologist to imaginc culturc as a sharcd,
unificd sct ol bclicls and valucs that producc, causc, or govcrn and thus cxplain
illncss and hcalth bchaviors. Tc carlicr studics ol “culturcbound syndromcs”
cxcmplifics this approach, in which culturc is sccn as playing cithcr a “patho
gcnic” or “pathoplastic” rolc in thc manilcstation ol syndromcs, such as amok and
2 TRANSFORMI NG EMOTI ONS
latah in Southcast Asia.⁴ Most crosscultural studics ol psychiatric disordcrs in
Chincsc socicty also problcmatizc thc conncctions bctwccn cultural institu
tions and univcrsal psychiatric disordcrs. Tc cmphasis on harmonious lamily
and intcrpcrsonal rclationships is idcntificd as thc main lactor that influcnccs
mcntal hcalth in Chincsc socicty.⁵ Arthur Klcinman’s anthropological study ol
ncurasthcnia and dcprcssion in Chincsc socicty is also typical. Traditional cul
tural valucs and norms arc said to lcad Chincsc to supprcss distrcssing cmotions
and somatizc social and psychological problcms, thus translorming a univcrsal
discasc ol dcprcssion into a culturally particular illncss—ncurasthcnia.⁶
Tis “culturc vcrsus a univcrsal discasc” approach is problcmatic in scvcral
ways. First, local knowlcdgc is mcasurcd against thc Vcstcrn conccptual cat
cgorics undcrstood as normativc and univcrsal, thc diffcrcncc is pcrccivcd as
dcviant lrom thc norm and thcn cxplaincd by rclcrring to local cultural bclicls
and practiccs. Somctimcs, thc argumcnt can go thc othcr way around. A har
monious and thcrapcutic traditional culturc is prcscntcd in contrast to disin
tcgratcd, alicnating, and pathogcnic modcrn socicty.⁷ ¡ithcr rcflccts thc samc
oricntalist imagination that constructs a cultural othcr “in tcrms ol spccifically
Vcstcrn discursivc catcgorics.”⁸ Sccond, as shown in rcccnt mcdical anthropo
logical studics, illncss bchavior and hcalthsccking stratcgics arc complicatcd
proccsscs that rcspond to a complcx ol pcrsonal, social, and matcrial cxigcncics
and involvc ncgotiating among divcrsificd pcrspcctivcs and rcsourccs availablc
to paticnts and thcir lamilics. To assumc that pcoplc makc rational dccisions
simply bascd on what thcy bclicvc and cxplain thc complcxity ol hcalth and
illncss in tcrms ol a lcw ovcrsimplificd cultural rulcs and bclicls offcrs an im
povcrishcd undcrstanding ol both culturc and mcdicinc.
My cthnographic account ol cmotionrclatcd disordcrs in thc contcxt ol
Chincsc mcdicinc is inlormcd by thrcc diffcrcnt thcorctical pcrspcctivcs.
My approach to thc Chincsc cxpcricncc ol cmotions and illncss is inspircd
by thc rcccnt anthropological discoursc ol cmbodimcnt that locatcs culturc
in “thc livcd body” ol cvcryday practicc and dirccts analytical attcntion to thc
cxpcricntial aspcct ol culturc in cvcryday lilc.⁹ Culturc is not simply undcr
stood in symbolic or structural tcrms as rcprcscntations or abstract structurcs
dctachcd lrom bodily pcrlormancc and prcscncc.'⁰ ¡thnographic writing has
shown incrcascd intcrcst in “cmbodicd culturc.” !n hcr cthnography Training
the Body for China, 8rowncll makcs a compclling argumcnt that “an cthnogra
phy account that ovcrlooks thc body omits thc ccntcr ol human cxpcricncc.”''
!ncrcasingly, mcdical anthropologists locus on “livcd body” as a way to think
and talk about illncss and distrcss as thcy arc cxpcricnccd and to producc “cx
pcricnccncar” cthnographic accounts ol suffcring. Jcnkins and \alicnt analyzc
thc narrativcs ol Salvadoran womcn to show el calor (hcat) as a culturally spc
cific body cxpcricncc that is “cxistcntially isomorphic with angcr and lcar.”'´
Òts offcrs a scmantic and phcnomcnological analysis ol somc ol thc most
common symptoms prcscntcd in zhongyi clinics and cxplorcs thc mcanings ol
bodily pcrccptions both in zhongyi discoursc and in paticnts’ prcscntations. Hc
I NTRODUCTI ON 3
suggcsts that thc Chincsc cxpcricncc ol body and cmotion providcs insight into
thc corrcspondcncc ol cmotions and bodily manilcstations in cmotionaffcctcd
disordcrs, and that bodily organs or cmotional mctaphors in Chincsc mcdicinc,
such as “thc angry livcr,” “thc anxious hcart,” and “thc mclancholy splccn,” “may
scrvc as cvidcncc lor thc rolc ol thc body in gcncrating culturc.”'`
Ðcsjarlais, in an cthnography bascd on his ficld cxpcricncc among thc
Yolmo ol Ncpal, proposcs an analytical approach that attcnds to thc “surlacc
imagcry, lclt quality, and cmbodicd valucs intrinsic to momcnts ol illncss and
hcaling.”'⁴ !n my writing ol qingzhi disordcrs, ! pay similar attcntion to lclt
quality ol culturc that inlorms and givcs stylcs and mcaning to Chincsc cxpc
ricncc ol pain and malaisc. 8y attcnding to acsthctics ol bodypcrson (shenti
身体) that ordinary Chincsc arc tacitly oricntcd to in thcir cvcryday livcs, my
study cxplorcs thc intcrplay among thc bodily scnsibilitics, zhongyi construc
tions, and local social proccsscs and givcs a scnsc as to how it might “lccl”
lor somconc suffcring a qingzhi disordcr and thc lccling ol thc hcartcmotion
(xinqing 心情) blockcd lrom flowing and cxtcnding lrccly.
My rcscarch also draws cxtcnsivcly lrom currcnt languagc thcorics that
givc primacy to languagc usc in its social contcxt. As Good and Good arguc,
any approach to studying illncss and mcdicinc, cspccially crossculturally, has
to addrcss mcaning and thus is cmbcddcd in a particular thcory ol languagc.'⁵
¡thnomcdical rcscarch bascd on “cmic” studics ol lolk nosologics'⁶ and com
bining “cmic” catcgorics with “ctic” mcasurcs ol bioscicnccs'⁷ is groundcd in thc
convcntional thcory ol mcaning'⁸ that links a word to an objcct or a conccpt.
Tc mcdical discoursc is thcrclorc sccn as cstablishing conncctions bctwccn a
paticnt’s pathological condition and a particular discasc catcgory. Accordingly,
thc mcaning ol a lolk illncss can bc uncovcrcd through a scrics ol mappings,
such as mapping “cmic” symptom cxprcssions onto thc indigcnous catcgorics
ol illncsscs, thcn onto thc undcrlying physiological proccss, and finally onto
thc “ctic” diagnostic cntitics ol scicntific mcdicinc.'⁹ Tis rclcrcntial approach
to mcaning and its application lor crosscultural comparisons havc bccn laultcd
lor its scrious limitations in accounting lor mcanings in particular sociocultural
contcxts. As notcd by many mcdical anthropologists, illncss rcalitics arc ncvcr
mcrcly rcflcctions ol human biology but arc socioculturally constitutcd and
thcrclorc nccd a diffcrcnt articulation ol mcaning.
8yron Good, in his study ol “hcart distrcss” in a small town in !ran, sys
tcmatically rccords thc domains ol mcaning associatcd with corc symbols and
symptoms in mcdical lcxicon and rcvcals a configuration ol mcanings that as
sociatc old agc, sorrow and sadncss, ritual mourning, povcrty, worrics and anxi
cty, blood problcms, and so on. Hc argucs that “such a syndromc is not mcrcly
a rcflcction ol symptoms linkcd with cach othcr in natural rcality, but a sct ol
cxpcricnccs associatcd through nctworks ol mcaning and social intcraction in
a socicty.”´⁰ Tis conccption ol mcdical languagc dirccts rcscarch attcntion to
thc crcativc usc ol mcdical discoursc in articulating cxpcricncc ol social distrcss
and in ncgotiating mcanings ol suffcring. Adding a critical dimcnsion to this
4 TRANSFORMI NG EMOTI ONS
mcaningccntcrcd approach, somc mcdical anthropologists arguc that cultural
analysis ol illncss and mcdicinc havc to takc into considcration sociopolitical
dimcnsions ol powcr, intcrcst, and rcsistancc.´' For thcsc mcdical anthropolo
gists, hcaling is also an idcological practicc, and mcdicinc can bc analyzcd as
part ol thc social ordcr, which also cngagcs itscll in thc proccss ol objcctifica
tion and mystification ol social lacts, spccifically, thc proccss ol mcdicalization
ol social problcms and political opprcssion.´´ !n hcr analysis ol thc disordcr
ol ncrvosa among impovcrishcd shantytown dwcllcrs in northcast 8razil,
SchcpcrHughcs points to multiplc mcanings associatcd with thc illncss, such
as a rclusal ol “dcmcaning and dcbilitating labor” and a rcsponsc to violcncc
and tragcdy in cvcryday lilc.´` Similarly, Klcinman & Klcinman analyzc illncss
narrativcs ol Chincsc paticnts suffcring chronic pains and cmotional disordcrs
to show thc conncction bctwccn physical complaints and political violcncc,
pcrsonal or collcctivc dcmoralization and dclcgitimization.´⁴
My own rcscarch is aligncd with thc abovc outlincd mcaningccntcrcd
cntcrprisc ol mcdical anthropology but gocs bcyond thc symbolic and scmiotic
dimcnsions ol mcaning by including intcractivc aspccts ol actual clinical cn
countcrs. !l it is agrccd that talking is an act that is socially cffcctivc, thc intcrac
tivc dimcnsions ol social discoursc—how a pcrson prcscnts and cvaluatcs his/hcr
own cxpcricncc and how hc/shc is intcrprctcd, undcrstood, and rcspondcd to
by othcrs—offcrs a practical and usclul way lor undcrstanding local cxpcricncc
in cvcryday lilc. \arious mcdical discoursc analyscs, lor cxamplc, dcmonstratc
that a closc cxamination ol “talk” could bc an cffcctivc tool to cxplorc how ill
ncss rcalitics arc actually constructcd and social rolcs and rclations arc cnactcd
through clinical intcractions.´⁵ Taking zhongyi clinical cncountcrs as rcaltimc
sociolinguistic cvcnts, my cthnographic rcscarch incorporatcs microanalytical
conccpts and mcthods dcvclopcd by various discoursc analysis scholars´⁶ in cx
amining intcractivc cxchangcs bctwccn doctors and paticnts during thc routinc
clinical proccss ol “looking at illncss” (kanbing 看病) to tracc and dcmonstratc
how and at what point various clinical dccisions wcrc madc and thcrapcutic
translormations achicvcd. From this pcrspcctivc, culturc is cxamincd as local
proccsscs and rcsourccs that mcmbcrs arc oricntcd to lrom diffcrcnt subjcct
positioning and that arc cvokcd by thc mcmbcrs in cvcryday social intcractions
to ncgotiatc with and makc scnsc ol onc anothcr. !t is in this mundanc practicc
that culturc is confirmcd, contcstcd, dcstablcd, and translormcd.
Finally, contcmporary zhongyi scholarphysicians scc thcir prolcssion as
built upon “a uniquc body ol mcdical thcorics” (dute de yixue lilun tixi 独特的
医学理论体系) that is dccply rootcd in “ancicnt |gudai 古代] Chincsc pcoplc’s
scicntific practicc and philosophical thinking.” !n othcr words, Chincsc mcdi
cinc not only is groundcd in collcctivcly accumulatcd practical cxpcricncc (jin-
yan 经验) but also owcs as much to particular ways ol thinking and thcorizing.
Classic Chincsc philosophy and mcdical rcasoning cmploy thc samc languagc,
such as yin-yang and wuxing 五行 (fivc translormativc phascs) intcractions and
corrclations as wcll as qi 气 (vital cncrgy) translormations. Tis languagc cvokcs
I NTRODUCTI ON 5
a world ol translormation, in which myriad things and cvcnts arc constantly
in motion and cxtcnsion and changcs arc sccn as rcsulting lrom inhcrcnt com
plcmcntary and contradictory yin-yang dynamics rathcr than rcsorting to any
transccndcntal powcr or lorcc csscntial in thc Vcstcrn intcllcctual traditions.´⁷
Tis particular way ol philosophizing and thcorizing is vcry much prcscnt in
contcmporary zhongyi tcxts and clinical rcasoning undcr thc namc ol rcphrascd
“simplc matcrialism and dialcctic thinking” (pusu weiwuzhuyi he bianzhengfa
sixiang 朴素唯物主义和辩证法思想). Any intcrprctation ol Chincsc mcdi
cinc thcn has to bc awarc ol thc lundamcntal diffcrcncc ol thc intcllcctual cn
vironmcnt that has brcd and nourishcd Chincsc mcdicinc and to bc inlormcd
by classic Chincsc cosmological assumptions distinctivc lrom thosc undcrlying
modcrn scicntific thinking.´⁸
!t is this cnrichcd mcaningccntcrcd intcrprctivc approach combining
analysis ol local, intcractivc, and cmbodicd mcanings with a scnsitivity to thc
cpistcmology and with a “civilization awarcncss”´⁹ that providcs thc gcncral
conccptual and mcthodological oricntations ol this book. !t cxplorcs how in
digcnous Chincsc mcdical conccpts and knowlcdgc rclatcd to qingzhi and its
disordcrs arc constructcd, cxplaincd, and cmbodicd in cvcryday zhongyi clini
cal practiccs and cxpcricnccs. !t also cxamincs thc intcractivc dimcnsions ol
mcdical and social discoursc ol qingzhi illncsscs and analyzcs how thc zhongyi
discoursc links thc illncss construction to cxprcsscd and tacit cultural oricnta
tions, and how this indigcnous illncss catcgory that rccognizcs simultancously
bodily, mcntalcmotional, and social cxpcricncc in thc illncss providcs mcan
inglul lorms ol suffcring lor Chincsc paticnts. Although ! do not rcsort to
rcductivc, objcctivc, and standardizcd catcgorics ol comparison, ! ncvcrthclcss
scc my study as comparativc. For thc cthnographic work to grasp thc mcan
ing ol thc “livcd” lilc ol a pcoplc and to convcy it cffcctivcly to a rcadcr who is
linguistically and culturally alicn to that pcoplc, thc comparativcncss must bc
alrcady immancnt in thc cthnographic translation itscll.
TOPI C ORI ENTATI ONS
Ðocs Chincsc mcdicinc trcat disordcrcd cmotions or cmotional distrcsscs:
Contcmporary zhongyi physicians sccm uncquivocal about Chincsc mcdicinc’s
rolc in trcating disordcrcd cmotions. Tcy insist that zhongyi has always paid
considcrablc attcntion to cmotional or psychosocial aspccts in illncss and hcalth,
and thcy could citc numcrous cxamplcs lrom zhongyi classics to support this
claim.`⁰ My own obscrvations in 8cijing confirmcd that Chincsc paticnts do
habitually scck hclp in zhongyi clinics lor what, in thc Vcst, might bc consid
crcd psychological distrcss or a psychiatric disordcr.`' Typically, paticnts prcscnt
thcir complaints in “bodily languagc,”`´ yct without dcnying affcctivity as a
sourcc ol thcir suffcring. Tcy takc hcrbal rcmcdics or othcr “traditional” lorms
ol trcatmcnt`` and claim to lccl much bcttcr (haoduo le 好多了). 8oth paticnts
and doctors ol Chincsc mcdicinc with whom ! intcractcd in 8cijing insistcd
6 TRANSFORMI NG EMOTI ONS
that zhongyi cnjoys a spccial cfficacy with such “lunctional disordcrs” (gongneng
xing jibing 功能性疾病), whilc xiyi 西医 (litcrally, “Vcstcrn mcdicinc,” rclcr
ring to thc biomcdicinc practiccd in modcrn China) shows no cffcctivc mcans
in trcating such illncsscs.
Yct, thc qucstion rcmains a problcmatic issuc lor anthropologists and schol
ars ol Chincsc mcdicinc. For somc, thc topic is a slippcry tcrrain that is bcttcr
to bc circumvcntcd. Tc undcrlying conccrn is that Chincsc mcdicinc docs
not prcsupposc a dualistic scparation ol mind and body, nor docs it typically
makc a catcgorical distinction bctwccn psychological and physical disordcrs,`⁴
thcrclorc any discussion ol zhongyi locusing on cmotion incvitably makcs mod
crn clinical psychology or psychiatric mcdicinc a comparativc rclcrcncc, thus
imposing on Chincsc mcdicinc thc structurc ol thc Vcstcrn biomcdical modcl
that typically vicws discascs as having a scparatc ontology as il thcy arc cithcr
“in thc body” or “in thc mind.”`⁵
Tis is a lcgitimatc conccrn. Tc ordinary Chincsc tcrms lor body, mind,
and cmotion do not cvokc a simplc dividc bctwccn thc physical and thc psycho
logical. Shenti, a word with a connotation ol “pcrson” and “scll,” is much morc
activc and intcntional than body, which ctymologically is in ¡nglish a physi
cal “containcr” dcvoid ol thc mind.`⁶ Shenti is both physical and cxtraphysical,
capablc ol lccling, pcrcciving, crcating, and rcsonating or cmbodying changcs
and translormations in thc social world as wcll as in thc natural world. !t is
thc world: at thc samc timc, cmotivc, moral, acsthctic, and visccral. Ncithcr is
jingshen 精神`⁷ an cquivalcnt to soul or spirit in ¡nglish. !t docs not imply a
discmbodicd mcntality or a highcr ordcr ol cxistcncc. !n lact, jingshen, thc com
bination ol two charactcrs ol jing 精 (conccntratcd basis ol vitality) and shen 神
(vitality as manilcstcd through lunctional activitics ol mind and body), suggcsts
a dynamic and inscparablc rclationship in thc livcd world ol mindbody. Simi
larly, xin 心 is both hcart and mind, qingzhi is also a proccss both mindlul and
visccral. Tcsc arc not considcrcd as csscntially diffcrcnt kinds ol cxistcncc`⁸ but
diffcrcnt in lunctions or manilcstations that arc tcmporal and contingcnt.
!n othcr words, thc domains ol body, mind, and cmotion arc mutually
pcnctrating and activating. Such corrclativity is cmbodicd in thc most mundanc
lcvcls ol cvcryday lilc, in thc pattcrns and rhythms ol work, cxcrcising, cating,
slccping, and bccoming ill and bcing hcalcd. Apparcntly, Chincsc mcdicinc
hcals qingzhi disordcrs in a world that is not consistcnt with thc cpistcmologi
cal structurc ol thc Vcstcrn biomcdical modcl ol knowing and practicc.`⁹ !ts
practical logic involvcs a languagc ol “bodics” in dynamic proccss and constant
translormation and a languagc ol rclations. Tc zhongyi languagc ol yin-yang,
jing (conccntratcd basis lor vitality), qi(vital cncrgy), shen (vitality), zangfu
脏腑 (thc visccral systcms), jingluo 经络 (mcridian tracts), has its roots in a dis
tinctivc cultural tradition and a uniquc history and cvokcs a diffcrcnt scnsc and
cxpcricncc ol ordcr and disordcr. !ts cultural and thcrapcutic cfficacy cvolvcs
through a proccss ol attuning (tiao 调), which in diffcrcnt clinical contcxts
is dcmonstratcd as thc actions ol rcordcring (li 理), unblocking and lrccing
I NTRODUCTI ON 7
(tong 通), calming and ncutralizing (ping 平), harmonizing and mcdiating
(he 和) rclcasing and dissolving (jie 解), and so on.
Tcrclorc, languagc itscll bccomcs problcmatic and a subjcct ol locus lor
this book. !t sccks to undcrstand qingzhi disordcrs as thcy arc trcatcd in thc clin
ics ol a zhongyi hospital on its own tcrms. !n thc words ol my zhongyi tcachcr
in 8cijing, that mcans not to usc a Vcstcrn scicntific way ol thinking (siwei
fangshi 思维方式) to lramc zhongyi thcory and practicc but to undcrstand how
it rcally works within thc rclations bctwccn its own thcory and practicc (zishen
lilun he shijian de guanxi 自身理论和实践的关系). Tc primary conccrn is not
only to translatc thc rclcvant tcrms and conccpts but also to makc scnsc ol a
distinctivc cmbodicd cxpcricncc ol bcing ill and bcing hcalcd.
For many scholars cngagcd in crossculturc psychiatric studics in Chincsc
socicty, zhongyi, bccausc it docs not rccognizc thc scparation ol thc mcntal
lrom thc physical, not only docs not offcr a lcgitimatc way to trcat an cmo
tional distrcss but also cxcrts a ncgativc cultural influcncc on dcvcloping a mod
crn mcntal hcalth carc systcm lor China.⁴⁰ Prcvious crosscultural psychiatric
and mcdical anthropological rcscarch on cmotional distrcss and disordcrs was
mostly carricd out in thc Vcstcrn psychiatric contcxt in Chincsc socicty using
biomcdical modcls as thc standard lor comparativc invcstigations.⁴' Studics
ol this paradigm, in gcncral, lail to assign any significant mcaning to Chincsc
mcdicinc in trcating cmotionrclatcd disordcrs. Tcy tcnd to intcrprct thc way
Chincsc prcscnt, cxpcricncc, and scck hclp lor cmotionrclatcd disordcrs in
tcrms ol cultural bclicls and norms that cmphasizc somatic cxpcricncc, “cogni
tivc coping stratcgics” that paticnts and lamilics cmploy to copc with highly
stigmatizcd dysphoric affccts, or simply cognitivc and linguistic dcficicncy in
cxprcssing lcclings.⁴´ !n short, it is conccptualizcd as “somatization,”⁴` a cul
tural proccss that translorms “an csscntial psychological cvcnt into a sccondary
somatic cxprcssion.”⁴⁴
Somatization has bccn sccn as “a basic lcaturc ol thc construction ol ill
ncss in Chincsc culturc”⁴⁵ and lor somc timc was allcgcd to bc a “culturc
spccific trait typical ol thc Chincsc pcoplc.”⁴⁶ Zhongyi languagc is said to lack
cxplicit tcrms lor thc dcscription ol cmotional statcs and contributcs to thc
somatization ol affcctivc illncss among Chincsc.⁴⁷ Tscng, too, argucs that thc
charactcristics ol Chincsc mcdicinc, such as cmphasis ol visccral organs and
thc conccpts ol “cxhaustion,” “wcakncss,” and “cmptincss,” strongly influcncc
Chincsc psychiatric paticnts.⁴⁸
Tis book sharcs thc crosscultural psychiatric intcrcst in cmotionrclatcd
disordcrs in Chincsc socicty, howcvcr, my rcscarch is ol a diffcrcnt typc. !t is
situatcd in a contcxt ol Chincsc mcdicinc, in which thc basic psychiatric con
ccption ol “mcntal” vcrsus “physical,” “cmotion” vcrsus “cognitivc,” or “illncss
cntity” vcrsus “illncss bchavior” is qucstionablc. ! qucstion applicability ol thc
conccpt ol somatization in Chincsc cxpcricncc. !n lact, Chincsc psychiatrists
in actual clinical scttings havc no difficulty making conncctions bctwccn bodily
and cmotional changcs as Chincsc mcdical doctors habitually do. Tcy agrcc
8 TRANSFORMI NG EMOTI ONS
that symptom cxprcssion, bc it somatic or psychological, dcpcnds on how thc
individual cxpcricnccs thcsc changcs at thc spccific momcnt and that Chi
ncsc paticnts do not limit thcir complaints to a somatic modc but prcscnt psy
chological and cmotional symptoms too.⁴⁹ ! also qucstion thc soundncss ol
any national or communitybascd mcntal hcalth policy and scrvicc in China
that cxcludcs zhongyi lrom playing an activc rolc dcspitc thc lact that Chincsc
pcoplc routincly utilizc zhongyi thcmsclvcs in thcir fight against thc illncsscs
allcgcdly cmotional or mcntal according to thc biomcdical modcl.⁵⁰
My study lics outsidc thc paradigm ol crossculturc psychiatry and asks dil
lcrcnt qucstions. Zhongyi doctors in thc past and prcscnt do not havc to rcsort
to thc undcrlying assumption ol modcrn psychiatry—thc dichotomy ol mind
and body—in ordcr to undcrstand and trcat thc disordcrs that prcdominantly
involvc cmotions and thoughts. Tis docs not mcan that zhongyi clinicians havc
bccn unablc to scc thc distinctions,⁵' but rathcr thcir cpistcmological and pro
lcssional “bias” cmphasizcs intcrconncctions among cmotions, thoughts, and
various visccral systcms. Tcsc undcrlying conncctions arc activcly cxplorcd by
thcm as sourccs lor fighting illncsscs, physical as wcll as cmotional. To zhon-
gyi clinicians, disordcrcd cmotions or thoughts can havc physiological consc
qucnccs and vicc vcrsa, and a clinical intcrvcntion may start lrom cithcr cnd or
both. Tcn thc qucstions arc Ðocs zhongyi’s distinctivc approach to disordcrcd
cmotions and thoughts havc any thcrapcutic valuc in contcmporary China: !l
thc answcr is ycs, how docs it actually work clinically today: Can zhongyi bc
incorporatcd as cffcctivc rcsourccs into thc national and community programs
and scrviccs to improvc mcntal hcalth carc lor Chincsc pcoplc: Tcrc is an ap
plicd dimcnsion implicd in this book. !t shows that zhongyi has a uniquc rolc to
play in its carc lor thc cmotionally ill and that social and mcntal hcalth lacilitics
can bcncfit lrom zhongyi’s participation.
!n my study, qingzhi disordcr is sccn as a zhongyi construct, complctc and
valid in itscll, not a culturally mcdiatcd vcrsion ol a “rcal” psychiatric discasc. !t
is an cthnographic rcscarch without psychobiological mcasurcmcnts. Trough
out thc book, qingzhi disordcr rcmains a Chincsc cxpcricncc: a mcaninglul
lorm ol suffcring lor thosc who scck to balancc and to put back in ordcr thcir
upsct world ol shenti (bodypcrson). Surcly it is possiblc to comparc qingzhi
disordcr with rclcvant psychiatric constructs ol dcprcssion or anxicty, yct it
rcquircs a diffcrcnt typc ol rcscarch that gocs bcyond thc lramc and thc scopc
ol this book.
Tis book is not mcant to offcr a comprchcnsivc account ol thc practicc ol
Chincsc mcdicinc in contcmporary China. Yct it is hclplul to situatc my own
cthnographic invcstigation ol qingzhi disordcrs in rclation to somc ol thc rcccnt
anthropological studics ol Chincsc mcdicinc in contcmporary China.
!n thc carly ·cs, Judith Farqhar spcnt cightccn months studying and con
ducting participant obscrvation at thc Guangzhou Collcgc ol Traditional Chi
ncsc Mcdicinc. Hcr book Knowing Practice: Te Clinical Encounter of Chinese
Medicine (.µµ¡) is bascd primarily on this cxpcricncc. !n thc book, Farquhar
I NTRODUCTI ON 9
discusscs in grcat dctail thc proccss ol “looking at illncss” (kanbing 看病) in
zhongyi clinical cncountcrs and thc practical logic ol this proccss, which a zhon-
gyi practitioncr has to lollow in ordcr to cffcct hcaling. My study is indcbtcd
to hcr insights in clinical cncountcrs ol Chincsc mcdicinc, and ! bcncfit lrom
hcr discussions on thc cpistcmological incompatibility bctwccn thc biomcdical
scicnccs and Chincsc mcdicinc.
A numbcr ol lactors sct my study apart lrom hcrs. Farquhar makcs cx
tcnsivc usc ol zhongyi tcxtbooks and publishcd cascs lor hcr analysis. My own
study locuscs mostly on thc actual clinical work with all ol its intcractivc impli
cations. Sccond, thc proccss ol kanbing is undcrstood as thc proccss ol doctor
and paticnt looking at illncss togcthcr. Farquhar’s analysis is morc dircctcd to
thc prolcssional point ol vicw, that is, what a doctor nccds to know in ordcr
to cffcct a curc. My study that takcs a lacctolacc intcraction as a stratcgic
sitc lor undcrstanding thc clinical proccss prcscnts both thc prolcssional and
thc paticnt’s pcrccptions and shows thc rolc that thc paticnt plays in both thc
diagnosis and thc hcaling. Finally, my locus is on qingzhi disordcrs whcrc al
lcctivc lactors in Chincsc mcdicinc havc rcccivcd an ultimatc attcntion, whilc
in Farquhar’s study, affcctivity is not a topic ol conccrn.
Any writing ol Chincsc mcdicinc in contcmporary China will incvitably
conlront thc issuc ol plurality. Ðivcrsity is obscrvablc at cvcry lcvcl ol Chi
ncsc mcdical discoursc and practicc. Tc hctcrogcncity ol Chincsc mcdicinc in
thc past and prcscnt has bccn widcly dcscribcd and commcntcd on by schol
ars mostly in thc Vcst.⁵´ Chincsc sourccs tcnd to takc zhongyi pluralitics lor
grantcd and scc littlc nccd lor lurthcr justification, whcrcas unity or unilor
mity is sccn as somcthing that nccds to bc cstablishcd. Scholarphysicians ol
diffcrcnt schools in thc past lound thcir idcntity by tracing thcir prolcssional
gcncalogics to Huangdi Neijing 黃帝内经 (Ycllow ¡mpcror’s !nncr Classics),
Shanghan Lun 伤寒论 (Ðiscussions ol Cold Ðamagc), and othcr canonical
tcxts, and to grcat mastcrs in thc history ol Chincsc mcdicinc. For contcm
porary zhongyi scholars, thcrc is not only a nccd to show continuity ol thcir
prolcssion lrom thc past but also a prcssurc to dcmonstratc its alignmcnt with
modcrn scicncc. !ntcrcstingly, whilc thc proccss ol standardization (guifanhua
规范化) or systcmization (xitonghua 系统化) bascd on biomcdical modcls has
significantly translormcd thc lacc ol zhongyi organization and practicc, original
stylcs, pcrsonal cxpcricncc, and individual virtuosity arc continuously valucd in
thc prolcssion and dclibcratcly sought by paticnts. !n a scnsc, thc participation
ol biomcdicinc adds morc dimcnsions to thc cxisting pluralitics ol Chincsc
mcdicinc.⁵`
Scholars ol Chincsc mcdicinc in thc Vcst, lrom a diffcrcnt background
in which cxistcncc ol thc objcctivc truth is prcsupposcd, arc morc likcly to
lccl a compclling nccd to cxplain and justily divcrsity in Chincsc mcdicinc. !n
¡lisabcth Hsu’s cthnography, Te Transmission of Chinese Medicine, thc plural
ity is cmbcddcd in thc transmission ol knowlcdgc in contcmporary Chincsc
mcdicinc. Shc shows that mcdical knowlcdgc acquircd through diffcrcnt modcs
10 TRANSFORMI NG EMOTI ONS
ol transmission and within diffcrcnt social rclationships is undcrstood and
“known” diffcrcntly. Shc dcscribcs thrcc diffcrcnt modcs ol knowlcdgc trans
mission in corrcspondcncc with thrcc distinctivc social scttings, namcly, thc
transmission ol “sccrct knowlcdgc” within a mastcrdisciplc rclationship, “thc
pcrsonal transmission ol knowlcdgc” bctwccn a mcntor and a lollowcr char
actcristic ol classical scholarship, and “thc standardizcd modc ol transmission”
in thc contcxt ol modcrn classroom lcarning.⁵⁴ \olkcr Schcid takcs plurality
and divcrsity as thc main thcsis ol his book, Chinese Medicine in Contemporary
China: Plurality and Synthesis, which cxamincs “a plurality ol agcncics and pro
ccsscs involvcd in thc shaping ol contcmporary Chincsc mcdicinc,” including
politicians and statc, paticnts and physicians, classical scholarship and modcrn
hcalth carc systcms, institutions, nctworks, and training ol zhongyi physicians.⁵⁵
!n my own cthnography, plurality is not a topic but a contcxt. ! takc Schcid’s
conclusion that plurality is “an intrinsic aspcct ol contcmporary Chincsc mcdi
cinc”⁵⁶ as a starting point and cxplorc how multiplc pcrspcctivcs and sourccs ol
knowlcdgc play out in an actual clinical proccss. !n this scnsc, my casc studics
ol qingzhi disordcrs should bc rcad as an analysis ol a microproccss ol a local
synthcsis rathcr than as an attcmpt to providc a complctc or comprchcnsivc
prcscntation ol how qingzhi disordcrs arc diagnoscd and trcatcd gcncrally in
clinics ol Chincsc mcdicinc.
ETHNOGRAPHI C SETTI NGS
Altcr bcing away lrom China lor about lour ycars, ! wcnt back to 8cijing in
January .µµ¡ to conduct a twclvcmonth ficldstudy lor my cthnographic study
on cmotionrclatcd disordcrs in thc clinics ol Chincsc mcdicinc, on which this
book is bascd. Howcvcr, my rcscarch lor thc book has continucd bcyond thc
original ficldwork through corrcspondcncc and intcractions with zhongyi pro
lcssionals and scholars both in and outsidc China, as wcll as subscqucnt visits to
thc original ficld sitcs and through rcading thc publishcd litcraturc on Chincsc
mcdicinc.
For this anthropological rcscarch, ! rclicd hcavily on participant obscrva
tion as wcll as scmistructurcd and unstructurcd intcrvicws with paticnts, doc
tors, and ordinary Chincsc citizcns, whom ! camc to know by diffcrcnt mcans
and at diffcrcnt timcs. My own pcrsonal background as a Chincsc nativc who
grcw up and was cducatcd in China pcrmittcd mc rcady acccss to thc Chincsc
cultural rcsourccs and social nctworks, which wcrc vcry much nccdcd in doing
such rcscarch. Nccdlcss to say, howcvcr, thc way ! lormulatcd my thcorctical
positions and intcrprctcd thc cmpirical data and thc way in which ! actually
wcnt about doing my intcrvicws and obscrvations borc thc cultural and cxpcri
cntial marks ol mc as a Vcstcrn traincd nativc anthropologist.
My ficldwork took mc to various hospitals and clinics ol Chincsc mcdicinc
in 8cijing, but thc major part ol thc clinical obscrvation was carricd out in onc
ol thc affiliatcd hospitals ol thc 8cijing Acadcmy ol Chincsc Mcdicinc. Tc
I NTRODUCTI ON 11
hospital was built in thc mid.µ¸cs. Òvcr thc dccadcs, it has bccn cxpandcd and
dcvclopcd into onc ol thc largcst zhongyi hospitals as wcll as a major clinical
rcscarch and tcaching ccntcr lor Chincsc mcdicinc in thc 8cijing arca. Many
physicians who work in thc hospital dividc thcir timc among clinical work,
rcscarch, and tcaching. Clcarly my cthnographic account ol clinical cncoun
tcrs rcflccts thc practicc ol this clitc and prolcssionalizcd Chincsc mcdicinc,
which, as an intcgratcd part ol thc national hcalth carc systcm, is sanctioncd
and closcly supcrviscd by thc statc.
Tc organization and managcmcnt ol thc hospital rcscmblcs, in cvcry im
portant way, a modcrn biomcdical hospital in 8cijing. !t consists ol a¡ clinical
dcpartmcnts (ke-shi 科室), including qigong 气功 (brcathing cxcrciscs lor im
proving hcalth or curing discasc) and zhenjiu 针灸 (acupuncturc and moxibus
tion) clinics that arc not common divisions in most biomcdical hospitals in
China, and .¸ labs and rcscarch dcpartmcnts ol mcdical scicnccs and tcchnology,
which ccntrally rcflcct thc policy ol “using modcrn scicncc and tcchnology to
conduct scicntific rcscarch ol traditional Chincsc mcdicinc.”⁵⁷ ! chosc Shcnjing
Kc 神经科 (Clinic ol Ncuropathic Ðisordcrs) as thc primary sitc lor my clini
cal obscrvations.⁵⁸ Likc many othcr structural catcgorics in a modcrn zhongyi
hospital, thc namc ol Shcnjing Kc itscll camc lrom thc biomcdical modcl in
an attcmpt to cstablish grcatcr authority in thc culturc ol modcrn scicncc. Tc
rcason ! chosc Shcnjing Kc as thc basc ol my rcscarch is mainly bccausc it has
a largc conccntration ol paticnts with qingzhi disordcrs. Vhcn rclcrring to an
illncss, ordinary Chincsc do not typically makc distinctions bctwccn “ol ncrvcs”
(shenjing 神经) and “ol mind or spirit” (jingshen 精神). Chincsc usc “ncurologi
cal disordcr” (shenjing bing 神经病) casually to mcan “mcntal illncss” (jingshen
bing 精神病). Tc doctors ! workcd with in this particular clinic cstimatcd that
about ,¸ º ol thcir paticnts who camc to scck mcdical hclp suffcrcd a qingzhi
rclatcd disordcr. !n addition, thc dircctor ol thc clinic is rccognizcd as an cxpcrt
in trcating such disordcrs, cspccially, stagnation syndromc (yuzheng 郁证), in
which ! was particularly intcrcstcd.
! was introduccd to thc hcad ol thc clinic, who is a scnor doctor known
lor his cfficacy in trcating qingzhi disordcrs, through a mutual lricnd. At our
first mccting, hc cmphasizcd that zhongyi and xiyi (Vcstcrn biomcdicinc) arc
ol two diffcrcnt “ways ol thinking” (siwei fangshi 思维方式) and that ! should
bc cautious not to intcrprct zhongyi simply in tcrms ol Vcstcrn scicntific cat
cgorics and languagc. According to him, a good undcrstanding ol zhongyi rc
quircs a complctcly diffcrcnt languagc, and it takcs timc to slowly “undcrstand
through dircct cxpcricncc” (tihui 体会) zhongyi thcorics and practiccs. ! could
not agrcc morc with this advicc. A good rapport bctwccn thc scnior doctor and
mc startcd lrom this straightlorward convcrsation. ! was latcr givcn pcrmission
to do participant obscrvations in his clinic. !n an anthropological cxprcssion, !
was “adoptcd” into thc community by assuming a studcnt rolc. Tc doctor took
it to bc his rcsponsibility to scc that ! rcally undcrstood Chincsc mcdical con
ccpts and clinical actions so that ! would not misrcprcscnt Chincsc mcdicinc in
12 TRANSFORMI NG EMOTI ONS
my rcscarch. ! lollowcd thc doctor in his clinic lor about tcn months likc onc ol
his studcnt doctors, though ! did not wcar thcir unilorm. As a rcsult, ! bccamc
lamiliar with his collcagucs working in thc samc consulting room, his graduatc
studcnts, and somc ol his paticnts. Most ol all, ! gaincd considcrablc tihui ol
Chincsc mcdicinc. Toward thc cnd ol my ficldwork, my doctor lricnds told mc
that ! uscd thcir languagc and askcd “corrcct” qucstions, and thcy jokcd that !
could cvcn opcn a clinic ol Chincsc mcdicinc myscll somc day.
Ðuring my clinical obscrvations, ! rccordcd morc than lour hundrcd cascs.
Tc proccdurc was to sit bcsidc thc doctor, takc notcs, and latcr with thc par
ticipants’ pcrmission to rccord clinical intcractions. ! was cncouragcd to movc
along with thc clinical proccss, whcn appropriatc, to lccl a paticnt’s pulsc, look
at his/hcr tonguc, and ask qucstions. Somctimcs, thc doctor would dircctly put
mc on thc spot by suggcsting that a paticnt talk with mc, and hc introduccd
mc as an anthropologist doing a rcscarch projcct on cmotionrclatcd disordcrs.
Ònly a lcw paticnts actually agrccd to sit down lor an intcrvicw. Most paticnts
would simply dcclinc thc invitation citing various rcasons. Most ol my intcr
vicws ol paticnts wcrc scmistructurcd and took placc outsidc thc clinical room.
Tc qucstions ccntcrcd on thc inlormants’ illncss history and cxpcricncc as wcll
as thcir zhongyi knowlcdgc. Tc purposc ol my qucstions was to undcrstand a
paticnt pcrspcctivc on his or hcr illncss and thc rolc ol cmotion in his or hcr ill
ncss cxpcricncc and also to rccord paticnts’ narrativcs rcgarding how thcy copcd
with and accountcd lor or madc scnsc ol thcir suffcrings, and why thcy chosc to
scc a zhongyi doctor. My onc disappointmcnt was that ! was not ablc to build
up a closcr rapport and havc morc indcpth intcrvicws with thc paticnts. Con
ducting an intcrvicw with a paticnt provcd to bc challcnging and, somctimcs,
lrustrating. Partly this was duc to thc clinical scttings ol my rcscarch. Paticnts
camc to thc clinic lor trcatmcnt bccausc thcy wcrc suffcring. Tcy had littlc
timc or intcrcst in talking to a strangcr, much lcss talking about thcir pcrsonal
livcs bcyond thcir immcdiatc conccrns ol thcir illncsscs. ! also lclt littlc justificd
to probc into a paticnt’s pcrsonal lilc. !n lact, zhongyi doctors arc vcry subtlc
whcn coming to scnsitivc pcrsonal qucstions. ! was told that a doctor should
not probc into anything that a paticnt was dclibcratcly avoiding talking about,
bccausc that could only add strcss and anxicty to thc paticnt and intcrlcrc with
thc cfficacy ol thc thcrapy. Tis is cspccially a conccrn with paticnts who suffcr
lrom a qingzhi disordcr. Howcvcr, ! was ablc to carry out lcngthy and indcpth
intcrvicws with thc paticnts whom ! happcncd to know wcll and lricnds and
rclativcs who suffcrcd cmotionrclatcd disordcrs and sought Chincsc mcdical
trcatmcnt.
My cxpcricncc with doctors was quitc diffcrcnt. ! saw thcm scvcral timcs a
wcck and had lunch with thcm at thc hospital’s calctcria. Tcy wcrc intcrcstcd
in my cxpcricnccs in thc Unitcd Statcs. My intcraction with thcm was inlormal
and rclaxcd. Unstructurcd intcrvicws wcrc carricd out with thcm whcncvcr it
was convcnicnt. Tcsc intcrvicws covcrcd broad mcdical, social, cultural, and
political topics, as wcll as pcrsonal cxpcricnccs.⁵⁹
I NTRODUCTI ON 13
My participant obscrvation also wcnt bcyond thc major ficld sitc. Ðircctly
undcr thc Ministry ol Hcalth, this hospital closcly rcflccts thc official policics
to promotc zhongyi to a modcrn scicntific rcalm and to cxplorc ways to com
binc Vcstcrn and Chincsc mcdicincs. !n tcrms ol lunding and othcr lorms ol
govcrnmcnt support, it has advantagcs ovcr many othcr smallcr hospitals. My
cxpcricncc in othcr Chincsc mcdical institutions that arc lcss prcstigious pro
vidcd a comparativc pcrspcctivc.
Coming back to thc much changcd ncighborhood in thc Haidian district
whcrc ! uscd to livc, ! was imprcsscd by thc numbcr ol zhongyi clinics in thc
ncighborhood. Vithin thc arca whcrc ! livc, thcrc wcrc two zhongyi outpaticnt
clinics with a Chincsc pharmacy attachcd, a small zhongyi hospital, a zhon-
gyi clinic within a community hospital, and a ncw zhongyi consulting room
addcd to a hcalth clinic. ! lrcqucntcd thcsc smallcr Chincsc mcdical institu
tions, cspccially thc small zhongyi hospital, which lay hiddcn in a small lanc
bchind tall buildings. Tc hospital spccializcd in trcating chronic and difficult
discascs (manxing yinan bingzheng 慢性疑难病证) by combining Chincsc and
Vcstcrn mcdicincs (zhong-xi yi jiehe 中西医结合). ! was surpriscd to find a
Jingshen Ke 精神科 (mcntal hcalth clinic) in this small hospital, which was
not a common division in zhongyi hospitals. From thc inlormation providcd in
thc various postcrs, picturcs, and banncrs in this location, ! rccognizcd quitc a
lcw namcs ol lamous scnior doctors (laozhongyi 老中医) and prolcssors, who
wcrc invitcd to work part timc thcrc, whilc kccping thcir pcrmancnt positions
in othcr hospitals and rcscarch or tcaching institutcs. Tcir prcscncc madc this
small hospital popular. Somc ol my intcrvicws with paticnts wcrc carricd out
in this small hospital.
Tc cconomic rclorms that gaincd momcntum in thc .µ·cs and thc movc
mcnt toward thc lrcc markct systcm havc changcd thc lacc ol zhongyi practicc
in an important way. Tc ncw cconomic policics havc cncouragcd thc flow ol
zhongyi knowlcdgc and practitioncrs lrom thc largc statc institutions to smallcr
community clinics and privatc hospitals.⁶⁰ Not only do wcllcstablishcd scnior
doctors run thcir own privatc clinics, but thc young graduatcs ol zhongyi col
lcgcs and univcrsitics may also cngagc in sidclinc busincsscs.⁶' 8ctwccn largc
statcsponsorcd institutions and smallcr or privatcly owncd practiccs, thcrc is
no strict boundary but a constant flow ol knowlcdgc and rcsourccs.
Ðuring my rcsidcncy in 8cijing, ! staycd in a community whcrc my parcnts
livcd and whcrc lamilics had known onc anothcr lor a long timc and sharcd
many social occasions. !n this community ! was a truc participant in cvcry
scnsc, visiting my ncighbors, hclping out and bcing hclpcd, listcning to gossip
in thc mail room, and talking to pcoplc whilc taking a walk in thc ncighbor
hood parks. Not only did ! obscrvc daily social and cmotional intcractions and
actual managcmcnt ol cmotional crisis and illncsscs, but ! was also somctimcs
part ol that proccss. Formcr classmatcs, lricnds, and rclativcs wcrc also valu
ablc rcsourccs lor my rcscarch. ! was givcn acccss to thcir mcdical rccords and
prcscriptions and was allowcd to accompany thcm to scc a doctor. Vith thcm, !
14 TRANSFORMI NG EMOTI ONS
carricd out lcngthy and indcpth intcrvicws rcgarding thcir pcrsonal and cmo
tional cxpcricncc. ! undcrstood thcm and sharcd many ol thcir worrics, anxict
ics, conlusions, and hopcs.
THE FRAMEWORK OF THE BOOK
!n this introduction, ! havc outlincd somc thcorctical and conccptual consid
crations that arc ccntral to a cultural undcrstanding ol qingzhi disordcrs in
contcmporary practicc ol Chincsc mcdicinc and introduccd thc cthnographic
subjccts and scttings. ! situatc my rcscarch in thc anthropological discoursc ol
body, cmotion, illncss, and mcdicinc. ! show how my study is rclatcd to and
diffcrcnt lrom othcr rclcvant studics thcorctically and cmpirically. Chaptcr a
discusscs thc continuity and modcrn translormation ol Chincsc mcdicinc. Ònc
purposc ol this chaptcr is to historicizc thc lorm ol zhongyi practicc in con
tcmporary China. !t cxplorcs how thc manilold historical cvcnts and lorccs
sincc thc latc ninctccnth ccntury havc bccn at work in shaping thc traditional
indigcnous “yi (mcdicinc)” into prcscnt day cosmopolitan zhongyi. Tis chaptcr
also sccks to ground “modcrn” zhongyi in an cpistcmological tradition that ap
proachcs knowlcdgc, thcory, and practicc diffcrcntly lrom that ol thc modcrn
Vcstcrn scicncc and that givcs Chincsc mcdicinc a scnsc ol continuity lrom
its distant and rcccnt past. Chaptcr ¸ cxplorcs thc Chincsc world ol body
pcrson (shenti), through thc analysis ol cultural scmantics and acsthctics ol
shenti cmbodicd in thc way Chincsc talk about thcir body and cxpcricncc thc
“loss ol balancc” (shitiao 失调) or “bcing in discord” (weihe 违和). ! show that
thc way Chincsc paticnts cxpcricncc qingzhi disordcrs and thc Chincsc mcdical
thcrapcutic proccss in hcaling thcm arc proloundly cmbcddcd in thc cultural
scnsibilitics and thc mcanings ol body, pcrson, and socicty. !n othcr words, thc
cultural acsthctics and valucs pcrsistcnt in Chincsc socicty arc cmbodicd and
arc thus particularly visiblc whcn thc bodypcrson is in “discasc.” Chaptcr
¡, locusing spccifically on thc Chincsc conccpt ol “qingzhi” (cmotionmind),
cxplorcs thc sociocultural and cthnomcdical contcxts whcrc qingzhi and disor
dcrcd qingzhi arc lormulatcd, talkcd about, and cxpcricnccd. Chaptcrs ¸ and 6
cxaminc thc mcaning and thc catcgorization ol qingzhi disordcrs in rclation to
thc zhongyi clinical proccss ol “diffcrcntiation ol syndromcs and dctcrmination
ol thcrapics” (bianzheng lunzhi 辩正论治). Chaptcr , offcrs a closc cxamination
ol an actual lacctolacc clinical intcraction, which shows how thc syndromc
ol a particular qingzhi disordcr is dcfincd through ordinary clinical work and
how thc proccss ol tiao (attuning) works to translorm thc paticnt’s cxpcricncc.
Finally, Chaptcr , offcrs somc gcncral conclusions bascd on prcvious analysis
and discussions. !t is cvidcnt that qingzhi disordcrs—illncsscs rcsultcd lrom
disordcrcd cmotions and social difficultics—in contcmporary Chincsc mcdi
cinc offcr a mcaninglul lorm and a viablc languagc lor Chincsc paticnts to
makc scnsc ol thcir suffcrings and a practicablc rcgimcn to managc a livcd body
that lalls out ol ordcr.
I NTRODUCTI ON 15
Troughout thc book, Chincsc mcdicinc is uscd intcrchangcably with
zhongyi to rclcr to thc prolcssional Chincsc mcdicinc practiccd in contcmpo
rary China and its classic lorm ol scholarly mcdicinc, lrom which thc prcscnt
day zhongyi has cvolvcd and translormcd. Accordingly, xiyi and Vcstcrn mcdi
cinc, its dircct translation, arc also uscd intcrchangcably to rclcr to thc lorm
ol biomcdicinc practiccd in modcrn China. Translation ol Chincsc mcdical
tcrminology provcs to bc a difficult task. My translation docs not lollow onc
singlc sourcc. !nstcad, ! consultcd various sourccs⁶´ and dccidcd on thc oncs !
lccl bcst rcflcct my undcrstanding ol thc tcrms in thc contcxt. !n othcr words,
thc translation itscll may not bc minc, but thc choicc is. Somc Chincsc tcrms
arc uscd untranslatcd, such as qi and yin-yang, which havc bccn largcly acccptcd
as ¡nglish words. For othcr commonly uscd tcrms that appcar rcpcatcdly in
this book and ol which no simplc ¡nglish translation is sufficicnt to capturc an
array ol mcanings, such as qingzhi, ! tcnd to usc thc original Chincsc tcrm in
pinyin transcript, which is supplcmcntcd with a suggcstcd ¡nglish translation
at lcast whcn it appcars lor thc first timc in thc chaptcr. Chincsc charactcrs ol
thc tcrm arc also providcd at lcast oncc in a chaptcr. ! apprcciatc thc challcngc
that this makcs lor nonChincsc rcadcrs, but ! lccl that it was important to
includc Chincsc charactcrs lor thosc rcadcrs who rcad Chincsc and dcpcnd on
charactcrs lor spccific mcanings and sourccs ol thc tcrms.
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17
I I
Chinese Medicine:
Continuity and Modern Transformations
Although ! did not cxpcct to find “purc” Chincsc mcdicinc in practical clinical
work, obscrving doctors in zhongyi 中医 (Chincsc mcdicinc) clinics handling
thc rcsults ol various biomcdical tcsts and cxaminations with considcrablc con
fidcncc and skill was imprcssivc. Zhongyi doctors and studcnts ! mct in 8cijing
tcnd to scc zhongyi and xiyi 西医 (Vcstcrn mcdicinc) as complcmcntary and
that both havc thcir particular strcngths (youshi 优势) in trcating illncsscs. Tcy
agrcc that nowadays, a good zhongyi doctor has to bc knowlcdgcablc in xiyi as
wcll. Paticnts also sccm to lack rcspcct lor thc boundarics bctwccn thcsc two
diffcrcnt mcdical practiccs. Tcy do not hcsitatc to show zhongyi doctors thc
rcsults ol thcir rcccnt clcctrocnccphalograms or CAT scans and to discuss thcir
prcvious clinical cncountcrs in biomcdical hospitals. Zhongyi physicians arc
cxpcctcd not only to undcrstand biomcdical tcst rcsults but also to bc ablc to
usc biomcdical conccpts and tcrms.' Tcy, too, somctimcs ordcr laboratory tcsts
lor a paticnt and takc his/hcr blood prcssurc or prcscribc biomcdicincs, oltcn
at a paticnt’s rcqucst.´ Tc influcncc ol modcrn scicncc and its cpistcmology
on thc practicc and organization ol prolcssional Chincsc mcdicinc has bccn
so cxtcnsivc that thc vcry idcntity ol zhongyi practicc as “traditional mcdicinc”
(chuantong yixue 传统医学) calls lor rcflcction.
Morcovcr, Chincsc pcoplc do not sccm to bc conluscd at all as to which
systcm is Chincsc and which is not. Zhongyi vcrsus xiyi rcmains a significant
distinction rccognizcd by both mcdical prolcssionals and thc gcncral popu
lation. Paticnts choosc to utilizc zhongyi or xiyi, or a combination ol both`
according to commonly rccognizcd lcaturcs ol thc diffcrcnt mcdical systcms
in rclation to thcir spccific illncsscs or illncss cpisodcs, knowlcdgc, prcvious
cxpcricnccs, and othcr practical conccrns, such as cost and convcnicncc. Ju
dith Farqhuar, in hcr book Knowing Practice, argucs lor “historical toughncss”
and cpistcmological distinctivcncss ol this nonVcstcrn hcaling practicc.⁴ “Tc
18 TRANSFORMI NG EMOTI ONS
practical logic” ol zhongyi and “its ways ol sccking cfficacy” obscrvcd by Far
quhar in thc .µ·cs rcmaincd largcly truc in thc .µµcs whcn my study bcgan.
Tc prcscnt situation ol zhongyi has to bc undcrstood both in its continuity as
a body ol mcdical knowlcdgc and practiccs that havc bccn cvolving lor morc
than two thousand ycars and as thc product ol thc particular historical momcnt
ol thc modcrn cra.
MODERN TRANSFORMATI ONS
8clorc Vcstcrn mcdicinc bcgan to strcam into China in thc lattcr hall ol thc
ninctccnth ccntury, thc indigcnous mcdicinc in China was simply callcd “yi”
(mcdicinc). Historically, yi cocxistcd and intcractcd with othcr hcaling prac
ticcs, such as shamanic and rcligious hcalings. Tc boundarics among thcm in
practicc might not bc clcar cut. Howcvcr, it was documcntcd that as carly as
thc Spring and Autumn ol thc Zhou Ðynasty (,,c–¡,6 ncv) yi had acquircd
an idcntity distinctivc lrom wu 巫 or zhu 祝 (shamanic/spiritual hcaling) in
its thcrapcutic rationalization and tcchnology.⁵ Yi 医 (mcdicinc), as thc his
torical sourcc ol today’s zhongyi, rclcrs mainly to a body ol accumulatcd hcal
ing knowlcdgc and practiccs bascd on a naturalistic cxplanation ol discasc and
hcalth rationalizcd in thc languagc ol “yinyang” 阴阳 and “wuxing” 五行 (thc
fivc translormativc phascs),”⁶ and “passcd down by China’s cducatcd clitc.”⁷
Tc .µ¡µ lounding ol thc Pcoplc’s Rcpublic ol China is commonly rcc
ognizcd as thc significant historical momcnt that markcd a drastic transition
in zhongyi practicc and cducation in China. According to thc contcmporary
Chincsc historical narrativcs, bclorc thc Libcration (lounding ol PRC in .µ¡µ),
zhongyi was “on thc vcrgc ol dying out” (binlin miewang 濒临灭亡) undcr thc
old national govcrnmcnt’s discriminating policics against zhongyi, and it was
with thc cstablishmcnt ol thc Ncw China that zhongyi “acquircd a ncw lilc”
(huode xinsheng 获得新生).⁸ !n thc past, most traditional Chincsc mcdical doc
tors wcrc individual practitioncrs working in thcir privatc clinics and pharma
cics (oltcn not complctcly scparatcd lrom thcir living quartcrs). Tc practicc
was gcncrally inhcritcd within a lamily or passcd down lrom a mastcr to dis
ciplcs. Tc bcginning ol thc twcnticth ccntury witncsscd incrcasing zhongyi ac
tivitics in cstablishing acadcmics and hospitals, organizing prolcssional groups,
and standardizing thc knowlcdgc. Howcvcr, lacking in govcrnmcntal support
and cndorscmcnt, thcsc activitics rcmaincd largcly wcak and localizcd.
Tc modcrn institutionalization ol Chincsc mcdicinc startcd in thc mid
.µ¸cs. Tc Chincsc Acadcmy ol Traditional Chincsc Mcdicinc, thc first zhongyi
institution dircctly undcr thc Ministry ol Public Hcalth, was sct up on Ðcccm
bcr .µ, .µ¸¸, through thc mcrging ol fivc diffcrcnt mcdical and rcscarch institu
tions. Tc hospital whcrc ! did most ol my ficld rcscarch was onc ol thc two
zhongyi hospitals affiliatcd with thc acadcmy. Tcy wcrc among thc first lcw
zhongyi hospitals and collcgcs cstablishcd in thc mid.µ¸cs. !n .µ¸6, lour zhon-
gyi collcgcs wcrc cstablishcd rcspcctivcly in 8cijing, Shanghai, Guangzhou, and
CONTI NUI TY AND MODERN TRANSFORMATI ONS 19
Chcngdu to train advanccd Chincsc mcdical doctors and pharmacists. Fol
lowing this trcnd, many provincial govcrnmcnts cstablishcd thcir own highcr
cducational institutions ol Chincsc mcdicinc. At thc samc timc, thc individual
practitioncrs ol Chincsc mcdicinc who had bccn working in privatc clinics
wcrc invitcd to trcat paticnts in hospitals, and many ol thcm wcrc assimilatcd
into thc diffcrcnt lcvcls ol public hcalth institutions. “Tc divcrsc and scattcrcd
practitioncrs ol traditional mcdicinc, with thcir small acadcmics and lamily
clinics, wcrc organizcd into a rapidly growing national hicrarchy ol clinical and
acadcmic institutions.”⁹
Howcvcr, to undcrstand thc contcmporary situation ol zhongyi in China,
wc should also pay attcntion to thc manilold historical lorccs that havc bccn at
work in shaping yi into today’s zhongyi sincc thc sccond hall ol thc ninctccnth
ccntury whcn China was translormcd abruptly into a shattcrcd scmicolonial
socicty.
Tc practicc ol Vcstcrn mcdicinc in China bclorc thc sccond hall ol thc
ninctccnth ccntury was practically insignificant.'⁰ !t did not posc a scrious
challcngc to Chincsc mcdicinc until thc turn ol thc ccntury whcn Vcstcrn
mcdicinc, armcd with modcrn cxpcrimcntal scicncc and importcd into China
togcthcr lollowing thc Vcstcrn military powcrs and thc Christian God,'' cs
tablishcd its pcrmancnt prcscncc in China. Howcvcr, lor many rclormmindcd
intcllcctuals and rcvolutionarics, what Vcstcrn mcdicinc offcrcd at thc turn ol
thc ccntury was not as much cffcctivc hcaling as thc promisc ol Vcstcrn scicn
tific culturc lor national salvation.'´ Tc dccadcs ol humiliation lollowing thc
brutal cncountcr with thc modcrn Vcstcrn civilization sct many intcllcctuals
to scarch lor “salvation” bcyond thc boundary ol thcir own civilization. Vcstcrn
scicncc bccamc a powcrlul intcllcctual rcsourcc that thc Chincsc rclormists
and rcvolutionarics drcw on lor an cxtcnsivc cultural criticism ol thcir own
tradition, rcaching its climax in thc May ¡ movcmcnt in .µ.µ. “Mr. Scicncc”
(Sai Xianshcng 赛先生), as wcll as “Mr. Ðcmocracy” (Ðc Xianshcng 德先生),
bccamc an ovcrwhclming voicc in twcnticthccntury China, so powcrlul that,
as Hu Shi dcclarcd in .µa¸, “thcrc is not a singlc pcrson who calls himscll a
modcrn man and yct darcs opcnly to bclittlc scicncc.”'`
Vithin this historical atmosphcrc, thc tcnsion and polarity bctwccn Chi
ncsc and Vcstcrn lcarning wcrc obvious. Tis can bc sccn in thc labcls that idcn
tificd traditional Chincsc scholarship as “Chincsc lcarning” (zhongxue 中学),
“national lcarning” (guoxue 国学), or “old lcarning” (jiuxue 旧学), thc Vcstcrn
knowlcdgc as “Vcstcrn lcarning” (xixue 西学) or “ncw lcarning” (xinxue 新学).
Accordingly, indigcnous mcdicinc (yi) bccamc “Chincsc mcdicinc” (zhongyi 中
医), “national mcdicinc” (guoyi 国医), or “old mcdicinc” (jiuyi 旧医), whilc thc
biomcdicinc bccamc “Vcstcrn mcdicinc” (xiyi 西医) or “ncw mcdicinc” (xinyi
新医).'⁴ 8uilding a strong “ncw China” undcr thc guidancc ol a scicntific spirit
has bccn thc dominant national scntimcnt lrom thc bcginning ol thc twcn
ticth ccntury to thc prcscnt. !t is rcitcratcd in thc contcmporary discoursc ol
thc Four Modcrnizations, which draws hcavily lrom thc historical cxpcricncc
20 TRANSFORMI NG EMOTI ONS
ol thc Chincsc pcoplc at thc turn ol thc ccntury. Tc phrasc backwardncss
incurring humiliation (luohou jiuyao aida 落后就要挨打) is a lrcqucntly uscd
rhctoric in both official and popular discoursc.
Ðuring thc Rcpublic pcriod, attcmpts at climinating zhongyi wcrc a con
stant thrcat to thc zhongyi prolcssion. Zhongyi, sccn as a partncr ol thc old
lcudal culturc and incompatiblc with modcrn scicntific thinking, was an ob
staclc on thc way to “wholchcartcdmodcrnization.” !n .µ.¡ Vang Ðaxic, thc
ministcr ol cducation ol thc govcrnmcnt ol Northcrn warlords (.µ.a–a,), dc
clarcd that “|thc govcrnmcnt| had madc up its mind to climinatc thc traditional
Chincsc mcdical systcm and discard thc usc ol Chincsc matcrial mcdica.”'⁵
Òn thc occasion ol thc first convcntion ol thc Ccntral Committcc lor Public
Hcalth ol thc Kuomingtang govcrnmcnt in .µaµ, a lcw mcmbcrs ol a commit
tcc hcadcd by Yu Yunxiu prcscntcd a motion to “wipc out obstaclcs in hygicnc
work by climinating thc traditional Chincsc mcdicinc systcm.”'⁶ Many intcl
lcctuals within thc Communist Party in thc .µacs and ¸cs also argucd vigor
ously against traditional mcdicinc.'⁷
!n thc dccadcs ol advcrsity, zhongyi, in rcsistancc to official and clitc prcs
surc and in adaptation to thc compctition ol xiyi lor cconomic and politi
cal rcsourccs, translormcd itscll in scvcral important ways. First, whcn lacing
thc cxtcrnal challcngc ol an alicn knowlcdgc systcm ol Vcstcrn mcdicinc,
thc intcrnal tcnsion among divcrsc doctrincs and intcrprctations ol Chincsc
mcdicinc was rcduccd. Prior to its cncountcr with Vcstcrn mcdicinc, Chi
ncsc mcdicinc lrom thc SongYuan pcriod (µ6c–.¸6· ~b) was charactcrizcd by
tcnsion bctwccn diffcrcnt schools ol mcdical doctrincs.'⁸ ¡spccially, lrom thc
cnd ol thc Ming dynasty (.¸6·–.6¡¡ ~b) whcn thc school ol lcbrilc/warm ill
ncsscs (wenbing xuepai 温病学派) cmcrgcd, thc compctition and cvcn hostility
bctwccn thc school ol cold damagc illncsscs (shanghan 伤寒) and thc lcbrilc/
warm illncss (wenbing 温病) school bccamc incrcasingly lurious as il thcy wcrc
as “incompatiblc as watcr and firc.”'⁹ Tc rcduction ol intcrnal tcnsion was duc
as much to intcntional cfforts to lorm a unitcd lront against cncroachmcnt
ol Vcstcrn mcdicinc as to thc lact that in rclcrcncc to Vcstcrn mcdicinc, thc
common intcllcctual loundations and sharcd qualitics ol thc diffcrcnt schools
ol Chincsc mcdicinc suddcnly stood out. Tc diffcrcnccs in knowlcdgc inhcri
tancc, in intcrprctation ol mcdical conccpts in thc classics, and in cmphasis on
particular illncss lactors (bingyin 病因) and illncss mcchanisms (bingji 病机)
bccamc lcss significant. Focusing on thc common charactcrs ol Chincsc mcdi
cinc in antithcsis to Vcstcrn mcdicinc, thc knowlcdgc ol Chincsc mcdicinc was
incvitably rcconstructcd and shapcd into a morc cohcrcntly rcprcscntcd body
ol knowlcdgc. Tc rhctoric ol “contcntion bctwccn diffcrcnt schools ol mcdical
thought” (xuepaizhizheng 学派之争) was ovcrshadowcd by thc discoursc ol
zhongyi vcrsus xiyi.
Sccond, in rcaction to thc official attcmpts to dclcgitimizc thc practicc and
tcaching ol zhongyi in thc .µacs and ¸cs, thc zhongyi practitioncrs and pharma
cists wcrc mobilizcd to stagc national protcsts, which did lorcc thc govcrnmcnt
CONTI NUI TY AND MODERN TRANSFORMATI ONS 21
to stcp back lrom its radical policics to abandon Chincsc mcdicinc.´⁰ Tcsc
protcsts also lcd to thc cstablishmcnt ol thc national organization ol Chincsc
mcdicinc.´' Zhongyi at this momcnt bcgan to scc cmcrgcnt prolcssional com
munitics and institutions. !n thc two dccadcs bctwccn thc .µacs and ¸cs, about
scvcnty zhongyi schools and nincty zhongyi prolcssional organizations wcrc sct
up nationally. Although thcsc institutions wcrc still largcly rcgional, thcir influ
cnccs cut across thc boundarics maintaincd in thc past by thc vcrtical rclation
ship bctwccn mastcrs and disciplcs, and thc practitioncrs bccamc awarc ol thcir
common idcntity as zhongyi (Chincsc mcdical practitioncrs).´´
Finally, many analyscs ol Chincsc mcdicinc ol this pcriod cmphasizc thc
thcmc ol nationalism, which idcntificd zhongyi as “national csscncc” (guocui
国粹) and thus an important basis lor its modcrn lcgitimacy.´` !n thc casc ol
zhonyi, howcvcr, thc voicc ol prcscrving “national csscncc” did not go lar. !t was
ridiculcd as conscrvativc and unpractical both bclorc and altcr .µ¡µ. Altcr all,
thc succcss ol zhongyi could not bc bascd solcly on its “antiqucncss” that nccdcd
to bc prcscrvcd, but lay in its valuc as a practiccd and organizcd way against
discascs comparablc to Vcstcrn mcdicinc in thc modcrn world. Tc voiccs that
had lasting influcncc on thc modcrn lorm ol zhongyi camc lrom thc discus
sions and publications that locuscd on intcgrating zhongyi and xiyi (zhongx-
iyi huitong 中西医汇通) rcprcscntcd by rcnowncd Chincsc physicians, such
as Zhang Xichun (.·6c–.µ¸¸) and Yun Ticqiao (.·,·–.µ¸¸). Yun rcalizcd that
“zhongyi has no way out but to dcal with Vcstcrn mcdicinc” and that “zhongyi
has dcmonstratcd its capacity ol intcgrating and cvolving, and it will surcly
absorb thc strcngth ol xiyi, and intcgratc it into its systcm to lorm a ncw zhon-
gyi.”´⁴ Although how to intcgratc Chincsc and Vcstcrn mcdicincs rcmaincd
a dcbatc lor a long timc to comc, cruditc Chincsc physicians rccognizcd thc
nccd lor changc. Tcy cxpcctcd to scc a “ncw Chincsc mcdicinc” cmcrgc lrom
communication and convcrgcncc with thc strcngths ol Vcstcrn mcdicinc. Tis
articulation ol thc combination ol Chincsc mcdicinc and Vcstcrn mcdicinc
continucs to inlorm thc discoursc and practicc ol Chincsc mcdicinc today.
As discusscd abovc, thc lull lcgitimization and institutionalization ol Chi
ncsc mcdicinc in thc carly .µ¸cs and thc latcr ycars undcr thc govcrnmcnt’s
supporting policics was not without historical basis. Howcvcr, comparcd to
indigcnous mcdical practiccs in othcr Asian socictics and in othcr parts ol
thc world, thc idcological support lor zhongyi cducation and practicc lrom thc
ncw govcrnmcnt by thc Communist Party was unprcccdcntcd. !n lact, thc first
gcncration ol lcadcrship ol PRC, including Mao Zcdong, Zhou ¡nlai, and
Liu Shaoqi, gavc instructions rcgarding incorporating zhongyi into thc lormal
hcalth carc systcms ol thc ncw socicty.´⁵ At thc First National Conlcrcncc on
Hcalth hcld in .µ¸c, Mao callcd lor “uniting all thc hcalth carc workcrs, thc old
and ncw, Chincsc and Vcstcrn, to lorm a strong unitcd lront linc lor thc causc
ol pcoplc’s hcalth.” Tc principlc ol “uniting Chincsc and Vcstcrn mcdical
prolcssionals” (tuanjie zhongxiyi 团结中西医), and latcr “giving cqual cmphasis
to both Chincsc and Vcstcrn mcdicincs” (zhongxiyi bingzhong 中西医并重)
22 TRANSFORMI NG EMOTI ONS
has bccn thc basic approach to dcvcloping thc dual statc hcalth systcm. Mao’s
lamous commcnt ol .µ¸· that “Chincsc mcdicinc and pharmaccutics arc a grcat
trcasurc housc, and (wc) must makc all cfforts to uncovcr it and raisc its stan
dard”´⁶ has bccn lrcqucntly quotcd to givc zhongyi an official voicc and political
status.
Chincsc writings on modcrn zhongyi history tcnd to crcdit thc Chincsc
Communist Party (CCP)’s “historical matcrialistic attitudc toward thc cultural
lcgacy” (dui wenhua yichan de lishi weiwuzhuyi taidu 对文化遗产的历史唯物
主义态度) with much ol thc rcsponsibility lor thc last growing ol zhongyi altcr
thc cstablishmcnt ol thc PRC. !t is said that such a historicism rccognizcs thc
valuc ol zhongyi as accumulatcd knowlcdgc and cxpcricncc against discascs
throughout a long history ol “practiccs ol thc masscs” and calls lor “inhcriting”
(jicheng 继承) and “dcvcloping or carrying lorward” (fazhan 发展) thc tradi
tional Chincsc mcdicinc.
Tc ncw govcrnmcnt’s strong support lor zhongyi also camc lrom practical
considcrations. At thc timc whcn thc Communists took powcr, thc country’s
public hcalth situation was appalling, and biomcdical rcsourccs wcrc scarcc and
uncvcnly distributcd.´⁷ Scholars arc gcncrally convinccd that thc lormidablc
task lor thc ncw govcrnmcnt to providc a largc population with basic hcalth
carc motivatcd thc policy makcrs to bring thc traditional Chincsc mcdical
practitioncrs into thc public hcalth construction. Ònc ol thc most cffcctivc ap
proachcs that charactcrizcd thc rcvolution lcd by thc CCP was thc cmphasis on
mobilizing thc masscs, that is, working with whatcvcr lorccs possiblc to lorm “a
unitcd lront” (tongyi zhanxian 统一战线) against thc main cncmy ol thc timc.
At thc timc, Chincsc mcdicinc, which did not havc thc clitc status ol Vcstcrn
mcdicinc, was morc aligncd with thc masscs to bc mobilizcd and incorporatcd
into thc public hcalth programs. Tc slogan ol tuanjie zhongyi 团结中医 (unit
ing with Chincsc mcdical workcrs) thus was not just a pragmatic stratcgy but
also a politically significant movc. Morcovcr, combining Vcstcrn and Chincsc
mcdicincs lor a practical hcalth carc purposc was nothing ncw lor thc CCP.´⁸
Tc Communist Party, in its long pcriod ol armcd rcsistancc, accumulatcd cx
pcricncc ol having both Chincsc and Vcstcrn doctors work togcthcr in its basc
arcas. Tc policy to cncouragc both Chincsc and Vcstcrn doctors to lcarn lrom
cach othcr (huxiang xuexi 互相学习) workcd wcll to producc a coopcrativc
rclationship bctwccn thc Chincsc and Vcstcrn doctors, which was not lound
outsidc CCP’s libcratcd bascs (jiefangqu 解放区).´⁹ Arguably, thc combination
ol Vcstcrn and Chincsc mcdicincs (zhong-xiyi jiehe 中西医结合) lor practical
purposc has bccn largcly a continuous hcalth carc policy lor thc CCP, although
it has not gonc without controvcrsics at thc thcorctical lcvcl.`⁰
As shown abovc, thc drastic translormation ol Chincsc mcdicinc altcr
.µ¡µ—thc hospitalbascd practicc, standardization ol knowlcdgc, and class
roomccntcrcd cducation,—was built upon continuous changcs that happcncd
during thc Rcpublic cra or cvcn carlicr. Tc movc to modcrnizc and scicntizc
Chincsc mcdicinc had startcd long bclorc thc .µ¸cs.`' Zhongyi prolcssionals,
CONTI NUI TY AND MODERN TRANSFORMATI ONS 23
particularly thosc wcllknown physicians and staunch advocatcs ol zhongyi
practicc and cducation in thc .µacs and ¸cs, wcrc willing participants and activc
agcncics in thc proccss ol zhongyi translormation in thc .µ¸cs. As Schcid notcs,
many ol thcm “bccamc kcy playcrs in thc shaping ol Chincsc mcdicinc altcr
.µ¸¡.”`´ !n addition, thc ncwly acquircd political status and prolcssional spacc
in thc official hcalth carc systcm lurthcr motivatcd thc zhongyi community to
align with thc political and practical goals ol thc ncw govcrnmcnt.
THE PROBLEM OF THEORY
AND CONTI NUI TY OF CHI NESE MEDI CI NE
Modcrn zhongyi writings habitually makc discursivc conncctions bctwccn thc
prcscnt practiccs and past achicvcmcnts to highlight thc continuity ol thc prcs
cnt lrom thc ancicnt. Ðiscussions ol zhongyi basic thcorics incvitably citc thc
Huangdi Neijing 黄帝内经 (Ycllow ¡mpcror’s !nncr Classics)`` lor laying out
thc thcorctical loundations ol Chincsc mcdicinc.`⁴ Similarly, thc cxposition ol
lormulas (fangjixue 方剂学) consistcntly crcdits thc ancicnt books on lormulas
(jingfang 经方), cspccially Zhang Zhongjing’s Shanghan Zabing Lun 伤寒雜
病论 (Ðiscussions ol Cold Ðamagc and various Ðisordcrs) lor sctting up thc
basics lor Chincsc mcdical lormulas.`⁵
For many Vcstcrn scholars ol Chincsc mcdicinc, thc storics told by thc
Chincsc physicians at bcst constitutc an imagincd continuity or a lalsc imprcs
sion that thc socallcd zhongyi consists ol a wclldcfincd, unificd, and cohcrcnt
systcm ol knowlcdgc comparablc to thc Vcstcrn biomcdicinc and “basically
unchangcd sincc antiquity.`⁶ To thcm, this tradition has bccn markcd by con
ccptual contradictions, hctcrogcncous origins, historical rupturcs, and con
tinuous adjustmcnts to sociopolitical changcs.`⁷ Any historical narrativc is a
lorm ol construction, thc story ol thc cvolution ol Chincsc mcdicinc is not an
cxccption. Howcvcr, to assumc zhongyi scholars’ cmphasis on continuity and
conncctions incvitably cntails a dcnial ol divcrsity and changcs is a misrcading
rcflccting thc Vcstcrn cpistcmological bias that dichotomizcs unity (tongyi 同
一) and divcrsity (chayi 差异).
From thc pcrspcctivc ol thc Chincsc corrclativc way ol thinking cvidcnt
in thc Chincsc philosophic rcflcctions and historical discourscs, continuity
and crcativity or unity and divcrsity prcsupposc cach othcr. Tcy arc vicwcd
as intcrdcpcndcnt, thus lorming a pair ol complcmcntary oppositions. For
instancc, Shanghai Lun (Ðiscussion ol Cold Ðamagc) is considcrcd anothcr
paramount achicvcmcnt in thc history ol Chincsc mcdicinc altcr thc publi
cation ol Neijing (thc !nncr Classics). !ts author, Zhang Zhongjing, an ¡ast
Han physician, was said to havc produccd thc highly innovativc trcatisc on
trcating colddamagc rclatcd and othcr disordcrs, drawing on his intcnsivc
studics ol various mcdical tcxts ol and bclorc his timc, including thc classic
Neijing. His accomplishmcnt is oltcn talkcd about in tcrms ol continuity lrom
thc prcvious monumcntal achicvcmcnts, such as Neijing. Yct thc contcnt ol
24 TRANSFORMI NG EMOTI ONS
Shanghan Lun shows an obviously diffcrcnt approach lrom Neijing. Neijing’s
discussions ol “mcridian channcls” (jingluo 经络) and “visccral organ systcms”
(zangfu 脏腑) lcaturc littlc in Zhongjing’s “six pattcrns ol diagnosis” (liu-
jing bianzheng 六经辨证). Tc thcorctical claboration ol wuxing 五行 (fivc
translormativc phascs) lound in Neijing is complctcly abscnt lrom Shanghan
Lun.`⁸ Howcvcr, hc drcw lrccly lrom thc ancicnt tcxts on lormulas (jingfang).
8y virtuc ol thc diffcrcnccs, innovations, and physician’s uniquc synthcsis ol
thc past knowlcdgc with his own clinical practiccs and cxpcricnccs, Shang-
han Lun positions itscll in a particular rclationship to Neijing and thcrclorc
constitutcs a continuity that not only brings thc past to thc prcscnt but also
opcns ncw dircctions lor thc luturc. Tis corrclativc way ol cxplaining thc
translormativc proccss ol Chincsc mcdicinc can bc lound in thc classic Chi
ncsc thought ol “continuity through changcs” (tongbian 通变) traccablc to thc
carlicst Chincsc philosophic rcflcctions in Yijing 易经 (8ook ol changcs)`⁹
and in thc languagc ol “inhcriting” (jicheng 继承) and “dcvcloping/carrying
lorward” (fazhan 发展) ol thc modcrn discoursc ol “historical matcrialism”
(lishi weiwuzhuyi 历史唯物主义).
!ntcrcstingly, thc diffcrcnt cxplanation and usc ol mcdical conccpts and
thc innovativc clinical approachcs in Shanghan Lun arc not vicwcd by Chincsc
scholarphysicians as somcthing invalidating thc Neijing tcachings, similarly,
thc Neijing doctrincs arc not uscd as thc basis to judgc and disqualily Shanghan
Lun. 8oth arc cqually cstccmcd lor offcring valid and invaluablc thcorctical and
practical guidancc lor zhongyi clinical work and havc bccn studicd diligcntly by
gcncrations ol Chincsc scholarphysicians. !n lact, Chincsc mcdical classics arc
markcd by a lack ol consistcncy and, somctimcs, by obvious disagrccmcnts.⁴⁰
Yct Chincsc physicians sccm to takc thc divcrsity lor grantcd and arc not con
ccrncd much by sccmingly conflicting statcmcnts in thc mcdical thcorics. Such
is thc casc. Tc articulation ol thcory (lilun 理论) within Chincsc mcdicinc
thcrclorc mcrits critical attcntion.
Modcrn zhongyi scholarphysicians ncvcr lail to strcss that zhongyi pos
scsscs “a distinctivc body ol thcorics” (dute de lilun tixi 独特的理论体系)
groundcd in accc ycars ol practicc (shijian 实践), cmbodicd in cvcrincrcasing
canonical tcxts (jingdian lunzhu 经典论著), and manilcstcd in thc virtuosity ol
cxcmplary physicians (dayi 大医). ¡xpcricnccd scnior physicians ol thc modcrn
timc invariably cmphasizc thc rclcvancc ol Chincsc mcdical thcorics (lilun 理
论) in clinical practiccs.⁴' Scnior doctors somctimcs complain that thc youngcr
gcncration ol Chincsc mcdical doctors has not paid sufficicnt attcntion to
zhongyi thcorics. My zhongyi tcachcr claimcd that thc qucstions and cvcn thc
scqucncc ol qucstions hc asks during a clinical consultation arc not random at
all, likc thc thcrapcutic actions hc chooscs and thc lormulas hc dcsigns, all havc
a thcorctical basis (lilun genju 理论根据). Hc lrcqucntly cautioncd his studcnt
doctors who wcrc busy taking notcs that it would not hclp with thcir clinical
work no mattcr how many lormulas thcy took down il thcy did not undcr
stand thc undcrlying logic ol his qucstions and his thcrapcutic dccisions. Tc
CONTI NUI TY AND MODERN TRANSFORMATI ONS 25
scnior doctor’s claim was somctimcs vcrificd by youngcr doctors’ lrustrations.
My lricnd, Ðr. Vang, oncc complaincd, “Vc usc a scnior doctor’s lormula thc
samc way as hc did, but wc ncvcr gct thc samc cffcct.” Tcn, what do Chincsc
scholarphysicians actually mcan whcn thcy talk about zhongyi lilun (Chincsc
mcdical thcorics) or simply yili 医理 (mcdical thcorics), and in what scnsc
thcsc lilun arc considcrcd “distinctivc.”
Tc Chincsc charactcr li 理 has thc mcaning ol naturally lormcd pattcrns
or rclations within thc dynamic proccss ol things (shiwu 事物). As a vcrb, li
mcans to “tracc out” or “map out” thc “corrclatcd dctails and thc cxtcndcd pat
tcrn ol rclationships.”⁴´ Lilun (thcory) in Chincsc mcdicinc is rathcr a discus
sion ol and a rcasoning out ol thc concrctc and complicatcd rclations among all
thc lactors rclcvant to a particular illncss coursc and manipulating thc particular
rclations to cffcct a curc. Zhongyi lilun as shown in thc canonical tcxts cmploys
a languagc ol imagcry and mctaphor (xingxiang siwei yuyan 形象思维语言)
and allows dircct acccss to concrctc dctails and nuanccs. As such, lilun in thc
contcxt ol Chincsc mcdicinc should not bc undcrstood as rclcrring to a cohcr
cnt sct ol normativc principlcs distinguishcd lrom practicc. Accordingly, thc
canonical Chincsc mcdical tcxts should not bc rcad as norms or standardizcd
mcthods by which practicc is produccd. Chincsc mcdical classics, as Farquhar
argucs, “lunction morc as allcgorical rcsourccs lor clinical thinking than as first
principlcs.”⁴`
Zhongyi lilun arc sccn as typically cmbodicd in thc canonical tcxts, and
lcarning thcm by hcart is thc way to mastcr Chincsc mcdical thcorics.⁴⁴ As !
obscrvcd in clinics, a scnior doctor would lrcqucntly quotc a scntcncc or two
lrom thc mcdical classics to show his studcnts thc conncction ol his prcscnt
clinical action to past knowlcdgc and practicc. Rclcrcncc to such knowlcdgc is
morc than just providing “symbolic anchors” to thc past.⁴⁵ For many zhongyi
doctors, thosc who mastcr thc mcdical classics wcll and arc ablc to conncct
skilllully thcir own clinical actions to thc practiccs ol thc past mastcrs arc con
sidcrcd strong in lilun. Tcy bclicvc that classical lcarning lunctions as a loun
dation lor zhongyi clinical thinking.
Tc traditional way ol bccoming a zhongyi physician involvcd ycars ol
pcrsonal apprcnticcship to a mastcr physician and rcading and mcmorizing
zhongyi canonical tcxts. Tc importancc ol knowing classical tcxts has bccn
always cmphasizcd in thc prolcssion. Tc classic tcxts, such as Neijing (Tc
!nncr Classics), Nanjing 难经 (Òn Ðifficult Mcdical !ssucs), Shanghan Lun
(Ðiscussions ol Cold Ðamagc), and Jinkui Yaolue 金匮要略 (Tc Goldcn
Principlcs), had bccn rcquircd rcadings in mcdical cducation lor gcncrations
until thc rcccnt past. Although, standardizcd tcxtbooks and classroom tcach
ing arc thc dominant lorm ol contcmporary zhongyi cducation,⁴⁶ Neijing still
“figurcs particularly promincntly in contcmporary tcaching ol thc thcorctical
loundations ol Chincsc mcdicinc, scrving as a lund ol ultimatc cxplanations
on which many modcrn writcrs draw.”⁴⁷ For advanccd studcnts ol Chincsc
mcdicinc, a good knowlcdgc ol thc classical mcdical tcxts is indispcnsablc.
26 TRANSFORMI NG EMOTI ONS
Comparcd with modcrn biomcdical tcchnology, zhongyi’s powcr ovcr lilc and
dcath is limitcd. Clinical actions thcrclorc involvc a comprchcnsivc awarcncss
ol intcrdcpcndcnt conditions and rclations, a carclul wcighing ol all thc obvi
ous or latcnt possibilitics, and a grasping ol thc momcnt ol opportunity lor
action to bring about changcs. !n this scnsc, a good clinician nccds to cultivatc
in himscll or hcrscll an almost intuitivc ability to disccrn subtlc changcs and
multitudc rclations conccrning thc cntirc pathological condition and to flcx
ibly dcploy all thc rcsourccs availablc lor a succcsslul intcrvcntion.⁴⁸ A diligcnt
study ol zhongyi classics is a timchonorcd way to lurthcr prcparc oncscll lor
such complicatcd clinical tasks. Tc proccss ol lcarning mcdical classics is thcn
a proccss ol lamiliarizing oncscll with thc way, thc stylc, and thc languagc
by which a particular cxcmplary physician dcmonstratcd his art ol mcdicinc.
Lcarning in this scnsc, similar to Hall and Amcs’ intcrprctation ol “lcarning”
(xue 学) in Conlucian thinking, “rclcrs to an unmcdiatcd proccss ol bccoming
awarc rathcr than a conccptually mcdiatcd knowlcdgc ol a world ol objcctivc
lact.”⁴⁹
Practically, lilun in Chincsc mcdicinc is vcry much a summarizcd or tcx
tualizcd lorm ol accumulatcd cxpcricncc lrom practicc (shijian jingyan 实践
经验). !t providcs concrctc instanccs and cvcnts as modcls and rcsourccs lor
organizing clinical actions. !n lact, a largc proportion ol thc publications con
ccrning Chincsc mcdicinc throughout history havc bccn rccords ol mcdical
cascs (yian 医案), trcatmcnt lormulac (fangshu 方书), and thc pcrsonal and
prolcssional rcflcctions (xinde 心得) by rcnowncd scholarphysicians. Classic
tcxts likc thcsc do not lunction to sct up standards or principlcs lor clinical
practiccs, but to invokc, to cnrich, and to inspirc crcativitics.⁵⁰ Sincc thc .µ·cs,
collcctions ol mcdical cascs by and biographic writings ol cxcmplary scholar
physicians ol thc modcrn timc havc bccn publishcd in largc quantity and rcad
by ncw gcncrations ol physicians.
Tcory or knowlcdgc undcrstood in this scnsc is not a rcprcscntation ol
any abstract undcrlying truth or objcctivc principlc and thcrclorc is not typi
cally amcnablc to thc absolutc judgmcnt ol right or wrong. !t spcaks about
thc succcss ol a particular momcnt with all its contingcncy and tcmporality.
!t bccomcs “truth” or usclul knowlcdgc whcn it bccomcs rclcvant to onc’s own
momcnt ol practicc and thus bccomcs an intcgral part ol thc proccss ol crcating
that momcnt. An individual physician thcn bccomcs a ccntcr or a transmittcr
that is both inhcriting (jicheng 继承) and dcvcloping (fazhan 发展) zhongyi
knowlcdgc and bringing thc past into thc prcscnt and thc luturc. Tis “distinc
tivc” stylc ol knowing is dccply rootcd in thc traditional Chincsc nontran
sccndcntal and noncsscntialistic worldvicw⁵' rathcr than as thc product ol any
psychologizcd Chincsc cognitivc dynamics.⁵´ As a mcdical tradition, Chincsc
mcdicinc is quintcsscntially cmbodicd and transmittcd in thc momcnt ol clini
cal practicc.⁵` !n its cmphasis ol pcrsonalizcd, tcxtualizcd, and accumulatcd
cxpcricncc (jingyan) bascd on clinical practicc (shijian), thc modcrn world ol
zhongyi dcmonstratcs its unity and continuity.
CONTI NUI TY AND MODERN TRANSFORMATI ONS 27
CONTEMPORARY CHALLENGES AND DEBATES
Zhongyi’s idcntity in modcrn timcs is ambiguous. !t is said to bc ancicnt (gulao
古老), traditional (chuantong 传统), and as such, is aligncd with thc past. !t
is also claimcd as having “scicntific componcnts” (kexuexing 科学性) dcmon
stratcd in its thcrapcutic cffcctivcncss. Yct it docs not fit comlortably into thc
paradigm ol modcrn scicntific mcdicinc. “Scicncc” (kexue), sincc thc carly twcn
ticth ccntury, has bccn continuously cvokcd to both lcgitimizc and dclcgitimizc
zhongyi and to justily thc zhongyi official policics. Howcvcr, thc conccpt ol
“kexue” (scicncc) docs not always mcan thc samc in diffcrcnt historical con
tcxts. !n thc carly twcnticth ccntury, kexue mcant morc as thc Vcstcrn scicntific
culturc—a ncw valuc systcm that providcd an intcllcctual rcsourcc lor China’s
ncw cultural movcmcnt aimcd at ovcrhauling thc traditional Chincsc culturc,
including Chincsc mcdicinc. From thc .µ¸cs to thc ,cs, kexue was aligncd with
thc Maoist “dialcctical matcrialism” (weiwu bianzhengfa),” rclcrring morc to
thc mcthodology or idcologically corrcct way in undcrstanding “laws or pat
tcrns ol thc cxistcncc and dcvclopmcnt ol things” (shiwu fazhan de guilu 事物
发展的规律) through thc unity ol thcory and practicc, to which zhongyi finds
closcr affinity than to thc cpistcmological loundation ol thc modcrn scicntific
mcdicinc.⁵⁴ !n thc postMao cra, kexue is prcdominantly idcntificd with mod
crn Vcstcrn cxpcrimcntal scicncc and is vicwcd as thc objcctivc knowlcdgc
systcm, indcpcndcnt ol any cultural, idcological, and philosophical matrix. Tis
rcading ol scicncc hclpcd to inspirc a surgc ol scicntism that has impactcd all
thc domains ol thc contcmporary zhongyi ficld.
Using advanccd bioscicncc conccpts and tcchniqucs to cxplicatc zhon-
gyi thcorics, cvaluatc clinical work, and chcmically analyzc Chincsc matcrial
mcdica and lormulas has bccomc mainstrcam in zhongyi rcscarch. Tc zhongyi
administration at its various lcvcls and thc rcgulations it imposcs arc also in
crcasingly modclcd on thcir Vcstcrn countcrparts. !n somc arcas, thc “wcstcrn
ization ol Chincsc mcdicinc” (zhongyi xiyi hua 中医西医化) is so scvcrc that it
is satirizcd as “running a tcmplc as a church and having a pricst guiding monks”
(siyuan dang jiaotang, shenfu guan heshang 寺院当教堂,神父管和尚).⁵⁵” Tc
contcmporary systcm ol zhongyi cducation that valucs bioscicnccs morc than
classic zhongyi thcorics as basic thcorctical loundations is now laultcd by many
zhongyi scholarphysicians lor producing zhongyi prolcssionals who havc a hard
timc idcntilying with zhongyi thcorics and mcthods or arc mcrcly “tcchnolo
gists” knowing morc about trcating a mousc in a laboratory sctting than using
zhongyi’s way ol rcasoning to trcat rcal paticnts (yong zhongyi siwei fangshi 用
中医思维方式看病).⁵⁶
Many zhongyi scholars, cspccially scnior physicians, lcar that thc currcnt
proccss ol “zhongyi modcrnization” lollowing thc biomcdical modcl will cut
Chincsc mcdicinc lrom its cultural hcritagc (wenhua chengchuan 文化承传)
and cvcntually rcndcr it lilclcss. Tc various conccrns lor zhongyi’s prcscnt situ
ation and luturc havc bccn discusscd in a scrics ol controvcrsial articlcs undcr
28 TRANSFORMI NG EMOTI ONS
thc titlc ol “Sombcr Rcflcctions on thc Ðcvclopmcnt ol Chincsc Mcdicinc”
calling lor rcpositioning (chongxin dingwei 重新定位) or rcdcfining zhongyi in
rclation to modcrn scicncc.⁵⁷ Tis discussion has cxtcndcd bcyond thc zhongy;
prolcssion and has attractcd thc attcntion ol scholars lrom various disciplincs,
including scicntists, historians, and philosophcrs, who, lrom thc pcrspcctivcs
ol thcir own spccialtics, advancc various stratcgics to advocatc lor zhongyi’s
indcpcndcnt cxistcncc and dcvclopmcnt apart lrom thc dominancc ol thc bio
scicncc and its valuc systcm.⁵⁸ Tcsc stratcgics includc: (.) dctaching kexue (sci
cncc) lrom thc narrowly dcfincd modcl ol thc modcrn cxpcrimcntal scicncc and
rccognizing thc plurality ol scicnccs or knowlcdgc systcms, (a) aligning zhongyi
with lronticr scicntific rcscarch, such as nonlincar and complcxity scicnccs, (¸)
acknowlcdging zhongyi’s humanistic tradition (renwen chuantong 人文传统) ol
not scparating thc natural world lrom thc human sphcrc and “scicntific” activi
tics lrom mcaning systcms. Ònc thing is clcar, thc contcnding discourscs ol
kexue (scicncc) arc continuing to shapc thc coursc ol zhongyi dcvclopmcnt.
Tc contcmporary doctors ol Chincsc mcdicinc also tcnd to locatc lcgiti
macy ol zhongyi in its cfficacy ol trcatmcnt (liaoxiao 疗效). For many doctors,
cffcctivcncss indicatcs a scicntific valuc, as thcy likc to say “what is cffcctivc is
scicntific” (youxiaode jiushi kexuede 有效的就是科学的). Tis statcmcnt finds
its lorcc in Mao’s lamous words in On Practice (Shijian Lun 实践论) “practicc is
thc critcrion ol thc truth” (shijian shi jianyan zhenli de biaozhun 实践是检验真
理的标准), which was madc into powcrlul political rhctoric by thc postMao
rclormists in China in thc carly .µ·cs. Yct, asscssing and dcmonstrating zhongyi
cfficacy rcmains a problcm. Should zhongyi adopt thc biomcdical critcria and
usc quantifiablc data bascd on laboratory tcsts to validatc thc claim ol cfficacy:
!t sccms that zhongyi clinical rcscarch is moving toward such a dircction. As my
zhongyi tcachcr told mc, “nowadays you can’t just say that a thcrapy works, you
havc to show thc numbcrs (quantitativc data) and biological indications.” “To
cstablish systcmatic and scicntific critcria lor asscssing zhongyi clinical cfficacy”
is rccognizcd as onc ol thc urgcnt tasks ol prcscnt zhongyi clinical rcscarch.”⁵⁹
!t is also rcalizcd that using a biomcdical modcl to cvaluatc zhongyi thcra
pics can lcad to scrious conscqucnccs, as shown by thc wcllknown incidcncc
ol xiao chaihu tang (dccoction ol blupcuri).⁶⁰ Rcccnt dcbatc ovcr thc toxic sidc
cffccts (du-fu zuoyong 毒副作用) ol zhongyao (Chincsc pharmaccutics) is an
othcr cxamplc. !t raiscs thc qucstion: how should a toxic/sidc cffcct ol a Chi
ncsc thcrapy bc cvaluatcd and dctcrmincd: Zhongyi scholarphysicians, such as
Yuc Fcngxian and Lu Guangshcn, insist that whcn a Chincsc thcrapy is uscd
outsidc ol its zhongyi contcxt, lor cxamplc prcscribcd by a biomcdical doctor
bascd on thc biomcdical knowlcdgc, thc unintcndcd rcaction ol thc mcdica
tion thcn should not bc labclcd as thc toxic sidc cffcct ol a zhongyao (Chincsc
pharmaccutic). Tcy arguc that thc usc ol a Chincsc mcdical thcrapy has to
bc dctcrmincd through thc proccss ol “diffcrcntiating pattcrns and dctcrmin
ing thcrapics” (bianzheng lunzhi 辨证论治) as guidcd by zhongyi thcorics bc
lorc onc can talk about a toxin or sidc cffcct ol that spccific Chincsc mcdical
CONTI NUI TY AND MODERN TRANSFORMATI ONS 29
thcrapy.⁶' Similarly, should zhongyi cfficacy also bc tcstcd and cvaluatcd within
its own thcorctical lramcwork and thcrapcutic cxpcctations: !n light ol thc
incrcasingly globalizcd zhongyi prcscncc, Chincsc mcdicinc is lorccd to dcvclop
its own systcm to asscss cfficacy that is both accommodating to zhongyi’s par
ticularity and casily acccptcd by thc intcrnational community ol mcdicinc.
Physicians and scholars ol Chincsc mcdicinc cmphasizc its social and cul
tural valucs in addition to its thcrapcutic cffcctivcncss. Tcy insist that zhongyi
is a hcaling systcm that “fits Chincsc national conditions” (fuhe guoqing 符合国
情), or that zhongyi has “thc support ol thc masscs” (you qunzhong jichu 群众基
础). As many Chincsc mcdical prolcssionals havc rccognizcd, thc continuous
cocxistcncc ol Chincsc mcdicinc with Vcstcrn mcdicinc in thc modcrn scicn
tific cra in China dcpcnds on two mcasurcs, that is, to “improvc” (tigao 提高)
its cfficacy and to “sprcad” (puji 普及) its knowlcdgc. Tc rclationship bctwccn
thcsc two aspccts is vcry wcll capturcd in Lu’s (.µ··) introduction to a sct ol
popularizcd zhongyi rcadings:
!n ordcr to promotc Chincsc mcdicinc, it is cxtrcmcly important to tigao
(raisc) thc rcscarch lcvcl ol prolcssional Chincsc mcdicinc. . . . Tc ccntral
conccrn hcrc is to improvc clinical cfficacy and to illuminatc its logic by cm
ploying modcrn scicntific mcthods in cvcry possiblc way. . . . Yct, thc proccss
ol tigao cannot bc scparatcd lrom thc work ol puji (popularization). Vithout
puji as loundation, tigao is no diffcrcnt lrom building a mansion in thc air. . . .
Ònly altcr wc havc a largc population who undcrstand Chincsc mcdicinc, carc
about its luturc, and arc willing to contributc to its causc, can wc havc a stablc
loundation to dcvclop Chincsc mcdicinc.⁶´
Tc official Chincsc mcdicinc, no mattcr how rigorous it has bccomc, is
only a limitcd part ol thc pcrmissivc zhongyi culturc. To undcrstand Chincsc
mcdicinc, onc’s gazc has to go bcyond thc institutions ol Chincsc mcdicinc
and into thc communitics and lamilics. Many Chincsc lamilics practicc “lolk
vcrsions” ol zhongyi, using hcrbal rcmcdics lor minor illncsscs or “as part ol con
tinuing programs ol prcvcntivc homc carc.”⁶` Nowadays, in addition to kccping
hcrbal mcdicincs at homc, lamilics tcnd to storc various kinds ol zhongchengyao
中成药 (rcadymadc Chincsc mcdicinc in lorms ol pills, powdcr, and small
balls), which arc casy to undcrstand and casy to prcparc. Paticnts can gct thcm
without prcscription in most pharmacics. Many hospitals arc cithcr associatcd
with pharmaccutical companics or makc thc mcdications thcmsclvcs. Tcy cn
couragc thcir staff to dcvclop ncw mcdicincs.⁶⁴ ¡xpcricnccd zhongyi doctors
cngagc thcmsclvcs in dcvcloping patcnt Chincsc mcdicinc bascd on classic
hcrbal mcdicinc lormulas. Òn thc onc hand, this dcvclopmcnt makcs many
classic rcmcdics rcadily availablc to pcoplc with modcrn lilcstylcs, who cithcr
do not havc thc timc or thc knowlcdgc to prcparc hcrbal mcdicincs or do not
carc to drink bittcr hcrbal concoctions. Òn thc othcr hand, thc casy acccss to
zhongyi patcnt mcdicinc docs not comc without a compromisc. Tc flcxiblc and
individualizcd usc ol drugs bascd on cach paticnt’s particular condition, which
30 TRANSFORMI NG EMOTI ONS
is thc corc ol a zhongyi thcrapy, gcts lost in thc simplc matching ol symptoms
with thc standardizcd rcadymadc mcdicinc.
Many homc mcdications arc lor trcating minor discasc and illncss, lor cx
amplc, flu and cold, indigcstion, and so on, but a closcr look rcvcals that many
ol such thcrapics arc mcant lor thc complaints rclatcd to qingzhi disordcrs.
Jicyu anshcn chongji 解郁安神冲剂 (mcdicinc to dispcl stagnatc cmotions and
calm thc mind), a rcadymadc mcdicinc dcvclopcd by my zhongyi tcachcr, is
mcant lor trcating cmotionrclatcd disordcrs, cspccially “stagnation syndromc”
(yuzheng 郁证). ¡vcn many widcly uscd hcrbal “tonics” and mcdicinal loods,
whilc lunctioning to nourish thc hcart and blood, arc takcn lor thc symptoms
associatcd with thc cmotions.
Apparcntly, culturc docs not cxist just as a way ol thinking or only in philo
sophical rcflcctions. !t is also an cmbodicd scnsc ol ordcr—pcrsistcnt acsthctic
valucs and oricntations cmbodicd in cvcryday bodily practiccs and social in
tcractions. Tc Chincsc cultural acsthctics that prioritizc conncctions, trans
lormations, and harmony manilcstcd in thc mundanc practicc ol cvcry day, arc
also thc cultural sourccs grounding thc “scicncc” ol zhongyi and lcgitimizing its
practicc. Tc ncxt chaptcr offcrs a dctailcd discussion ol thc cmbodicd world
ol Chincsc culturc.
31
I I I
The Chinese World of Shenti (Body-Person)
Phcnomcnologically inlormcd mcdical anthropology advocatcs a radical rolc
lor thc body as “thc cxistcntial ground ol culturc.”' Tis “anthropology ol cm
bodimcnt,” drawing on McrlcauPonty’s phcnomcnology ol pcrccption and
8ourdicu’s thcory ol practicc, locatcs culturc in “thc livcd body” ol cvcryday
practicc and dirccts analytical attcntion to thc cxpcricntial aspcct ol culturc
in cvcryday lilc. Tc conccpt ol “cmbodimcnt” with its intcndcd rcsistancc to
mind/body and subjcct/objcct dichotomics in undcrstanding human cxpcri
cncc lcnds a conccptual bridgc in talking about Chincsc conccptions and cxpc
ricncc ol shenti 身体 (bodypcrson).´ !n my analysis ol qingzhi 情志 (cmotion)
disordcr, ! scck to situatc thc Chincsc cxpcricncc ol illncss and hcaling in thc
contcxt ol “cmbodicd culturc.” 8y this, ! mcan thc pcrsistcnt and pcrvasivc
cultural valucs and scnsibilitics that arc dccply rootcd in bodily practiccs ol thc
cvcryday and thus havc bccomc “natural” or habitual ways ol bcing and doing
lor thc local pcoplc. Tc idca is to makc “cmbodicd culturc,” or “cultural acsthct
ics,” to lollow Robcrt Ðcsjarlais’ usc,` an intcrprctivc contcxt lor undcrstanding
cmotionrclatcd disordcrs in thc contcxt ol contcmporary Chincsc mcdicinc.
!n this chaptcr, ! considcr how ordinary Chincsc construc and cxpcricncc thcir
bodics in cvcryday lilc, what mcanings and scnsibilitics such bodily knowlcdgc
and dispositions cmbody and communicatc, and how thcsc scnsibilitics rcflcct
a world oricntation ol thc pcoplc, which is also cmbodicd in thc knowlcdgc and
practicc ol Chincsc mcdicinc. My conccrn is lundamcntally with mcaning and
thc “lclt quality” ol cultural cxpcricnccs.
Tis chaptcr ccntcrs on an cxploration ol thc Chincsc notion ol “shenti”
(routincly translatcd as “body” in ¡nglish) and thc rclatcd catcgorics. 8clorc wc
stcp into this Chincsc world, a critical cxamination ol thc Vcstcrn body in thc
contcxt ol Chincsc culturc and mcdicinc is ncccssary, bccausc whcn wc usc thc
¡nglish word body as a ncutral analytical conccpt, thcrc is always thc possibility
that wc unconsciously rcad thc ¡uroAmcrican body into thc cultural cxpc
ricncc that is bascd on a diffcrcnt tradition ol cmbodimcnt, and “ncccssarily
32 TRANSFORMI NG EMOTI ONS
import a varicty ol Vcstcrn valuc oricntations.”⁴ Tis problcm is particularly
cvidcnt in thc discussions ol somatization in Chincsc socicty.
THE PROBLEM OF SOMATI ZATI ON AND THE BODY
Chincsc arc widcly bclicvcd to bc “particularly pronc to somatization.”⁵ A sim
plc and lamiliar logic gocs: psychocmotional disordcrs arc psychobiological
cntitics, whilc cultural lcgitimization ol cmotional disordcrs lcads to an cm
phasis on thc psychological aspcct ol thc disordcrs, thc cultural stigmatization
ol cmotional disordcrs lcads to an cmphasis on thc somatic aspccts ol such dis
ordcrs.⁶ Psychologization and somatization arc thcrclorc sccn as two oppositc
illncss constructions. Tc lormcr is dominant in Vcstcrn industrializcd socicty,
and thc lattcr is charactcristic ol morc traditionoricntcd socicty, such as China,
whcrc a “longstanding tradition ol rcprcssion ol cmotions lcads to utmost
cmphasis on somatic dyslunctions.”⁷ Sccking hclp with Chincsc mcdicinc lor
cmotionrclatcd disordcrs is an utmost cvidcncc ol Chincsc somatization.⁸
Yct my ficldwork rcvcals that Chincsc paticnts lrcqucntly rclatc thcir sul
lcrings to cmotional, psychological, and social lactors in thc clinics ol Chincsc
mcdicinc. As a mattcr ol lact, most paticnts ! obscrvcd in Shenjing Ke 神经
科 (thc Clinic ol Ncuropathic Ðisordcrs) ol thc hospital prcscntcd cmotional
distrcss as wcll as bodily complaints. !n my obscrvation, Chincsc paticnts havc
no problcm with cmotions as a sourcc ol thcir suffcrings. Tcy arc morc likcly to
hidc lrom othcrs thcir problcm ol inlcrtility rathcr than thcir lcclings ol angcr
or sadncss.⁹ !n somc cascs, instcad ol “somatizing” thcir cmotional distrcss,
Chincsc paticnts arc inclincd to rcjcct thc diagnosis ol an organic discasc.
Ms. Vang’s casc is an cxamplc. Ms. Vang, in hcr filtics, was diagnoscd as
having coronary discasc (guanxin bing 冠心病) in a biomcdical hospital and
was hospitalizcd lor onc month. Soon altcr shc was dischargcd lrom thc bio
mcdical hospital, shc wcnt to scc a scnior zhongyi physician. Shc claimcd onc
month ol hospitalization and mcdication lailcd to curc hcr illncss, and hcr
symptoms bccamc cvcn worsc. Shc complaincd about a scnsc ol blockagc (du
堵) in hcr hcart, palpitation ol hcr hcart (xinhuang 心慌), lrcqucnt hicuups,
difficulty slccping, dcplction ol swcat (xuhan 虚汗) and cold cxtrcmitics. Shc
rcluscd to acccpt that shc had coronary discasc and insistcd that hcr illncss was
angcr rclatcd (qide 气的). According to thc zhongyi doctor, thc paticnt suffcrcd
lrom livcr qi stagnation (ganqi yujie 肝气郁结), obviously, a qingzhi (cmotion)
rclatcd disordcr. For many paticnts, thc cmotionrclatcd quality ol thcir sul
lcrings is prcciscly thc rcason why thcy comc to zhongyi.'⁰ Zhongyi doctors
accordingly scc thcmsclvcs as particularly strong in trcating cmotionaffcctcd
lunctional disordcrs, that is, qingzhi disordcrs.
Most zhongyi doctors simply dismiss thc conccpt ol “somatization” as ir
rclcvant, whcrcas Chincsc psychiatrists find thcmsclvcs caught at thc ccntcr ol
thc controvcrsy. Òn thc onc hand, thcy lccl it important to “fit” in (jiegui 接轨)
with thc intcrnational community ol psychiatric mcdicinc, on thc othcr hand,
THE CHI NESE WORLD OF SHENTI 33
thc cpistcmological tcnsion bctwccn thc Chincsc culturc ol hcalth and thc
modcrn biomcdicinc has to bc addrcsscd. Many ol thcm qucstion thc gcncral
application ol somatization and thc rclatcd conccpts to thc Chincsc contcxt
and suggcst limiting its usc.'' For cxamplc, on thc onc hand, Xu argucs that
Chincsc paticnts lrom thc rural arcas do not makc a distinction bctwccn or
ganic and lunctional disordcrs. Òn thc othcr hand, paticnts lrom citics rcadily
prcscnt cmotional symptoms and acknowlcdgc cmotions as thc sourcc ol thcir
illncss in thc contcxt ol a good doctorpaticnt rclationship.'´ For thcm, “bodily
distrcss and psychic suffcring arc intcgratcd and contcxtspccific.”'` !ndccd,
as Yamamoto and collcagucs rcport, instcad ol finding somatizing Asians vcr
sus dcprcssivc Caucasians as cxpcctcd, thcir study ol psychiatric outpaticnts in
Calilornia rcvcals that symptoms ol both dcprcssion and lunctional somatic
complaints arc highcr among thc Taiwancsc than in thc Caucasian comparison
group.'⁴
Adding complcxity to this problcm ol somatization, Chincsc vcrbal cx
prcssions cannot bc casily catcgorizcd as somatic and psychological. For cxam
plc, common symptoms prcscntcd by Chincsc paticnts in thc clinic ol Chincsc
mcdicinc, “blockagc in thc hcart” (xinli du 心里堵) and “vcxation” (xinfan 心烦)
arc cxpcricnccd both somatically and psychologically. Zhcng and his collcagucs
in thcir studics ol stylcs ol vcrbal cxprcssion ol cmotional and physical cxpcri
cncc in China noticc that many ol thc Chincsc cxprcssions do not casily lall
into thc catcgorics ol psychologization and somatization. Tcy havc to labcl
thc samc cxprcssion, “do not want to do anything,” in onc placc as psychologi
cal and in anothcr placc as somatic.'⁵ Apparcntly, Chincsc vcrbal cxprcssions
ol distrcss arc mostly cxpcricntial, both cmotional and somatic, ncithcr purcly
psychological nor purcly somatic. To catcgorizc cmbodicd cxpcricncc according
to dualistic catcgorics can bc vcry conlusing.
!n a way, this picturc ol somatizing Chincsc rcprcscnts a classic cxamplc ol
thc Vcstcrn “cthnoccntrism” which, in this casc, involvcs rcdcfining thc Chincsc
cxpcricncc within modcrn Vcstcrn biomcdical cpistcmology that prcsupposcs
an csscntialistic distinction bctwccn mind and body, psychc and soma, and thus
psychiatric and gcncral mcdical discascs. Tis biomcdical cpistcmology, as Fa
brcga shows, postulatcs a “modcl ol illncss” that connccts illncss proccss and
bchaviors to corrcspondcnt changcs in body and in mind.'⁶ Ðcviations lrom
thcsc norms imply cithcr somatizing or, possibly, psychologizing. !n applying
this dualistic modcl ol illncss to thc Chincsc illncss cxpcricncc, rcscarchcrs in
lact crcatc thc vcry imagc ol somatizing Chincsc, which thcy bclicvc to bc thcir
discovcry. !n lact, as illncss constructions, both somatization and psychologi
zation arc products ol a cultural tradition that csscntializcs and dichotomizcs
body and mind, and should only bc undcrstood in that contcxt. Tcy arc two
way rcductions ol thc samc dualistic proccss.
!ronically, somatization makcs much morc scnsc in thc contcxt ol modcrn
Amcrican culturc. As Pollock points out, “Tc lundamcntal bilurcation ol pcr
sons in Amcrican culturc into bodics and minds surcly lorms thc cultural and
34 TRANSFORMI NG EMOTI ONS
historical ground lor thc parallcl lundamcntal bilurcation ol illncsscs into thc
physical and thc mcntal, and ol prolcssional mcdical spccialtics into physical
mcdicinc and psychiatry/clinical psychology.”'⁷ Vithin cach ol thcsc sphcrcs
ol mcdicinc, conccptions ol illncss as wcll as lorms ol practicc tcnd to rcflcct
and rcproducc thc basic aspcct ol Amcrican pcrsonhood. Amcrican paticnts
arc noticcably oricntcd to this dualistic principlc ol body and mind. As Jcan
Jackson shows in hcr study ol chronic pain, paticnts “protcst loud and clcar at
any hint that a givcn pain is ‘cmotional’ and thcrclorc not ultimatcly produccd
by a physical causc,” bccausc thcy arc awarc that thcir problcms could bc in
tcrprctcd as “not rcal” or cxplaincd as mcntal illncss or “somc lorm ol charactcr
flaw.”'⁸ !n thc contcxt ol thc contcmporary gcncral biomcdical cpistcmology,
a physical pain must bc accompanicd with a physical causc, thcrclorc, a givcn
pain without a physical cxplanation implics an illncss “inauthcntic il not fic
tivc.”'⁹ Similarly, thc namc ol chronic latiguc syndromc (CFS) has bccn a topic
ol controvcrsy lor somc timc in North Amcrica. Somc mcdical prolcssionals
lccl thcy nccd to lcgitimatizc a disordcr by implying a biological basis, such as
an immunc dyslunction or virus inlcction. Paticnts, too, do not likc thc labcl ol
CFS. Tcy insist that without a rclcrcncc to a biological causc thcir suffcrings
arc trivializcd.´⁰ Tis typc ol illncss cxpcricncc contrasts sharply with what !
obscrvcd in thc clinics ol Chincsc mcdicinc, whcrc pain is simply pain cxpcri
cncc and cvcnt, lcgitimatc in itscll, rcgardlcss ol whcthcr it is cmotionally or
organically causcd.´'
Tc cultural dualism that bilurcatcs thc Amcrican pcrson and mcdicinc
has a firm grounding in thc Vcstcrn mainstrcam philosophic tradition, which
lrom its classic bcginning posits inhcrcnt dctcrminatc csscncc as thc dcfining
principlc lor things.´´ Tings arc diffcrcnt by virtuc ol thcir fixcd csscnccs. Tc
languagc ol csscntialism and thc scparation ol thc dctcrmining and thc dctcr
mincd pavcd thc way lor thc postCartcsian lramcwork ol mind vcrsus body,
which has sincc pcrmcatcd cvcry aspcct ol thc modcrn Vcstcrn commonscnsc
world and groundcd thc Vcstcrn vicws ol naturc, culturc, thc individual, and
socicty. Tcy arc not just “cognitivc habit”´` or a philosophic prcsumption, thcy
arc social valucs and acsthctic oricntations cmbodicd in cvcryday practiccs ol
thc pcoplc.
Although thc csscntializcd matcrial body has bccn challcngcd in various
postmodcrn writings, thc lundamcntal dualism ol mind/body “sccms to bc cs
pccially difficult to thcorizc into abandonmcnt.”´⁴ Ònc rcason lor this tcnac
ity lics pcrhaps in thc ¡nglish languagc itscll. As Nancy ShcpcrHughcs and
Margrct Lock point out, “wc lack a prccisc vocabulary with which to dcal with
mindbodysocicty intcractions and so arc lclt suspcndcd in hyphcns, tcstilying
to thc disconncctcdncss ol our thoughts.”´⁵
Vhcncvcr wc usc ¡nglish kcy tcrms, such as body, emotion, or disease, wc
invokc a varicty ol cultural and philosophical assumptions. !n thc contcxt ol
Chincsc mcdicinc, taking thcsc assumptions lor grantcd, wc in lact rcad an
ontology ol substancc into a morc proccssoricntcd “ontology ol cvcnts,”´⁶ an
THE CHI NESE WORLD OF SHENTI 35
cpistcmology that privilcgcs structurc and lorm into a morc tcmporally or
ganizcd proccss ol translormation, a rcprcscntation into morc cxpcricntially
oricntcd prcscntation, and a strict dualism into corrclativcly situatcd polar rcla
tions. Tc bodics that Chincsc mcdicinc works on and Chincsc paticnts cxpcri
cncc takc diffcrcnt lorms and cntail a diffcrcnt sct ol vocabularics.
A SEMANTI CS OF SHENTI ( BODY-PERSON)
8y scmantics, ! do not rclcr to an cthnoscmantic analysis ol thc conccpt ol
shenti, which only dcals with rclcrcntial mcaning. My approach, in principlc,
rcscmblcs Good’s “scmantic nctwork analysis,” which “scck(s) out lor analysis
thc potcnt clcmcnts in thc idiom ol social intcraction and cxplorc(s) thc as
sociatcd words, situations and lorms ol cxpcricncc which thcy condcnsc.”´⁷
!n lact, Chincsc culturc is biascd toward such scnsc ol mcaning in which “a
tcrm is dcfincd nonrclcrcntially by mining rclcvant and yct sccmingly random
associations.”´⁸
!n thc contcmporary Chincsc languagc, thc most commonly uscd cxprcs
sion dcnoting “body” or “bodily” is shenti, which, in lact, is composcd ol two
root words shen 身 and ti 体. 8oth can bc translatcd as “body,” but thc diffcr
cncc bctwccn shenti and thc ¡nglish word body is crucial. Tc ¡nglish body
comcs lrom Òld Gcrman budha mcaning “tub” or “containcr.” Vhcn body is
uscd without lurthcr cxplanation and dcfinition, it cvokcs in rcadcrs an imagc
ol physical, objcctivc, or anatomic cntity scparatc lrom what is spiritual and
social. !t rcquircs lurthcr modification and cxplanation in ordcr to convcy thc
nondualistic cxpcricncc ol cmbodicd pcrson, such as using combincd or hy
phcnatcd tcrms: livcd body, pcrcciving body, mindlul body, or bodymind. Tc
¡nglish body spcaks ol and to a dualistic rcality. !n contrast, whcn shenti is
uscd without lurthcr clarification, it implics a pcrson or scll with all thc con
notations ol thc physical, social, and mindlul. As May Tung rcports in hcr
study ol symbolic mcanings ol body in Chincsc culturc, with no cxccption,
all hcr inlormants idcntily shenti with thc pcrson, thc scll. Somc ol hcr inlor
mants simply substitutcd body (shen 身) in hcr qucstionnairc lor “thc pcrson,”
“thc scll,” or simply uscd a pcrsonal pronoun.´⁹ !t is thc spccific mcaning ol
shen (rcgarding spccifically physical, cmotional, spiritual, or social aspccts ol a
pcrson or scll ) that rcquircs lurthcr contcxt. !n othcr words, Chincsc shenti is
undiffcrcntiatcd, its spccific mcaning, somctimcs, rcquircs a sccond charactcr
as an cnvironmcnt, as in thc words ol shenqu 身躯 (body trunk) or xingti 形体
(shapc ol a body).
Mark ¡lvin also noticcs that shen appcars in most Chincsc phrascs that
imply “pcrson,” “scll,” or “lilctimc” in ¡nglish translations. For cxamplc, anshen
安身—scttlc down in lilc, shenfen 身分—social status, benshen 本身—oncscll,
zhongshen 终身—to thc cnd ol onc’s lilc, shenshi 身世—pcrsonal history. !t is
lor this rcason that ¡lvin translatcs shen as “bodypcrson.”`⁰ Tc claim that
duc to incrcasing dichotomization bctwccn hcartmind and bodily cmotions,
36 TRANSFORMI NG EMOTI ONS
thc mcaning ol Chincsc shen has bccn rcduccd to “bodyobjcct” sccms to bc
problcmatic.`'
Similar to shen, ti 体, thc sccond charactcr ol shenti, has polyscmic dimcn
sions in usc. Surcly it dcnotcs physical body, but it also cxtcnds to includc
mcanings ol lorm, shapc, convcntion, stylc, and so on, as in wenti 文体 (writ
ing stylc), and zhengti 政体 (polity). Vhat is rcmarkablc about ti is that it is
oltcn uscd as a vcrb or in a vcrbal phrasc, mcaning “to contain,” “to intimatc,”
“to implcmcnt,” “to lormalizc,” and “to undcrstand,” suggcsting an agcncy ol
livcd body that pcrccivcs and acts. Chincsc common cxprcssions arc lull ol such
vcrbs, such as tiyan 体验 (cxpcricncc body pcrsonally) and tihui 体会 (undcr
stand body pcrsonally), and cvcn tiren 体认 (know body pcrsonally).`´
Susan 8rowncll, comparing thc Chincsc words shen and ti, with Gcrman
leib and korper, suggcsts that shen is similar to thc Gcrman conccpt ol “leib”
which is thc subjcctivc, cxpcricnccd body, whilc ti somchow rcscmblcs thc con
ccpt ol “korper,” thc “alicnatcd objcct body.”`` Howcvcr, shc sccms not quitc
comlortablc with this comparison hcrscll and suggcsts that onc should not
takc thc parallcls bctwccn thc two Chincsc and Gcrman conccptions ol thc
body too litcrally bccausc thc Chincsc docs not cxhibit strict subjcctobjcct
dualism as thc Gcrman docs. Rccognizing that in lact both shen and ti contain
a subjcctivc, cxpcricntial componcnt, shc qualifics hcr obscrvation: “(N)cithcr
word has thc discmbodicd Vcstcrn sort ol connotation in which a pcrson is
somchow insidc thc body that is cxpcricncing lilc—a body that is scparatc lrom
thc cxpcricncing subjcct.”`⁴ !l wc havc to makc a distinction bctwccn shen and
ti as bodics, wc may say that shen implics a socially inlormcd bodypcrson or
bodyscll, whilc ti, lrcqucntly uscd in or as a vcrb, cmphasizcs “cmbodying” as
a proccss ol knowing and acting. 8oth conccpts rcsist dualistically positioncd
mind and body, subjcct and objcct. ¡vcn thc modcrn conccpt ol “tiyu” 体育
(physical cducation) nccd not bc rcduccd to training a physical body objcct.`⁵
Tiyu is still vcry much an intcnsc proccss to cmbody social valucs and idcol
ogy through a highly lormalizcd body. !n this scnsc, shenti (both shen and ti) is
ccntrally important in Chincsc social lilc.
8csidcs shen and ti, othcr singlc charactcrs may also havc thc connotations
ol “body,” lor cxamplc, xing 形 (lorm, shapc), qu 躯 (body trunk), and shi 尸
(corpsc). !n modcrn Chincsc, thcy arc oltcn combincd with cithcr shen or ti to
crcatc multiplc scnscs that indicatc diffcrcnt statcs ol cmbodimcnt, lor cxamplc,
xingti 形体 (body shapc) and shenqu 身躯 (body build).
Jing 精, Shén 神, and Qi 气
Vithin thc Vcstcrn cultural dialcctic going back to Plato, mind has bccn dc
fincd typically as a quality that transccnds thc body (as somcthing that ani
matcs thc body and is distinct lrom it). So to claim that mind is part ol thc
body cvokcs contradictions. Although jingshen精神 is translatcd in ¡nglish
as “mind” or “spirit,” it is vcry much part ol shenti. Jingshen is lormcd by two
THE CHI NESE WORLD OF SHENTI 37
root charactcrs: jing 精 (conccntratcd basis ol vitality)`⁷ and shén 神 (vitality
as manilcstcd through lunctional activitics ol mind and body as a wholc). To
undcrstand thc conccpt ol “jingshen,” wc may first go to its root words: jing and
shén. 8oth arc ccntrally important in thc Chincsc conccptualization ol lilc.
As is statcd in Neijing: Suwen (!nncr Classics: Simplc Qucstions), “jing
is thc (conccntratcd) basis or root ol lilc” (shen zhi ben 身之本). !n contcm
porary Chincsc mcdicinc, it is oltcn dcscribcd as “tangiblc/visiblc lilcgiving
substancc” (you shengming huoli de youxing wuzhi 有生命活力的有形物质).
!t is implicd in this statcmcnt that tangiblc human bodics (or any bodics),
composcd ol musclcs, skin, hair, visccra, and boncs, arc thc rcsults ol jing trans
lormation, and that jing as a lilcgiving substancc is itscll alivc, constantly gcn
crating thc ncw and translorming thc old. Jing also has a narrowcr dcfinition
(xiayi 狭义), which rclcrs to thc lunctions ol shèn (thc kidncy systcm). Tis jing
is somctimcs translatcd as scmcn that is storcd in thc visccra ol thc kidncy and
is rcsponsiblc lor rcproductivc lunctions, affccting growth and aging.`⁸ !t is
thcrclorc also callcd “kidncy csscncc” (shenjing 肾精). !n addition to rcproduc
tivc lunctions, shenjing is also said to bc rcsponsiblc lor bonc growth (zhugu
主骨) and lor producing marrow and brains (shengsui 生髓), thcrclorc affccting
thc dcvclopmcnt ol intclligcncc. Tc narrowcr dcfinition ol jing bcars morc
clinical rclcvancc. Tc symptoms ol dctcrioration ol mcmory, poor conccntra
tion, and mcntal rctardation arc all sccn as conncctcd to dcficicncy in shenjing
(kidncy csscncc).
Jing 精 is lurthcr diffcrcntiatcd as “primary jing” (xiantianzhijing 先天之
精), which is inhcritcd lrom onc’s parcnts (bing yu fumu 秉于父母) and “ac
quircd jing” (houtianzhijing 后天之精), dcrivcd lrom lood. Primary jing pro
vidcs thc basis lor thc proccss ol translorming thc cncrgy distillcd lrom lood
and is cnrichcd and strcngthcncd by “acquircd jing.” Chincsc mcdical thcorics
vicw jing and qi 气 (air, brcath, vital cncrgy) as thc samc lilcgiving cncrgy.
Vhcn it is conccntratcd, it is jing, whcn it is dispcrscd, it turns into qi. !l jing
is thc nurturing aspcct ol this cncrgy, qi is thc activc configurational aspcct ol
thc samc cncrgy. Tcy comc togcthcr as jingqi 精气 which is thc basis ol all
lorms ol vitality.
Howcvcr, although jing is dcscribcd in contcmporary Chincsc mcdical dis
coursc as “visiblc” (youxing 有形) and rclcrrcd to as “substancc” (wuzhi 物质),
it cannot bc isolatcd. !ts cxistcncc can only bc known and lclt through its lunc
tions and cffcct. Hcalthy musclcs and skin, shining hair, strong and wclllormcd
boncs, and clcar mcmorics indicatc a sufficicncy ol jing. Howcvcr, poorly dc
vclopcd boncs, musclcs, and intclligcncc may indicatc insufficicnt jing in thc
visccral systcm ol thc kidncy.
Tc ordinary Chincsc may not bc lamiliar with thc classical or mcdical nu
anccs ol jing, ncvcrthclcss, it is part ol cvcryday languagc. !n lay languagc, ‘jing’
is lrcqucntly uscd in combination with li 力 (strcngth, cncrgy), both physical
and mcntal, as somcthing cxpcricnccd, lclt, and dcmonstratcd with onc’s shenti.
A pcrson who is lull ol cncrgy is said to “havc plcnty cncrgy ol jing” (enjingli
38 TRANSFORMI NG EMOTI ONS
wangsheng 精力旺盛), a pcrson who is boggcd down with cndlcss worrics may
complain about “insufficicnt jing” (jingli bugou 精力不够), to conccntratc is to
“gathcr onc’s strcngth ol jing” (jizhong jingli 集中精力), a pcrson growing old
may lccl “jing dccrcasing gradually” (jingli yitian buru yitian 精力一天不如一
天), altcr a strcnuous task onc may lccl “jing tircd out and strcngth uscd up”
(jingpi lijin 精疲力尽).
Hcrc, shén (manilcstcd vitalitics) comcs in.`⁹ !l jing and qi arc thc basis ol
lilc, thcn shén is thc manilcstation ol that lilc. Neijing: Lingshu (Tc !nncr Clas
sics: Spiritual Pivot) says “whcn two jing (malc and lcmalc jing) rcact to cach
othcr (xiangbo 相搏), this (conlrontation) is callcd shén.” !n othcr words, shén is
thc phcnomcnon ol lilc activity itscll. !t is typically said to bc manilcstcd in thc
appcarancc ol thc wholc pcrson: lacial complcxion and cxprcssion, cspccially
cxprcssions through cycs (yanshen 眼神), thc way ol talking and rcsponding,
and thc movcmcnt and position ol onc’s body. “Shén prcscnt” (youshen 有神)
or “shén abscnt” (wushen 无神) is important inlormation that an cxpcricnccd
Chincsc mcdical doctor pays attcntion to whcn cxamining a paticnt. Vhcn
shén is abscnt, cvcn though thc prcscntcd symptoms arc minor, thc illncss is
considcrcd morc scrious. ! noticcd that whilc taking a paticnt’s pulsc, my zhon-
gyi tcachcr usually spcnt a lcw quict minutcs just obscrving thc paticnt bclorc
starting an cxtcnsivc inquiry. Hc would also makc somc commcnts to bring his
studcnts’ attcntion to any signs ol shén ol thc paticnt. To his rcturning paticnts,
hc oltcn madc obscrvations rcgarding thcir shén, such as “thc manilcstation ol
shén (shense 神色) looks much bcttcr this timc.”
Shén, in a narrow scnsc, may rclcr spccifically to an individual’s mcntal
and cmotional activitics. Tis narrow scnsc is known as shenzhi 神志 (con
sciousncss) and qingzhi 情志 (cmotions) and is also rclcrrcd to in thc modcrn
languagc as “jingshen,” thc combination ol jing and shén. Although jingshen is
translatcs as mind or “mcntality,” it is cmbcddcd in thc cultural physiology ol
jing and shén, and it carrics distinctivc cultural scmantics. Ònc ol thc com
mon complaints that Chincsc prcscnt in and outsidc clinics is thc “low lcvcl ol
jingshen” (jingshen cha 精神差) or “lack ol jingshen” (mei jingshen 没精神). Tc
cxprcssions may includc mcanings lrom low physical cncrgy and tircdncss, to
difficulty in conccntration, poor mcmory, lack ol intcrcst in doing things, and
dcprcsscd cmotions. Lin commcnts that sincc thc kidncy storcs jing and thc
hcart govcrns shén , according to Chincsc physiology, a mcntal disordcr which
is jingshen bing 精神病 in Chincsc is litcrally a disordcr involving thc hcart and
thc kidncy.⁴⁰ Tc point is that jingshen is not pcrccivcd as oppositc to shenti but
constitutivc ol it.
Xin 心 (HcartMind) and Nao 脑 (8rain)
Xin commonly translatcd as “hcart” or “hcartmind,” is surcly part ol shenti. !t
lics litcrally at thc hcart ol thc Chincsc undcrstandings ol pcrson, particularly
ol thought and cmotion.
THE CHI NESE WORLD OF SHENTI 39
Tc Chincsc commonscnsc undcrstanding ol “thc hcart” is morc in tunc
with thc Chincsc mcdicinc conccpt ol “xin.” !t is, on thc onc hand, undcrstood
as thc most important visccral systcm that “govcrns thc flow ol blood in circula
tion vcsscls” (xin zhu xuemai 心主血脉), thus, it is rcsponsiblc lor coordinating
thc harmonious lunctioning ol all thc visccral systcms ol thc body. Òn thc othcr
hand, it is thc placc whcrc shén (spiritvitality) is storcd. Xin is likcncd to thc
court ol a king—“thc ccntral govcrning visccral systcm whcrc shenming 神明
(knowing and undcrstanding, cthics and morals) ariscs.”⁴' Xin or hcartmind,
though diffcrcnt lrom thc anatomic organ ol thc hcart dcsignatcd usually by
thc tcrm xinzang 心脏, is bclicvcd to bc locatcd within thc chcst. !ts normal
lunctioning can bc lclt and rccognizcd in rcgular hcartbcats, an cvcn pulsc, a
hcalthy lacial complcxion, and also “appropriatc bchavior, clcar mind, joylul
lcclings, and lucid languagc.”⁴´
Xin has social and moral significancc. Òn thc onc hand, a pcrson who is
thoughtlul and considcratc ol othcrs and is gcncrous and willing to hclp oth
crs in nccd is said to havc a good hcartmind. Òn thc othcr hand, a pcrson is
considcrcd to havc a bad hcardmind or docs not cvcn havc a hcartmind il hc
is grccdy and harbors sclfish intcntions toward othcrs. Asking my lricnds and
inlormants what thcy mcant by xin hao (good hcartmind), ! was always givcn
concrctc dcscriptions as to how thc pcrson bchavcd in rclation to othcrs. For
cxamplc, a studcnt doctor was dcscribcd by othcrs as cxtrcmcly goodhcartcd
whcn shc voluntccrcd to fill in on wcckcnd duty lor a collcaguc so this col
lcaguc could takc carc ol an urgcnt lamily mattcr. Ccrtainly, this usc ol thc
hcart as moral discoursc rings lamiliar. !n ¡nglish thcrc arc cxprcssions such as
a goodhcartcd pcrson or a pcrson with a goldcn hcart. Howcvcr, “hcartcdncss”
in ¡nglish is gcncrally a rclcrcncc to a pcrson’s inncr scll. Yct Chincsc do not
typically undcrstand xin as somc fixcd intcrior csscncc that dcfincs a pcrson but
rathcr as a pcrson’s bchaviors and attitudcs toward othcrs. Tc moral mcaning
ol hcartmind lics in how a pcrson rclatcs himscll or hcrscll to othcrs in thc
social contcxt. “Judgmcnt ol whcthcr a pcrson is good or bad is thcrclorc in
tcrms ol how this pcrson lccls and acts toward othcr pcrsons.”⁴`
Consciousncss, mcmorization, thinking, and lorming idcas arc thc activi
tics bclonging to thc xin systcm. Tc Chincsc conccpt ol “hcartmind” cncom
passcs thc lunctions ol nao (brain). Zhongyi doctors likc to say that hcartmind
and brain arc intcrconncctcd (xinnao xiangtong 心脑相通). Tc words thinking
and reflection (si思), desiring and imagining (xiang 想), meaning and intention
(yi 意), desiring and wanting (yu 慾), and planning (lu 虑) all havc a hcart radi
cal “心”indicating that thinking, rcflccting, dcsiring, imagining, and planning
arc thc domains ol onc’s hcartmind. !ntcrcstingly, psychology translatcd into
Chincsc bccomcs “studics ol thc pattcrns ol hcartmind” (xinlixue 心理学).
Nowadays, though pcoplc usc both nao (brain) and xin (hcartmind) intcr
changcably somctimcs, thcrc is a subtlc diffcrcncc in mcaning. Tc phrasc !
do not havc thc nao (brain) to do somcthing cmphasizcs mcntal capability, but
lacking thc xin (hcartmind) to do somcthing, thc cmphasis is on motivation
40 TRANSFORMI NG EMOTI ONS
and intcntion. Vhilc nao is rcscrvcd lor morc spccializcd discoursc which is
rclatcd to school or acadcmic work and intclligcncc, xin is a morc cncompassing
conccpt, appcaring morc in talking about thc cthics, morals, intcntions, dcsircs,
and cmotions. A lay pcrson’s undcrstanding ol “illncss ol thc hcart” (xinbing
心病) may includc disordcrs ranging lrom an organic hcart discasc to illncss
causcd by cxccssivc thinking and worrics, worry itscll, illncss causcd by strong
dcsircs and longings, and mcntal disordcrs.
¡motions arc thc domain ol xin. Tc vcry word lor “lccling” or “cmotion” in
Chincsc is qing 情 which also includcs xin as a radical, suggcsting hcart is also
thc scat ol cmotion. !n lact, thc scvcn cmotions rccognizcd by zhongyi as im
portant clcmcnts in hcalth, with thc cxccption ol xi 喜 (happy), all havc xin as
part ol thc charactcrs. Chincsc usc xin to dircctly talk about thcir statc ol mind
and cmotions. Tc ¡nglish cxprcssion ! am in a bad mood in Chincsc would
bc Tc circumstancc/condition/scntimcnt ol my hcart is not good (Wo xinqing
buhao 我心情不好). Xin appcars cvcrywhcrc in cmotion languagc. Joy is litcr
ally “opcning thc hcart” (kaixin 开心), happincss is “hcartscntimcnts flowing
lrccly” (xinqing shuchang 心情舒畅), sadncss is “thc hcart injurcd” (shangxin
伤心), compassion and affcction is “hcartachc” (xinteng 心疼), and dcspon
dcncc is “hcartcmotion dcprcsscd” (xinqing jusang 心情沮丧). Most Chincsc
cmotion words bcar hcart radicals, such as sadncss (bei 悲), angcr (nu 怒), worry
(you 忧), lcar (kong 恐), and lright (jing 惊).
According to my ficld notcs, Chincsc paticnts who suffcrcd qingzhirclatcd
disordcrs tcndcd to rcport symptoms dircctly rclatcd to xin. Frcqucntly, thcy
complaincd ol “hcart ncrvous” (xinhuang 心慌), “palpitation” (xinji 心悸), “hcart
agitation, vcxation” (xinfan 心烦), “hcartcmotion dcprcsscd” (xinqing yayi 心
情压抑), or “hcartmind not at pcacc” (xinshen buning 心神不宁). Somctimcs,
a paticnt would attributc his or hcr illncss to problcms that also havc somcthing
to do with xin, such as “small hcartmind” (xinyan xiao 心眼小) “narrow hcart
cdncss” (xinxiong xiazhai 心胸狭窄), or “working onc’s hcartmind too much”
(tai caoxin 太操心). Xin clcarly occupics a ccntrally important rolc in Chincsc
cxpcricncc ol qingzhi disordcrs.
Xin grows throughout onc’s lilc but may also shrink. A paticnt’s wilc
oncc complaincd about hcr husband, “Vhcn hc gcts oldcr his hcartmind gcts
smallcr that hc cannot hold anything in his hcart and constantly xia caoxin” 瞎
操心 (opcrating hcartmind blindly, mcaning worry usclcssly and unncccssar
ily). A pcrson with a big hcartmind is dcscribcd as bcing ablc to contain and
assimilatc morc. Hcartmind in this scnsc is also rclcrrcd to as “hcartchcst”
(xinxiong 心胸) or cvcn “capacity ol onc’s abdomcn” (duliang 肚量). My zhongyi
tcachcr, Ðr. Zhou, is univcrsally praiscd by his studcnts and collcagucs as having
“broad hcartmind” (xinkuan 心宽). Òncc a studcnt doctor said hall jokingly:
“pcoplc say a primc ministcr’s abdomcn is big cnough to polc a boat” (zaixiang
duli neng chengchuan 宰相肚里能撑船), “but Ðr. Zhou’s abdomcn is cvcn morc
spacious whcrc a warship is ablc to movc lrccly.” An cxcmplary pcrson (junzi
君子) is said to havc a hcartmind that is broad and opcn (tandang 坦荡), a
THE CHI NESE WORLD OF SHENTI 41
small pcrson (xiaoren 小人) cntanglcd in his narrow hcartmind is always sul
lcn and unhappy (qiqi 戚戚).
!n a way, xin is a systcm ol lunctions that lorms a continuous proccss ol
bcing or bccoming a pcrson, involving thc physiological, psychological, and
sociological. Tc lrcqucntly quotcd passagc lrom Neijing: Lingshu (!nncr Clas
sics: Spiritual Pivot) dcscribcs this somatopsychicsocial proccss ol xin as thc
lollowing:
Vhat rcsponds to cnvironmcnt is callcd xin 心 (hcartmind).
Vhat xin brings out is callcd yi 意 (imagcry)
Vhat yi storcs is callcd zhi 志 (mcmory, mcmorization)
8ccausc ol zhi, knowlcdgc is rcorganizcd.
Tis is callcd si 思 (thinking, rcflcction).
8ccausc ol si, onc thinks lor thc luturc.
Tis is callcd lu 虑 (stratcgy, plan).
8ccausc ol lu, onc makcs dccisions and takcs actions.
Tis is callcd zhi 智 (wisc, wisdom).
Again, yi 意, zhi 志, si 思, lu 虑, and zhi 智 arc not diffcrcnt things but dc
scriptions ol diffcrcnt phascs ol thc samc continuous proccss ol hcartmind,
whcrc cmotions and morals arc not scparatcd lrom thinking and pcrcciving.
Zhi is shenzhi 神志 (consciousncss) and also qingzhi 情志 (cmotion). Vhcn
much planning and calculations lail to lcad to a solution, worrics and anxict
ics arisc (bailu bu jie ze si 百虑不解则思), on thc othcr hand, whcn actions
takcn at thc critical momcnt translorm a dangcrous situation into a lavorablc
onc, happincss ariscs (fengxiong huaji ze xi 逢凶化吉则喜). Vhat is particular
about this proccssccntcrcd hcartmind physiology is not vcry much what Òts
calls “hcartmind controlling bodycmotion modcl,”⁴⁴ but thc commitmcnt to
an unobstructcd proccss ol translormations in accordancc with a givcn social
contcxt and natural cnvironmcnt.
!n lact, a pcrsistcnt tcndcncy throughout Chincsc intcllcctual culturc is to
scc “motion and translormation” (yundong 运动) as gcncrativc ol “thc myriad
things” ol thc world. For Zhuangzi 庄子, “thc Dao ol naturc constantly trans
lorms without stagnation, whcrcol myriad things arc gcncratcd” (tiandao yun
er wusuoji, gu wanwu sheng 天道运而无所积,故万物生)⁴⁵ !n Neijing: Suwen
(!nncr Classics: Simplc Qucstions), “unccasing movcmcnt lcads to translorma
tion (dong er buyi ze bianzuo yi 动而不已则变作矣)⁴⁶ For gcncrations growing
up rcading Mao’s On Contradictions (Maodun Lun 矛盾论), yundong is intrinsic
to cxistcncc. Dong 动 (motion) is sccn as givcn, whilc jing 静 (stasis, stablcncss)
is rclativc and conditional, a constitutivc silcncc or latcncy that marks rhythms
and variations ol an ongoing proccss ol dong. !n a dccply cmbodicd way, Chi
ncsc livc in “a world ol translorming cffccts.”⁴⁷ !n this world ol ccasclcss gcn
crativc proccss (shengsheng buxi 生生不息), cvcrything is rclatcd and yct uniquc
(not in kind) in tcrms ol dcgrcc (du 度), aspcct or manilcstation (xiang 象),
situation (qing 情), and configuration (shi 势). Vhat is csscntial to this world is
42 TRANSFORMI NG EMOTI ONS
to notc “thc qualitics and lorms ol manilcstations and thc changing timc and
spacc rclationships among thcm” and to look “lor cffcctivc combinations that
can influcncc dcvclopmcnts in a dcsircd dircction.”⁴⁸ Li Yiyuan also commcnts
that Chincsc throughout thcir livcs strivc to scck thc bcst timc configuration
(jishi 吉时) in taking any important stcp in lilc.⁴⁹ Many Chincsc lolk rcligious
practiccs involvc thc idca ol activc manipulation ol timing to coordinatc with
auspicious cosmic timc in ordcr to cxcrcisc somc control ovcr thc coursc ol a
pcrson’s lilc.
Tcn, how is yundong (motion/changc in timc) pcrccivcd and cxplaincd in
thc Chincsc cultural world, what docs this translormativc cosmos mcan to thc
pcoplc, and how docs thc cultural claboration on proccss and changc corrclatc
to thc acsthctic valucs and scnsibilitics that hclp shapc bodily cxpcricncc ol
cvcryday lilc and givc mcanings to it:
AN AESTHETI CS OF SHENTI
! usc thc tcrm aesthetics to indicatc cultural oricntations and bodily spontanc
ity that pattcrn thc ways Chincsc pcoplc livc thcir livcs and givc mcaning to
thcir cxpcricncc ol shenti as it is nurturcd (yang 养), cultivatcd (xiu 修), out ol
balancc (weihe 违和), or hcalcd and rcstorcd (kangfu 康复). An acsthctics ol
shenti 身体 is thcn a scnsc ol ordcr that is cmbodicd through visccral cxpcri
cncc and manilcstcd in social intcractions. My usc ol ‘acsthctics’ is influcnccd
by Ðcsjarlais’ discussion ol “acsthctic cxpcricncc,” in which hc rclatcs acsthctics
to “thc tacit lcitmotivs that shapc cultural construction ol bodily and social
intcractions.”⁵⁰ ‘Acsthctics’ in this scnsc rclcrs morc to cultural scnsibility or
oricntation rathcr than to apprcciation ol artistic bcauty. !llncss and suffcring,
though lack ol bcauty, arc still acsthctically rclcvant bccausc thcy arc “cxpcri
cnccd and intcrprctcd through a lcns ol acsthctic valuc.”⁵' An acsthctics ol or
dinary cxpcricncc thcn offcrs a point ol vicw to cxaminc cultural cxpcricncc as
cmbodicd, spontancous, tacit, and also pattcrncd, a dcpth that othcr catcgorics
ol cultural analysis, such as cultural structurcs, modcls, bclicls, idcals, or rulcs
usually do not accommodatc.
Tc Chincsc scnsc ol ordcr has its roots in thc conccpt ol “dao” (ordcrly
proccsscs ol changc) charactcrizcd by yin-yang dynamics.⁵´ Yin-yang is a dc
scriptivc languagc to talk about changc and is lundamcntal in Chincsc mcdical
rcasoning. !n classical Chincsc thinking, any phcnomcnon or proccss can bc
rcsolvcd into two oppositc and complimcntary aspccts, that is, yin and yang.
Tc quality ol thc phcnomcnon dcpcnds on thc rclationship bctwccn dynamic
polaritics ol thc yin aspcct and yang aspcct. For cxamplc, thc daily cyclc ol thc
sun can bc dcscribcd in tcrms ol waning and waxing ol light and darkncss.
Vhcn light is maximal at noon, darkncss is complctcly immancnt. Vhcn light
bcgins to dcclinc altcr it pcaks at noon, darkncss bcgins to incrcasc. Tis proccss
ol waning and waxing (xiaozhang 消长) continucs. Vhcn darkncss rcachcs lull
cxprcssion at midnight, and light is at thc lowcst point, thc proccss rcvcrscs.
THE CHI NESE WORLD OF SHENTI 43
Nathan Sivin suggcsts that yin and yang “arc bcst considcrcd thc activc and
latcnt phascs ol any proccss in spacc and timc.”⁵`
Tc point ol yin-yang is proccss, tcnsion, and rclationship ol mutual con
straining and gcncrating. As summarizcd in modcrn standard tcxtbooks ol
Chincsc mcdicinc, thc csscntial mcaning ol yin-yang rcasoning is about “con
tinuity ol thc two opposcd aspccts” (duili-tongyi 对立统一) that arc rootcd in
cach othcr (hugen 互根), constraining cach othcr (xianghu zhiyue 相互制约),
and translorming into cach othcr (xianghu zhuanhua 相互转化). Tis tcnsion
within a unity accounts lor thc univcrsal dynamics ol thc unccasing proccss ol
gcncration and translormation (shenghua 生化). Howcvcr, yin and yang arc not
causcs ol this proccss but dcscriptions ol how it happcns. Although abstract,
thcy “rcmain rootcd in concrctc cxpcricncc.” Sivin also cautions that yin and
yang arc not taxonomics, and thcy do not sort things into fixcd catcgorics ac
cording to ccrtain inhcrcnt csscnccs.⁵⁴ A passagc lrom Neijing: Suwen is a good
illustration:
Yin and yang arc thc dao ol sky and carth (tiandi zhidao 天地之道), thc nct
work ol myriad things, thc parcnts ol translormation and changc, thc root and
thc bcginning ol lilcgiving and lilctaking (shengsha zhi benshi 生杀之本始),
thc scat ol vitality and intcllcgcncc (shenming zhi fu 神明之府). To trcat ill
ncss, onc must tracc this root. Tus, accumulatcd yang is sky, accumulatcd yin
is carth. Yin is containcd (jing 静) and yang rcstlcss (zao 躁). . . . Vhcn cold
rcachcs an cxtrcmc, it givcs risc to hcat, whcn hcat rcachcs an cxtrcmc, it givcs
risc to cold. Cold qi gcncratcs turbid (zhuo 浊), hot qi gcncratcs clcar (qing 清).
Vhcn clcar qi (which is supposcd to risc) is trappcd in thc lowcr parts ol thc
body, it givcs risc to diarrhca, whcn turbid qi (which is supposcd to dcsccnd) is
in thc uppcr body, it produccs swclling and lullncss. Tis is abnormal action ol
yin and yang. Tis countcrmovcmcnt ol yin and yang rcsults in disordcrs.⁵⁵
As shown in thc passagc, “thc dao ol sky and carth” mirrors thc dao ol
shenti. !n lact, thc “ordcrly proccss ol changc” ol thc microcosmos ol shenti is
isomorphic to that ol thc macrocosmos ol univcrsc and human socicty. A pcr
son who has attaincd thc dao coordinatcs and rcsonatcs with, in his/hcr shenti,
thc rhythmic pulsc ol thc changcs in naturc. !n thc cvcryday lilc ol ordinary
Chincsc, dao is not a philosophic or rcligious conccpt, but an acsthctic rcalm
(jingjie 境界) whcrc thc coordination ol a pcrson to his or hcr cnvironmcnt
has achicvcd bodily spontancity. Tis acsthctic spontancity ol dao is achicvcd
through thc “mindlul” proccss ol “habituation,” in concrctc cxistcncc ol cvcry
day practicc. Dao is not an objcctivc cntity ol truth, it can ncvcr bc indcpcndcnt
lrom a particular pcrson who practiccs it. For cxamplc, thc dao ol mcdicinc
(yidao 医道) cxists only in thc way that a spccific doctor brings his own uniquc
knowlcdgc and cxpcricncc and thc paticnt’s uniquc circumstancc togcthcr and
cffccts a hcaling. Tc spontancity in timing, harmony in rhythms, and smooth,
flowing coordination ol thc movcmcnts arc acsthctically salicnt in thc cxpcri
cncc ol dao.
44 TRANSFORMI NG EMOTI ONS
!n what lollows, ! shall outlinc thc acsthctic valucs that arc kcy to Chincsc
cxpcricncc as thcy rclatc to illncss, hcalth, and hcaling.
TONG 通 ( FLOWI NG AND CONNECTI NG)
Ms. Zhu wcnt to thc doctor in carly April .µµ¡. Shc suffcrcd acutc chcst and
back pain whcncvcr shc took a dccp brcath. Any cmotional disturbancc ag
gravatcd hcr pain. Tc thcrapcutic principlc thc doctor chosc lor trcatmcnt was
“smoothing thc movcmcnt ol qi and activating thc blood” (liqi huxue 理气活
血). His prcscription lor thc paticnt did not includc a drug that was dircctly
rclatcd to killing thc pain. Noticing my puzzlcd cxprcssion, hc cxplaincd that
thc paticnt’s pain was rclatcd to thc stagnation ol hcr livcr qi (ganyu 肝郁). !n
hcr casc, thc yang qi was gathcrcd and trappcd (yuzhi 郁滞) within thc chcst
that blockcd thc passagc ol normal movcmcnt ol qi. Hc quotcd thc Chincsc
mcdical wisdom that “whcn thc circulation (ol qi) is blockcd, pain ariscs, whcn
thc passagc is opcn, pain disappcars” (butong ze tong, tong ze butong 不通则
痛, 通则不痛). Tc idca ol his trcatmcnt was to gct qi moving again. Òncc
that was accomplishcd, thc paticnt’s pain would disappcar automatically. Tc
association ol thc cxpcricncc ol pain (tong 痛) to thc blockagc (butong 不通)
ol qi is a markcd clinical manilcstation ol Chincsc mcdical disordcrs. Pain
thcn has a culturally distinctivc mcaning and pattcrn ol a blockcd circulation.
Tc cxpcricncc is ccrtainly inlormcd by a culturally cultivatcd scnsc ol ordcr: a
continuous proccss that should bc wcll coordinatcd at all thc lcvcls ol human
cxistcncc—thc cosmic, social, pcrsonal, and thc bodily.
Chincsc pcoplc arc oricntcd to thc scnsc ol a smoothly flowing proccss,
which is charactcrizcd by such imagcs as tong (opcn, through, cxtcnding, con
nccting, continuing, and flowing), huo 活 (alivc, activc, and flcxiblc), or shun 顺
(unobstructcd, smooth). Tcsc imagcs arc positivcly valucd by Chincsc in thcir
body as wcll as in thcir social world.⁵⁶ Ncgativc imagcs oppositc to tong, huo, and
shun arc blockagc, obstruction, stagnation, dcath, and lilclcssncss.
Tis acsthctic oricntation ol thc cvcryday is also playcd out in Chincsc
social lilc. Tc Chincsc arc known lor placing grcat cmphasis on cultivating
social nctworks (guanxi 关系).⁵⁷ Guanxi nctworks havc acquircd “pcrsonal cir
culation vcsscls” (renmai 人脉) as in thc cxprcssion ol Renmai fengpei 人脉丰
沛, mcaning, litcrally, “having rich and numcrous pcrsonal circulation vcsscls.”
Tcsc circulation nctworks arc dcvclopcd to cnsurc “pcrsonal or group survival
and dcvclopmcnt.”⁵⁸ Tc imagc ol thc cxprcssion is physiological. Similar val
ucs applicd to physiological circulation arc also oricntcd to in social circula
tions. Pcrsons who arc good at cultivating nctworks arc dcscribcd as having
many/flcxiblc channcls (luzi duo/huo 路子多/活). Tc imagc lor thosc who do
not cultivatc guanxi is dcath (si 死). !n somc arcas, thosc who arc disadvan
tagcd in cstablishing nctworks arc dcscribcd as “dcad doors” (si menzi 死门子)
that lcad to nowhcrc.⁵⁹ Tc acsthctic valucs shown in tong, huo, or shun also
THE CHI NESE WORLD OF SHENTI 45
guidc Chincsc pcoplc in crcating and dcvcloping social rclationships through
all lorms ol rcciprocity ol giving and taking.
Tc scnsc ol obstruction or disconncction (butong, bushun) in thc social
world can bc simultancously cxpcricnccd bodily and cmotionally. A paticnt,
who was a computcr tcchnician, told mc that his lilc was not going anywhcrc
no mattcr how hard hc tricd, as il hc had rcachcd a wall and could ncvcr gct
ovcr. Hc cxplaincd that most ol his classmatcs who had graduatcd lrom col
lcgc at thc samc timc as hc wcrc cithcr promotcd to highcr positions, lound a
bcttcr job, or wcnt abroad. Hc, a good studcnt at school, was now lclt bchind.
Hc could not kccp up with thc pacc ol othcrs. Noticcably, othcrs arc thc rcl
crcncc points lor a pcrson to asscss how wcll hc or shc “movcs” in thc social
world. Fcclings ol bcing lclt bchind can bc ovcrwhclming. Hc uscd to think
that as long as hc workcd hard hc could gct ahcad. 8ut now hc dcvotcs almost
all his waking hours to his studics and work, and thc rcsult was thc oppositc.
His mcmory sccms wcak, and hc can hardly conccntratc on his work, as il thc
lunctions ol his wholc shenti slowcd down, lcading to a slow rcaction (fanying
man 反应慢), low vitality lcvcl (jingshen cha 精神差), ncrvous hcart bcating
(xinhuang 心慌), lccling ol closurc/prcssurc in thc chcst (xiongmen 胸闷), and
hcartcmotion dcprcsscd (xingqing yayi 心情压抑). According to thc Chincsc
doctor’s diagnosis, this paticnt also suffcrcd lrom ganyu (stagnation ol qi in thc
livcr systcm).
Chincsc mcdicinc has numcrous words dcscribing all kinds ol blockagcs
and stasis in subtlc diffcrcntiations. Yu 郁 is mainly stagnation ol qi, which is
invisiblc (wuxing 无形) and which is closcly rclatcd to disordcrcd cmotions,⁶⁰
yu 瘀 is stasis ol tangiblc (youxing 有形) fluids, such as blood, zhi 滞 is sluggish
movcmcnt (ol qi), ji 积 is accumulation ol somcthing (shiji 食积 is accumula
tion ol lood), jie 结 is coagulation, somctimcs in thc lorm ol a lump, zu 阻 is
obstruction or blockagc ol thc circulation passagcs. Tcsc physiological dys
lunctions arc oltcn cxpcricnccd by Chincsc paticnts as tong 痛 (pain), du 堵
(blockagc usually in hcart or in onc’s throat), men 闷 (stuffincss in thc chcst),
and zhangman 胀满 (lullncss in chcst arca). Yu (stagnation/blockagc) occupics
such an important rolc in thc clinical manilcstation ol Chincsc mcdicinc that
somc lamous doctors in thc history ol Chincsc mcdicinc insist that yu is thc
singlc most important lactor that rcsults in mcdical disordcrs.⁶'
!l a phcnomcnology ol dcprcssion is univcrsally charactcrizcd by “soul loss”
(lccling ol cmptincss),⁶´ thcn thc Chincsc cxpcricncc ol yu disordcrs is strik
ingly diffcrcnt phcnomcnologically, though somc ol thc symptoms may appcar
lamiliar. !n lact, cmptincss (kong 空 or xu 虚) is not always a ncgativc lccling.
Kong or xu can bc positivc in thc Ðaoist scnsc ol a “dissolvcd scll ” (wuwo 无我)
that by virtuc ol its “cmptincss” pcrmcatcs cvcrywhcrc. !n modcrn cvcryday
Chincsc, thc imagc ol cmptincss is also uscd to convcy thc scnsc ol opcn
mindcdncss or humblcncss. A tolcrant and opcnmindcd pcrson is “having an
insidc as cmpty or spacious as a vallcy” (xuhuai-ruogu 虚怀若谷). A morally
46 TRANSFORMI NG EMOTI ONS
maturc pcrson is ablc to “makc room in oncscll to accommodatc othcrs” (xuji-
dairen 虚己待人). Tc quality ol “cmptying onc’s hcart” (xuxin 虚心), mcaning
modcsty or rcadincss in opcning oncscll to scc othcr pcoplc’s point ol vicw, is
a widcly advocatcd virtuc in a pcrson. As lor cxpcricncc ol lcclings, kong 空 as
in “cmpty and quict” (kongji 空寂) and xu 虚 as in “cmpty and pcacclul” (xujing
虚静) dcscribc an acsthctically plcasant mcditativc statc ol pcacclulncss and
wholcncss. Tc Chincsc cxpcricncc ol qingzhi disordcrs is largcly charactcrizcd
by yu (stagnation), a scnsc ol butong (almost oppositc to cmptincss)—obstruc
tion and blockagc to ordcrly motions and cxtcnsions. Tc main lorm ol qingzhi
disordcrs is yuzheng (illncss ol qi stagnation). Tc charactcr yu appcars in thc
Chincsc translation ol thc psychiatric tcrm ol dcprcssion yiyu 抑郁. !t is also
part ol thc word youyu 忧郁, which, in modcrn Chincsc, mcans sadncss and
mclancholy.⁶` Rcvcalingly, thc Chincsc lcclings ol unhappincss and sadncss arc
associatcd with thc cxpcricncc ol stagnation and blockagc in onc’s cxistcntial
world. Happincss is associatcd with thc cxpcricncc ol unblockcd and unim
pcdcd flowing as shown in thc cxprcssion ol “lrccly strctching and flowing ol
hcartmind” (xinqing-shuchang 心情舒畅).
DU 度 ( DEGREE/POSI TI ON AND MODERATI ON)
!n thc Chincsc acsthctic world, a myriad ol things arc conncctcd in an unccas
ing proccss ol changcs and translormations and arc diffcrcntiatcd according
to “numcrous positions on thc continuum” ol thc proccss bctwccn cxtrcmcs,⁶⁴
such that things arc rccognizcd as diffcrcnt according to thcir du, thc dcgrcc
or position, rathcr than solcly or mainly to any fixcd csscncc. Du is thcrclorc
ccntrally important in undcrstanding Chincsc cxpcricncc.
For cxamplc, mcntal illncss in Chincsc is jingshen bing 精神病, but not
all thc psychogcnic disordcrs arc labclcd as jingshen bing. !n thc Chincsc un
dcrstanding, psychological or cmotional disordcrs, only whcn thcy comc to a
ccrtain dcgrcc, can bc labclcd as jingshen bing. As Lcc and Vang rcport in
thcir Hong Kong studics, ncurasthcnia is pcrccivcd to bc psychogcnic by Hong
Kong Chincsc studcnts, howcvcr, thcy also insist it is not a mcntal illncss. At
thc samc timc thcy agrcc that whcn ncurasthcnia bccomcs scvcrc, it may lcad
to schizophrcnia, which thcn bccomcs a mcntal illncss.⁶⁵ Psychiatrists working
with Chincsc culturc mostly intcrprct this “contradiction” as causcd by stig
matization ol mcntal illncss in Chincsc socicty. Surcly, scvcrc mcntal illncss
may bc socially stigmatizcd, yct this is not a phcnomcnon uniquc to Chincsc
culturc. !t is also commonly known that in Vcstcrn socicty, mcntal illncsscs
arc stigmatizcd socially il not mcdically.⁶⁶ !n China, jingshen bing, in common
scnsical languagc, almost always rclcrs to rclativcly scvcrc psychiatric disordcrs
that upsct thc normal social lunctions ol a pcrson and crcatc disturbancc to thc
lamily and thc community. Gcncral cmotionrclatcd disordcrs arc pcrccivcd
as somc lorm ol “bodyhcart disordcrs” (shenxin jibing 身心疾病) or rcccntly
“subhcalth conditions” (ya jiankang zhuangtai 亚健康状态), which arc vicwcd
THE CHI NESE WORLD OF SHENTI 47
as bcnign and highly rcvcrsiblc. Similarly, thc Chincsc translation ol major
dcprcssion is “zhongxing yiyuzheng” 重型抑郁证 (scvcrc dcprcssion), which
translatcs a typological conccpt into a conccpt ol dcgrcc. Tis “translation dil
ficulty,” Lcc suspccts, might account partially lor miscommunication bctwccn
Chincsc psychiatrists and thcir Vcstcrn countcrparts and might also account
lor diffcrcntial diagnosis ol major dcprcssion in China.⁶⁷
Vcstcrn studcnts casily miss thc ccntrality ol du 度 (dcgrcc, tcnsity, quan
tity) in Chincsc cxpcricncc. Tc intcrprctation that sincc cxccssivc cmotion is
sccn as dctrimcntal to hcalth, cmotions or an ovcrly dcmonstrativc cxprcssion
ol cmotions arc thcrclorc highly stigmatizcd. Tis is cchocd in many major
studics ol cmotion and cmotional disordcrs in Chincsc socicty.⁶⁸ For cxamplc,
Òts argucs that in Chincsc mcdicinc: “According to thc thcory ol systcmatic
corrcspondcncc (wu xing xueshuo) thcsc cmotions, whcn in cxccss, hurt thcir
corrcsponding visccra as wcll as thc cncompassing hcartmind. ¡motional bc
havior, thcrclorc, is hcavily stigmatizcd.”⁶⁹ From thc zhongyi point ol vicw, such
logic is problcmatic. Tc conccpt ol “guodu” 过度 (surpassing thc du, cxccssivc)
to Chincsc is itscll valid in dcfining and cstablishing a situation. ¡motions
that surpass thc du arc sufficicntly diffcrcnt in significancc lrom thc cmotions
within thc du. !n addition, cmotions arc scldom talkcd about and cxpcricnccd
as abstract conccpts, but always in rclation to concrctc social situations that also
spccily appropriatc du ol actions. !n othcr words, it is not “cmotion,” but thc
cxccss dcfincd in concrctc social contcxts with ccrtain social and bodily cffccts
that is harmlul to onc’s hcalth. My imprcssion is that it is almost “natural” lor
Vcstcrntraincd scholars to scc cxccssivc as mcrcly an adjcctivc, a qualificr. !t
is cmotion, which is csscntialistically dctcrmincd, that dcfincs and counts. Tc
scnsc ol du gcts lost whcn cxccss ol cmotion is intcrprctcd as simply cmotion
or cmotional cxprcssions or bchavior. !n addition, cxccss not just in cmotion
but in almost cvcrything clsc is vicwcd ncgativcly by thc Chincsc: lor cxamplc,
cxccss in thinking may bc harmlul to onc’s hcart and splccn qi (silu guodu shang
xinpi 思虑过度伤心脾), and cxccss in cating and drinking hurts onc’s splccn
and stomach systcms (yinshi guodu shang piwei 饮食过度伤脾胃). !t would bc
absurd thcrclorc to asscrt that Chincsc culturc also stigmatizcs thinking and
cating.
Appropriatc scnsc ol du is also a lorm ol de 德 (virtuc, morals), thc hcart
ol Conlucian doctrinc ol zhongyong 中庸 (thc mcan) which advocatcs a social
political ordcr that docs “not lcan to any onc sidc” (bupian buyi 不偏不倚) and
is “ncithcr cxccssivc nor insufficiant” (wu guo buji 无过不及). Tis moral scnsc
ol du is wcll cxprcsscd in Conlucius’s own words: “Gricvc but not to thc cxtcnt
ol injury, cnjoy but not to thc cxtcnt ol cxccss” (ai er bu shang, le er bu yin 哀
而不伤, 乐而不淫). Ònc ol thc major tasks ol “cultivating onc’s bodypcrson”
(xiushen 修身) is to dcvclop thc spontancity ol du and thc scnsibility ol har
mony and modcration (zhonghe 中和). A maturc pcrson (an adult) is cxpcctcd
to dcmonstratc thc scnsibility ol du, knowing thc boundarics (fencun 分寸)
(litcrally dccimctcrs and inchcs) and limits (jindui 进退) (litcrally advancc and
48 TRANSFORMI NG EMOTI ONS
rctrcat). 8oth cxccss (guo 过) and insufficicnt (buji 不及) arc considcrcd undc
sirablc. !t is a cliché among Chincsc that truth, takcn a stcp lurthcr, bccomcs
lalsc. Many commonly uscd phrascs convcy this cultural scnsibility ol du, such
as “stop whcn it is right” (shike’erzhi 适可而止) or right to thc appropriatc point
(qiadao haochu 恰到好处).
Tc scnsc ol du is cmbodicd, acquircd, and dcvclopcd in concrctc cvcry
day cxistcncc through thc ways thc Chincsc intcract with cach othcr, carc lor
thcir young and old, cnjoy a piccc ol music, or cook a bowl ol soup. Du is not a
normativc conccpt or a fixcd standard by which onc dctcrmincs il a bchavior is
cxccssivc or not. Tcrclorc, assuming ovcrt cxprcssion ol cmotion or cmotional
bchavior is mcant by Chincsc as cxccssivc and thcrclorc is highly disvalucd and
cautiously guardcd against is a misintcrprctation. Du is rathcr an cxpcricntial
conccpt, which can only bc scnscd and lclt in concrctc human situations. ¡xccss
or not is not dctcrmincd by standard mcasurcmcnt but is contingcnt on thc
actual circumstanccs and cffccts.⁷⁰ Tis is common scnsc to Chincsc mcdical
doctors. ¡ach pcrson is a uniquc unity ol psychophysical dispositions (xing 性)
and sociocnvironmcntal conditions, such that lor onc pcrson at onc timc and
placc, it is normal, and lor anothcr pcrson or at anothcr timc and placc, it may
bc cxccssivc. !n simplc words, a doctor said to mc, “! may cat as many picccs
ol cold watcrmclon as ! likc without lccling any discomlort. You may havc a
stomachachc or diarrhca altcr just having two picccs, so in your particular casc,
onc piccc is right to thc du and two picccs arc cxccssivc.”
¡xccss (surpassing thc du) cannot bc judgcd indcpcndcntly lrom its cl
lcct. Asking my Chincsc lricnds to dcfinc cmotional cxccss, instcad ol gct
ting abstract normativc answcrs, ! was offcrcd various cmotional sccnarios. For
instancc, thc story ol Fan Jin passing thc provincial impcrial cxamination was
mcntioncd to show cxccss in thc cmotion ol joy. !n thc story, whcn Fan Jin
hcard that hc had passcd thc provincial impcrial cxamination altcr many ycars’
disappointmcnt, hc was so ovcrjoycd that hc suddcnly wcnt crazy. Similarly,
whcn Pottcr askcd hcr inlormants about cmotional cxccss, shc was told about
an old woman who, altcr thc dcath ol hcr child, cricd so much that shc bccamc
blind.⁷' ¡xccss and cffcct mutually cntail cach othcr in this scnsc. !l cxccssivc
thinking and worrying (silu guodu 思虑过度) “causcs” (thc Chincsc scnsc hcrc
is closcr to “contributcs to”) thc syndromc ol “hcartyin dcficicncy” (xinyin
buzu 心阴不足) charactcrizcd by symptoms ol “hot scnsation in fivcccntcrs”
(wuxin fanre 五心烦热), “disturbcd hcartmind” (xinshen buning 心神不宁),
“hcart vcxation” (xinfan 心烦), and “insomnia” (shimian 失眠), thcsc symptoms
may also indicatc an cxccss in thinking and worrying.
Sincc du is not a normativc conccpt, it should not bc sccn as an cxtcrnal
constraint lorccd on mcmbcrs ol thc socicty lrom thc outsidc and lcading to
“rcprcssion and supprcssion ol cmotions.” !t is rathcr an acsthctic valuc that
pcoplc arc oricntcd to and cngagcd with in thcir daily livcs. !t lunctions consti
tutivcly and immancntly within thc ordcr ol cvcryday lilc itscll.
THE CHI NESE WORLD OF SHENTI 49
HE 和 ( HARMONY)
Tc conccrn ol harmony (he 和 or hexie 和谐) is cvidcnt cvcrywhcrc in Chi
ncsc culturc lrom highly ritualizcd ccrcmonial pcrlomancc and structurcd
social rclations to mundanc practiccs ol thc cvcryday. Somc scholars bclicvc
that “sccking balancc and harmony” (zhizhonghe 致中和) has bccn an cnduring
cultural scnsibility in Chincsc tradition that guidcs how Chincsc, including
wcllcultivatcd clitcs and rudimcntally cducatcd laborcrs and pcasants as wcll,
livc thcir livcs.⁷´ Tc common cxprcssions ol today, such as “harmony brings
wcalth” (heqi shengcai 和气生财) and “all flourishing whcn thcrc is harmony
at homc” (jiahe wanshixing 家和万事兴) still ccho thc passagc in thc classic
Zhongyong 中庸 (Te Doctrine of the Mean): “Vhcn harmony is rcachcd, thc sky
and thc carth lollow thcir propcr routcs and myriad things flourish in lilc” (Zhi
zhonghe, tiandi wei yan, wanwu yu yan 致中和, 天地位焉, 万物育焉). Òrdi
nary Chincsc arc oltcn lound quoting thc provcrb lrom thc Analects: “harmony
is most valuablc” (heweigui 和为贵) whcn pcrsuading othcrs to rcsolvc conflicts
or cxplaining thcir own bchaviors ol rcconciliation. Tc origin ol thc saying can
bc traccd back to thc statcmcnt “thc most valuablc lunction ol propricty is to
cnsurc harmony (lizhiyong, heweigui 礼之用和为贵) in Lunyu 论语 (Te Ana-
lects: ) morc than two thousand ycars ago. Tc rcccnt discussions ol “culturc ol
harmony” (hehe wenhua 和合文化) in China strcss that “he” is a pcrsistcnt and
most commonly acccptcd cultural valuc throughout Chincsc history.⁷`
According to Li, thc ovcrall scnsc ol harmony lor Chincsc dcpcnds on
harmonious rclationships at thrcc lcvcls: harmony at thc lcvcl ol natural cnvi
ronmcnt, harmony at thc lcvcl ol bodypcrson (shenti), and harmony ol social
rclations (both intcrpcrsonal and to thc spiritual world).⁷⁴ Sincc an acsthctics
ol harmony is cmbodicd, disharmony at any ol thc thrcc lcvcls upscts thc bodily
scnsc ol ordcr. Tcrclorc, he as a kcy acsthctic valuc is quintcsscntially rcflcctcd
in Chincsc mcdicinc, an art ol hcalth and hcaling. Zhongyi somctimcs is actu
ally rclcrrcd to as “mcdicinc ol harmony” (zhonghe zhi yi 中和之医). As is statcd
in Neijing, “whcn qi and blood movc in harmony, no illncss will arisc” (qixue
chonghe, baibing bu sheng 气血冲和百病不生). So lalling ill is thc “bodypcrson
lalling out ol harmony” (shenti weihe 身体违和). !n lact, many Chincsc mcdical
disordcrs can bc summarizcd simply as “out ol harmony” (buhe 不和) or “out ol
balancc” (butiao 不调). Many timcs, thc doctors ! obscrvcd simply cxplaincd to
thcir paticnts that thcy suffcrcd “yin and yang not in harmony” (yinyang buhe
阴阳不和) “splccn and stomach qi not in harmony” (piwei buhe 脾胃不和), or
“qi and blood out ol balancc” (qixue butiao 气血不调) so that thc paticnts could
grasp basic idcas without thc doctors using too much zhongyi jargon.
According to Chincsc mcdical rcasoning, “a human bodypcrson rcso
natcs with thc way ol sky and carth” (ren yu tiandi xiangying 人与天地相应).
Tc movcmcnt ol qi and blood and thc lunctions ol thc visccral systcms and
othcr bodily systcms may dcmonstratc diffcrcnt charactcristics in accordancc
50 TRANSFORMI NG EMOTI ONS
with thc changcs ol “sky and carth.” A pcrson is cncouragcd to anticipatc thc
changcs and adapt onc’s bchavior to thc changcs. Tc importancc ol harmony
ol a pcrson in rclation to thc changcs ol thc macrocnvironmcnts, such as thc
changcs ol scasons, wcathcr, tcmpcraturc, and moisturc during thc day or thc
ycar is strcsscd in all kinds ol popular publications on “cultivating lilc” (yang-
sheng 养生).
He (harmony) is oltcn citcd as thc most important lactor lcading to social
succcss and achicvcmcnt. Trcc clcmcnts arc considcrcd by Chincsc as im
portant in virtually any kind ol succcss. Tcsc arc right timc (tianshi 天时),
advantagcous position (dili 地利), and harmonious intcrpcrsonal rclationship
(renhe 人和). !n comparison, harmonious intcrpcrsonal rclationship is dccmcd
morc important than thc othcr two clcmcnts, as shown in thc still popular
cxprcssion quotcd lrom Mencius that “thc right timc yiclds to advantagcous po
sition, advantagcous position yiclds to harmonious intcrpcrsonal rclationship”
(tianshi buru dili, dili buru renhe 天时不如地利, 地利不如人和). Tc cultural
acsthctics ol renhe (harmonious intcrpcrsonal rclationship) finds its lull cxprcs
sion in Chincsc lamily cthics that guidc thc way thc lamily mcmbcrs carc lor
and intcract with cach othcr according to thcir placcs within thc lamily. Tc
harmonious lamily also includcs a vcrtical dimcnsion. Tis conccrn lor har
monious lamily rclationships cxtcnds to thc dcccascd mcmbcrs ol thc lamily,
that is, thc spiritual world.⁷⁵ Apparcntly, thc cultural scnsc ol harmony (he) is
also at work whcn Chincsc takc carc ol thcir anccstors’ tombs, and offcr loods
and burn papcr moncy to thcir anccstors. !t is still a common practicc in many
rural arcas that lamily mcmbcrs, bclicving in a harmonious rcciprocity with
onc’s anccstors, pay rcspcct to thcir anccstors lollowing a pcrsonal succcss such
as passing a collcgc cntrancc cxamination. Hcrc, thc Chincsc spiritual world is
conncctcd with thc prcscnt world. Tis is also rclatcd to thc Chincsc scnsibility
ol tong (conncction and flowing) discusscd abovc. For thc Chincsc, harmony
prcsupposcs a hcalthy proccss ol connccting and cxtcnding.
!t is also important that thc cultural acsthctics ol renhe (harmonious in
tcrpcrsonal rclations) cxtcnd bcyond onc’s immcdiatc circlc ol lamily mcmbcrs
and rclativcs through cxtcnsivc nctworks ol “human cmotions” (renqing 人情)
crcatcd and maintaincd diligcntly by all lorms ol social cxchangcs, ol gilts,
labor, scrviccs, rcspcct, and so on.⁷⁶ Li points out that thc ultimatc goal ol
Chincsc cxchangc rclationship is to scck harmony and balancc in thc social
world, that rcsonatcs harmoniously with thc macrocosmos ol naturc and thc
microcosmos ol bodypcrson.⁷⁷
Vcstcrn scholars oltcn tcnd to associatc an cmphasis on harmony with
rcprcssion or supprcssion ol cmotions in Chincsc social lilc, as il thcrc is an
intrinsic conflict bctwccn harmony and cmotions. Yct, il wc givc thc Chincsc
conccpt ol harmony, “he,” a closc cxamination, wc can scc that he docs not mcan
lorcing a conlormity by appcaling to a singlc cxisting standard. According to
thc Zhongyong 中庸 (Te Doctrine of the Mean), “latcnt cmotions ol happi
ncss, angcr, sadncss, and joy arc callcd ncutral (zhong 中), whcn activc and yct
THE CHI NESE WORLD OF SHENTI 51
appropriatc (zhongjie 中节), thcy arc callcd harmony (he).” Harmony dcfincd
hcrc is rclatcd to thc Chincsc scnsc ol du (dcgrcc, cxtcnt, position) discusscd
prcviously. Zhongjie litcrally mcans “hit thc rhythm,” or “right to thc mark”
convcys thc scnsc ol du that is ncithcr cxccssivc nor insufficicnt (wu guo buji
无过不及). !n othcr words, in a dynamic intcractivc cnvironmcnt, harmony
is brought out whcn cach particular unlolds itscll in its uniquc way and to an
appropriatc du such that “cach shincs morc brilliantly in thc othcr’s company”
(xiangde-yizhang 相得益彰). !n lact, carly Chincsc thinkcrs had alrcady madc
a clcar distinction bctwccn thc conccpt ol harmony (he) and that ol “samcncss
and conlormity” (tong 同). For cxamplc, in Guo Yu: Zhcng Yu 国语: 郑语
(compilcd during thc ¡astcn Zhou pcriod ¡,¸ nc–aa. nc), it is statcd that “to
complcmcnt onc thing with a diffcrcnt thing is callcd harmony, with which
things flourish and join cach othcr, yct to strcngthcn onc thing by adding thc
samc thing (which is callcd conlormity), brings an cnd to cvcrything.”⁷⁸ !n thc
Chincsc scnsc, harmony prcsupposcs divcrsity, diffcrcntiation, and conlron
tation. Similarly, Amcs and Hall translatc he as “attuning”: “combining and
blcnding ol two or morc ingrcdicnts in a harmonious wholc with bcncfit and
cnhanccmcnt that maximizcs thc possibilitics ol all without sacrificing thcir
scparatc and particular idcntity.”⁷⁹
As shown abovc, Chincsc pcoplc in thcir cvcryday livcs arc, cxplicitly or
tacitly, oricntcd to a sct ol cultural acsthctic valucs. Tc acsthctic scnsibilitics
arc cvidcnt in thcir way ol “making thc world,” in thcir cxpcricncc ol illncss
whcn thc world is “unmadc” by blockcd circulations (butong), lack ol modcra
tion (shidu), or loss ol harmony (weihe), and in thc proccss ol “rcmaking thcir
world” through hcaling, known also in Chincsc mcdicinc as attuning (tiao 调).
¡motions, as vicwcd lrom thc pcrspcctivc ol Chincsc mcdicinc, arc ccntrally
important to this proccss ol making and unmaking thc world ol bodypcrson.
Tc lollowing chaptcr locuscs on thc Chincsc conccpt ol “cmotions” and cx
plorcs thc cultural world ol cmotional mcanings as thcy rclatc to illncss and
hcalings.
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53
I V
Contextualizing Qingzhi 情志 (Emotions)
An cthnographic study on illncss and hcalth that addrcsscs socioculturally con
stitutcd “bodypcrson” ncccssarily cntails a translation ol a cultural world ol
cmotional mcanings. Tis is particularly rclcvant to our undcrstanding ol thc
disordcrs that arc pcrccivcd locally as “cmotionrclatcd,” such as qingzhi 情志
disordcrs in Chincsc mcdicinc. Two rcccnt lincs in anthropological thinking
ol cmotion lcnd complcmcntary pcrspcctivcs to this cnquiry. Tc sociocultural
construction approach advocatcd and practiccd by anthropologists such as Abu
Lughod, Lutz, and Vhitc, locuscs typically on cmotions as discursivc (mcaning
making) social practicc,' whilc thc phcnomcnologically inspircd approach ad
optcd by such anthropologists as Cosdas, Ðcsjalcis, Lock and ShcpcrHughcs
pays ultimatc attcntion to thc lclt or cmbodicd quality ol cmotional cxpcricncc.´
Sccing qingzhi and disordcrcd qingzhi as an intcractivc social phcnomcnon and
cmbodicd cxpcricncc inlormcd with thc cultural scnsibilitics ol tong 通 (flow
ing, cxtcnding), du 度 (dcgrcc, position, intcnsity), and he 和 (harmony), this
chaptcr cxplorcs thc sociocultural and cthnomcdical contcxts whcrc qingzhi
and disordcrcd qingzhi arc lormulatcd, talkcd about, and cxpcricnccd.
UNRAVELI NG QING 情 ( EMOTI ON)
Tc studics that thcorizc thc Chincsc cxpcricncc ol cmotions arc markcd by
thcir contradictory obscrvations and rivaling intcrprctations. Arthur Klcinman,
lor cxamplc, in his works about thc Chincsc cxpcricncc ol illncss and hcalth,
dcscribcs cmotiontacit Chincsc who through socialization havc lcarncd that
pcrsonal affccts, cspccially ncgativc or disphoric cmotions, should not bc opcnly
cxprcsscd. Hc gcncralizcs that in Chincsc socicty ncgativc cmotions such as dc
prcssion, sadncss, and irritability arc supprcsscd and not to bc rcvcalcd outsidc
onc’s lamily.` Òts also argucs that Chincsc culturc stigmatizcs cmotional bc
haviors and that opcn cxprcssion ol cmotion is dcvalucd and carclully guardcd
against.⁴ Howcvcr, Pottcr and Pottcr contcnd that such a gcncralization docs
not conlorm to thc obscrvcd social rcality. According to Pottcrs’ obscrvation in
54 TRANSFORMI NG EMOTI ONS
a villagc in Guangdong, villagcrs arc actually cmotionally cxprcssivc in cvcry
scnsc including thc cmotions that could bc listcd as dysphoric, strong, and
ncgativc or cvcn hostilc. Tcy thcn arguc that Chincsc cmotions arc natural
phcnomcna lacking important social and symbolic significancc “lor thc main
tcnancc and pcrpctuation ol social rclationships.”⁵ Andrcw Kipnis, drawing on
his own cthnographic cxpcricncc in thc countrysidc ol Shandong, takcs issuc
with Pottcr and Pottcr. Hc argucs that Chincsc cmotion is indccd a social pcr
lormancc through which social rclationship is cstablishcd and maintaincd. Ònc
ol thc most obvious points ol cvidcncc hc mcntions is that during thc cultural
rcvolution, thc crossclass crying at luncrals was banncd bccausc ritual crying
at a luncral, a modc ol cmotional cxprcssion, was pcrccivcd as cstablishing and
consolidating a social rclationship, and any such crossclass dcmonstration ol
rclationship was dccmcd politically incorrcct at thc timc. Kipnis argucs il it
wcrc truc that Chincsc cmotion, as Pottcr and Pottcr havc argucd, did not havc
any lormal social significancc, crossclass crying at luncrals would not havc
bccn a conccrn at all.⁶
Tcsc obscrvations, sccmingly inconsistcnt, do havc a contribution to
makc. Tc cultural scnsibility ol shamc and laccsaving docs play its rolc in thc
way Chincsc cxprcss and cxpcricncc thcir cmotions.⁷ !n clinical intcractions,
doctors usually do not cxplicitly pursuc scnsitivc pcrsonal inlormation, but
rathcr rcly on thcir own dcvclopcd scnsitivity to asccrtain thc problcms. Yct
cmotions arc cxprcsscd opcnly cvcrywhcrc, somctimcs vcry lorcclully. For cx
amplc, Chincsc arc notorious lor thcir opcn displays ol angcr on buscs. Martin
Schocnhals obscrvcd that cvcry day or two, hc cncountcrcd an argumcnt or a
fight on thc strcct or on thc bus.⁸ An Amcrican lricnd also told mc that hc was
surpriscd to scc how ordinary Chincsc could opcnly display thcir strong cmo
tions toward authoritativc figurcs. Hc rclcrrcd to an incidcnt hc saw in 8cijing
whcrc a cyclist, altcr bcing stoppcd by a policcman, ycllcd angrily at thc policc
man and drcw a crowd ol onlookcrs. ! pcrsonally obscrvcd at numcrous timcs
in thc clinics that paticnts cricd opcnly in lront ol doctors and othcr paticnts
whilc talking about thcir illncss, lrustrations, and sadncss. Òl coursc, such cx
prcssivcncss docs not logically lcad to thc conclusion that Chincsc cmotion has
no lormal social significancc. Òn thc contrary, cxprcssing cmotion is always
opcn to social and moral intcrprctations and judgmcnt. ¡motions, such as
“moral indignation” (yifen 义愤) and “public indignation” (gongfen 公愤) arc
uscd lrcqucntly to justily social actions. ! agrcc with Schocnhals who sug
gcsts, in his cthnographic study ol a Chincsc middlc school, that cxprcssion ol
cmotions in Chincsc socicty is highly contcxtualizcd and that in ccrtain social
contcxts cxprcssivcncss and aggrcssion arc tolcratcd, sanctioncd, and cvcn cx
pcctcd.⁹ Vc may also say that ccrtain cmotions or ccrtain ways ol doing cmo
tions arc callcd lor in ccrtain contcxts or within ccrtain structural rclationships.
Tc abscncc ol thcm invitcs intcrprctations and judgmcnt, too. !n othcr words,
a good undcrstanding ol thc Chincsc cxpcricncc ol cmotion lics in thc cultur
ally inlormcd scnsitivity to contcxts, givcn that thc Chincsc cultural tradition
CONTEXTUALI ZI NG QI NGZHI 55
in gcncral is intcrcstcd morc in proccss and cvcnts rathcr than in csscncc and
agcncy.'⁰
!l wc takc “cmotion insidc out” as Gcoffrcy Vhitc suggcsts, thc undcr
standing ol cmotion, thcn, docs not rcquirc a commitmcnt to any particular
ontology ol cmotions, but involvcs “thc study ol mcaning making practiccs ol
pcrsons cngagcd in ordinary talk and intcractions.”'' At thc samc timc, wc nccd
to scc how cmotion is conccptualizcd within thc culturc and how a particular
cmotion “fits into thc systcmatic world vicw, languagc, and way ol lilc ol thc
socicty.”'´ Vhat is involvcd is “a tracing out and unravcling ol thc rclationships
and conditions ol thc phcnomcnon’s contcxt, and its multiplc corrclations.”'`
!n othcr words, a morc inlormativc way to undcrstand thc mcaning ol Chi
ncsc cmotion is to map out a nctwork ol mcanings, situations, cxpcricncc, and
cvcnts that typically associatc with “qing” (cmotion). Again, this approach is
inspircd by 8yron Good’s modcl ol scmantic nctwork analysis, which fits wcll
in thc cnduring Chincsc modc ol knowing charactcrizcd by thc “onc cvoking
many” modcl.'⁴ !t is particularly rclcvant to how zhongyi works, whcrc ccrtain
symptoms, cxpcricnccs, and situations arc vicwcd as typically associatcd with
onc anothcr to lorm a clustcr or pattcrn known as “syndromc clustcr or pattcrn”
(zhenghouqun 症候群). Ònc obvious diffcrcncc bctwccn an cxpcricnccd doctor
and an incxpcricnccd onc in clinical work, according to my zhongyi tcachcr, is
that an cxpcricnccd doctor is lamiliar with zhenghou qun and thus is morc cffi
cicnt in mapping out thc illncss situations and tracing thc roots ol thc problcm.
Similarly, undcrstanding ol qingzhi will bcncfit lrom mapping out a nctwork ol
associatcd mcanings and cvcnts ol “qing” and tracing thc mcaning to its root.
Likc many othcr kcy tcrms in thc Chincsc languagc, qing hardly translatcs
unambiguously. Li Ji 礼记 (Tc 8ook ol Rituals ca. ¡6¸–¡¸c ncv) dcfincs ‘qing’
as thc human lcclings ol “joy, angcr, sadncss, lcar, likc, dislikc, and dcsirc—thc
scvcn (abilitics) acquircd (by human bcings) without thc dclibcratc cffort ol
lcarning.” Xunzi also sccs qing as a pcrson’s natural tcndcncy (xing 性) ol “likcs
and dislikcs, joy, angcr, and sadncss.”'⁵ Ðong Zhongshu, thc Conlucian scholar
ol thc carly Han dynasty, rclcrs to qing as “human capacity ol dcsiring, wanting,
and motivating” (ren zhi yu 人之欲). Tc dcfinition ol qing that has morc or
lcss continucd up to today strcsscs thc intcraction ol human bcings with thcir
cnvironmcnt. For cxamplc, Han Yu ol thc Tang dynasty writcs, “Qing ariscs
whcn (a pcrson) comcs into contact with thc world” (qingyezhe, jieyuwu er sheng
情也者, 接于物而生).'⁶ Qing sccms to bc broadcr than cmotivc statcs and “in
cludcs all rcality inputs”'⁷ or pcrhaps all rcality configurations. Qing, thcrclorc,
is “ganqing, 感情” (scntimcnts or lcclings, cmotional attachmcnt), “aiqing 爱情”
(good lcclings and lovc bctwccn couplcs), and “qingyu 情欲”—(scnsual dcsircs).
Qing is also “qingmian 情面” (social lacc), “renqing 人情” (social obligation and
cthics, a social nctwork), “qingli 情理” (commonscnsc, rcasons), and “qingkuang
情况” or “qingxing 情形” (situations, circumstanccs, or rcality). Qing prcsup
poscs participation in social rclations and intcractions. !ndccd, as Solomon
commcnts, onc cannot lccl any ol thc cmotions, such as lovc, angcr, sadncss,
56 TRANSFORMI NG EMOTI ONS
shamc, without cngaging othcrs in onc’s cxpcricncc.'⁸ !mportantly, qing is a rc
lational and situational conccpt. Chincsc tcnd not to conccptualizc cmotions as
purc inncr lcclings scparatcd lrom concrctc situations. ¡motions arc not talkcd
about and cxpcricnccd as abstract conccpts but in rclation to particular social
situations. Qing, thcrclorc, is corrclatcd with rcason or rationality (li 理), spccch
or languagc (yan 言), bchavior or action (xing 行), and appropriatcncss (yi 义).
Qing as Sensibility of Face
Tc ¡nglish cxprcssion hurting somebody’s feelings may simply translatc as “in
juring somcbody’s lacc” (shang mianzi 伤面子) in Chincsc. As many scholars
havc prcviously pointcd out, thc conccpt ol “lacc” is ccntral to thc Chincsc
cxpcricncc and is an important mcchanism ol social control.'⁹ !n addition, lacc
is lrcqucntly cxprcsscd and cxpcricnccd in tcrms ol cmotions.
Tc Chincsc scnsc ol lacc is rccognizcd as having two aspccts: mianzi 面子
(social lacc) and lian 脸 (moral lacc).´⁰ Mianzi is talkcd about in tcrms ol social
status and prcstigc. !t is thc pcrsonal mcrit rccognizcd by thc public. Tis typc
ol lacc is constantly undcr public scrutiny and subjcct to socicty’s cvaluations.
Logically, somc havc biggcr mianzi than othcrs. Tosc who arc morc cducatcd
and culturcd (you wenhua 有文化), thosc who arc distinctivcly rccognizcd, and
thosc who havc highcr social status, havc biggcr mianzi and conscqucntly bcar
thc burdcn ol living up to highcr cxpcctations. Tcy arc subjcct morc casily to
public humiliation and hcncc to thc cxpcricncc ol losing lacc (diu mianzi 丢面
子) which can bc intcnscly cmotional. ! pcrsonally cxpcricnccd such an incidcnt
whcn ! accidcntally parkcd my bicyclc along with scvcral othcr bicyclcs in an
arca whcrc bicyclc parking was not allowcd. Altcr ! showcd my idcntification
card, thc old guard dclibcratcly pointcd out lor cvcrybody to hcar that with my
background as a tcachcr what cxamplc ! was sctting lor my studcnts il ! could
not lollow thc rulcs myscll. Tis rctircd workcr, without his rcd band around his
lclt arm, would bc pcrlcctly ncgligiblc. 8ut with his indignant look and raiscd
voicc accusing somcbody wcll cducatcd, hc suddcnly gaincd social lacc and
bccamc morc important. Morcovcr, ! was madc to losc lacc and to lccl totally
humiliatcd. Undcr thc circumstanccs, thc only thing lor mc to do was to lcavc
thc sccnc as quickly as possiblc. To arguc was to losc lacc cvcn morc. Tc cxpcri
cncc ol losing lacc can bc vcry painlul.
Tc scnsc ol mianzi is not just somcthing supcrficial or skin dccp. !t is
said to havc somcthing to do with onc’s “hcart ol scllrcspcct” (zizunxin 自尊
心). Tosc who havc a strong scnsc ol scllrcspcct arc morc scnsitivc to mianzi.
Lian 脸, is uscd in talking about moral and cthical scnsibility. A pcrson whosc
conduct trcspasscs moral codcs loscs his or hcr “moral lacc” (dui lian 丢脸),
which is considcrcd morc scrious. “Ðo not want moral lacc” (buyao lian 不
要脸) is onc ol thc most insulting rcmarks onc can makc, implying that thc
pcrson “has laid asidc all claims to bc a pcrson.”´' Tc scnsc ol lian dcpcnds
on thc scnsc ol shamc (xiuchi xin 羞耻心), a painlul lccling similar to guilt.
CONTEXTUALI ZI NG QI NGZHI 57
Somc scholars considcr that thc scnsc ol lian, unlikc thc scnsc ol mianzi, which
dcpcnds on cxtcrnal sanction ol bchaviors, lunctions as an “intcrnal moral rc
straint.”´´ Howcvcr, mianzi and lian arc not two totally scparatc phcnomcna.
8oth involvc social norms and a pcrsonal scnsc ol pridc and shamc. Mianzi
and lian arc rathcr thc samc proccss ol bcing a pcrson sccn or talkcd about
lrom diffcrcnt points ol vicw. Mianzi is sccn lrom thc outsidc cxtcnding to thc
insidc, whilc lian is sccn and cxpcricnccd lrom thc insidc cxtcnding outsidc. !n
thc cxpcricncc ol a rcal lilc situation “moral lacc” and “social lacc” arc intcgratcd.
For this rcason ! prclcr to usc lian-mian 脸面 (lacc), cxccpt in thc situations
whcrc onc mcaning is ovcrwhclmingly dominant, to indicatc thc complcxity ol
thc Chincsc conccpt ol lacc.
Facc is an intcgrativc part ol bccoming a pcrson, and cvcry maturc Chincsc
pcrson (adult) is cxpcctcd to bc scnsitivc to lacc. Somctimcs talking about lacc
is anothcr way ol talking about “lcclings.” Howcvcr, lacc is morc a dynamic
phcnomcnon in Chincsc social lilc that onc can losc, gain, givc, protcct, or cvcn
buy. !n lact, it is lair to say that Chincsc in cvcryday lilc cngagc thcmsclvcs
activcly in thc proccss ol a “lacc cconomy.”´` Comparcd to othcr aspccts ol
lacc, thc loss ol lacc or a thrcatcncd loss ol lacc is morc cxpcricnccd and talkcd
about in tcrms ol cmotions. Schocnhals argucs that loss ol lacc is “lundamcn
tally an cmotional rcaction (usually tcmporary) ol a pcrson who lailcd to livc
up to othcrs cxpcctations.”´⁴ A paticnt inlormant clcarly rclatcd his illncss to
his lccling ol loss ol lacc. Hc told mc that hc uscd to bc a vcry good studcnt
in collcgc, and cvcrybody thought hc was smart. His company spcnt moncy
scnding him to Japan lor training and madc him thc dircctor ol his scction.
Hc was ovcrcomc by thc burdcn ol having to livc up to his rcputation. Hc was
worricd that hc might bc lound to bc incompctcnt in his position and unwor
thy ol his rcputation. Hc thcrclorc spcnt all his cncrgy trying to stay ahcad ol
his collcagucs. Now with an cxhaustcd bodyhcart (shenxin 身心), hc thought
that thc collcagucs who camc to thc company much latcr could pcrlorm bcttcr
work than hc did. “Now cvcrybody knows ! am not that smart altcr all,” hc said.
Tis, to him, was vcry lacc thrcatcning. Yct thc intcnsity ol a pcrson’s cxpcri
cncc ol loss ol lacc is not ncccssarily coordinatcd with thc public’s cvaluations.
Somctimcs with littlc actual public display, a pcrson may lccl an intcnsc loss
ol lacc. !t dcpcnds morc on a pcrson’s pcrccption ol thc public’s rcsponsc or on
how much a pcrson is oricntcd to social norms and moral codcs. An inlormant
talkcd about his lcclings ol guilt/shamc (kuijiu 愧疚) and incompctcncc (wun-
eng 无能) whcn hc, thc first son ol thc lamily, had to dclay his aging mothcr’s
coming to livc with his lamily bccausc hc did not havc cnough spacc in his onc
bcdroom apartmcnt. Hc kcpt tclling his mothcr hc was going to bc assigncd a
biggcr apartmcnt soon, but cach timc hc was disappointcd. Hc bccamc suicidal,
lccling that hc had lailcd both his social and moral obligations.
Likc thc Chincsc conccpt ol “pcrson,” lacc can cxtcnd to includc groups
with which onc is idcntificd. Litcrally, onc can losc onc’s parcnts’ lacc (diu fumu
de lian 丢父母的脸), onc’s lamily’s lacc (diu jiaren de lian 丢家人的脸), and
58 TRANSFORMI NG EMOTI ONS
cvcn losc onc’s country’s lacc (dui guojia de lian 丢国家的脸). Chincsc soci
cty is conncctcd in such an cxtcnsivc way that cvcrybody can potcntially losc
cvcrybody clsc’s lacc. A misbchaving child may losc hcr parcnts’ lacc, and an
incompctcnt or immoral parcnt may also losc his or hcr child’s lacc. Vc oltcn
hcar Chincsc parcnts scold thcir childrcn by asking whcrc thcy cxpcct thcir
parcnts to show thcir (thc parcnts’) lacc. Ònc important motivation lor a child
to cxccl in school is to cnhancc his or hcr parcnts’ lacc. Tis mutual invocation
ol lacc also happcns bctwccn studcnts and tcachcrs. Tc studcnts with good
acadcmic pcrlormancc cnhancc thc tcachcr’s lacc, and a tcachcr may also losc
lacc ovcr his or hcr studcnts’ poor pcrlormancc.
Schocnhals points out that lacc is so ccntral in Chincsc social lilc that
Chincsc virtually makc any pcrlormancc a lacc arcna and an cvaluating ground.
Pcrlorming wcll in school and on cxams, particularly in thc onccaycar collcgc
cntrancc cxams, can cntail cnormous prcssurc lor studcnts and thcir lamilics,
cspccially lor thosc with a good rcputation to uphold and thosc lrom “intcl
lcctual” lamilics.´⁵ Ðuring my clinic obscrvation, ! mct scvcral studcnt paticnts
whosc illncsscs wcrc clcarly rclatcd to lcclings ol loss ol lacc or to thc anxicty
ol potcntial loss ol lacc involving cxams and schoolwork. Ònc young lcmalc
paticnt was brought to thc clinic by hcr mothcr who rcportcd that altcr thc
daughtcr lailcd hcr collcgc cntrancc cxams, shc suffcrcd a mcntal trauma (jing-
shen ciji 精神刺激), lclt shc could not show hcr lacc to thc world anymorc, and
rcluscd to comc out ol hcr room during thc day. A paticnt who was a graduatc
studcnt was worricd so much about thc coming ¡nglish qualification cxam that
hc dcvclopcd a hcadachc.
!n thc culturc that makcs lian-mian ccntral to thc conccpt ol pcrson, cmo
tional cxprcssion itscll is thc pcrlormancc ol a pcrson, which is subjcct to social
cvaluation and intcrprctation. Vhat is important is not whcthcr cmotion is
cxprcsscd or not, but in what contcxt and how it is cxprcsscd. Tc rclcvant qucs
tions arc rathcr to whom, in what situation, with what purposc, and to what
cffcct onc cxprcsscs what cmotions. As said abovc, thosc with highcr status and
highcr cxpcctations to livc up to tcnd to bc morc scnsitivc to mianzi (social
lacc) than thosc who do not havc much mianzi in thc first placc. Tosc with
high social status thcrclorc tcnd to bc morc cautious about thcir bchavior in
public, including displaying thcir cmotions. Tcy tcnd to bc morc awarc ol thc
cultural norms rcgarding intcrpcrsonal bchavior and cultural acsthctic valucs
ol connccting, appropriatcncss, and harmony. Ðcmonstrating aggrcssivcncss in
public is considcrcd lowstatus bchavior. For a pcrson with highcr social status
to cngagc him or hcrscll in a public conflict is considcrcd to “diu mianzi or
diu shenfen” (losc lacc or social status). Tcrclorc, a pcrson with highcr social
status tcnds to discngagc himscll lrom thosc conflicts that gct intcnsc and ugly.
Howcvcr, thosc who do not havc social status to losc usually tcnd to bc morc
aggrcssivc. !ronically, il through aggrcssivcncss thc lowcr status pcrson is ablc
to cngagc thc highcr status pcrson in an argumcnt at thc samc lcvcl, hc actu
ally gains social lacc by dragging thc othcr pcrson down. So thc highcr status
CONTEXTUALI ZI NG QI NGZHI 59
pcrson who rcstrains lrom cngaging in thc conflict is said “not to givc thc othcr
pcrson lacc” (bu gei lian 不给脸). Howcvcr, this docs not mcan that a pcrson
with highcr social status will ncvcr display cmotions inappropriatcly but rathcr
that such display is subjcct to ncgativc public sanction.
!n any actual incidcncc, thcrc may bc scvcral cultural lactors at work in
volving social status, gcndcr rclations, and agc diffcrcncc. For cxamplc, whcn
womcn grow oldcr, thcy, at lcast among thc lcss cducatcd, bccomc lcast rc
straincd by lacc considcrations and arc cxpcctcd to bc morc cxprcssivc and
aggrcssivc. Vhcn somconc’s lacc is thrcatcncd and attackcd, hc is cxpcctcd to
bc angry. Vhcn a pcrson loscs a lamily mcmbcr or a closc lricnd, hc is cxpcctcd
to dcmonstratc gricl and sadncss. !n lact, whcn such dcmonstration is lacking,
an cxplanation is callcd lor. !n thc contcxt ol a villagc whcrc thc community is
closcly knit, somctimcs thc cntirc villagc is rclatcd in kinship tcrms, and cvcry
day cmotion cxpcricncc may takc diffcrcnt lorms and stylcs. ¡motional activi
tics tcnd to bc morc obscrvablc. !n addition, inappropriatc display ol cmotions,
at most, involvcs morc ol social lacc than moral lacc, and villagcrs carc morc
about lulfilling thcir moral obligations toward cach othcr than social prcstigc.
Tcy arc morc worricd about a gilt bcing rcturncd or a lavor bcing sharcd.
Tc communication ol cmotions in thc clinical contcxt is a slightly diffcrcnt
mattcr. How a doctor and paticnt intcract with cach othcr dcpcnds on how thcy
pcrccivc thc rclationship. A scnior doctor with a good rcputation commands
morc trust lrom a paticnt than a youngcr doctor. !n lront ol a doctor, a paticnt
who normally occupics a lowcr status docs not thcorctically havc much mianzi
to losc. Vhat makcs thc diffcrcncc is il thc doctor is pcrccivcd as “having a good
attitudc” (taiduhao 态度好), mcaning bcing kind and undcrstanding. Facing an
undcrstanding scnior doctor, paticnts tcnd to cxprcss angcr, sadncss, and lrus
tration quitc lrccly. !n lact, by thc action ol rcvcaling his or hcr own cmotions
to thc doctor and rccciving cmotional consoling, thc impcrsonal doctorpaticnt
rclationship is somchow translormcd into a morc pcrsonal typc ol rclationship.
Òncc a woman in hcr thirtics camc to scc thc doctor at thc clinic. Tcy talkcd
as il thcy wcrc old lricnds. Tcn thc doctor told hcr that thc pcrsonal stamp shc
carvcd lor him was ol no usc bccausc shc had thc sccond charactcr ol his namc
carvcd incorrcctly. Hc jokcd that altcr thc many scssions that shc had cricd
through, shc did not cvcn know thc charactcrs ol his namc. Tcir convcrsation
was lricndly and inlormal. Latcr, thc doctor told mc that this paticnt uscd to
comc to his officc oncc a wcck. Shc was always thc first to comc to thc clinic
in thc morning. As soon as shc sat down, shc startcd to cry. According to thc
doctor, shc rcally cricd, not just bccamc tcarycycd, but cricd loudly. Shc talkcd
about hcr problcms ol inlcrtility and lamily. Shc was dcprcsscd and suicidal. 8y
thc timc ! saw hcr, shc had rccovcrcd and was back at work. !n my ficld notcs,
! dcscribcd hcr as “having a hcalthy lacial complcxion and talkcd and laughcd
at casc.” Shc promiscd to carvc a stamp lor thc doctor as a tokcn ol hcr grati
tudc. 8y rcvcaling hcr cmotions opcnly to thc doctor, thc young lcmalc paticnt
prcscntcd hcrscll not only as a paticnt that nccdcd trcatmcnt lor hcr illncss but
60 TRANSFORMI NG EMOTI ONS
also as a suffcring pcrson who nccdcd undcrstanding and sympathy and thus
dcfincd and translormcd this particular doctorpaticnt rclationship.
Qing as Social Rclations
A most commonly uscd cmotion word is ganqing 感情. Tc tcrm is composcd
ol two charactcrs: gan 感 (to lccl, cxpcricncc, or bc movcd) and qing 情 (lccl
ings, cmotions). Tc conccpt takcs various mcanings in Chincsc cvcryday con
vcrsation, and its translation dcpcnds on thc contcxt in which it is uscd. Vhat
is uniquc about ganqing is its usc is always cmbcddcd in spccific dynamity ol
social rclations as qin qing 亲情 (cmotional attachmcnt bctwccn lamily mcm
bcrs), fuqi qing 夫妻情 (affcction bctwccn husband and wilc), shisheng qing 师
生情 (lcclings bctwccn tcachcr and studcnt), youqing 友情 (lricndship), and
morc. !n this scnsc, ganqing is simply renqing 人情, which ! translatc as “human
cmotions cxisting in/as spccific social rclations.” Hwang idcntifics renqing as
thc csscntial mcaning ol thc Chincsc conccpt ol cmotion,´⁶ and Klcinman and
Klcinman clarily it as “a contcxtualizcd rcsponsc, a rcsponsc onc lccls in cx
pcricncing thc concrctc particularity ol livcd situations.”´⁷ Yan suggcsts that
renqing commonly has lour diffcrcnt mcanings. Tcy arc (.) human lcclings
which arc basic cmotional rcsponscs ol an individual to cvcryday situations, (a)
a sct ol social norms and moral obligations, (¸) a lavor, a gilt, grcctings, a visit
and assistancc, and (¡) a social nctwork. !n short, renqing is sccn lundamcntally
as social rclations.´⁸
Having a good rclationship” in Chincsc is actually “having good lcclings”
(ganqing hao 感情好) or simply “having lcclings” (you ganqing 有感情). Tough
translatcd as “lcclings,” “to havc ganqing” in this Chincsc scnsc is not somcthing
simply “to havc,” but a proccss ol “doing” a rclationship in concrctc social situ
ations, and its communication thcrclorc rclics morc on contcxtualizcd actions
(xing 行) than mcrcly on talk and spccch (yan 言). Tc Pottcrs noticc that in
Chincsc culturc, rclationship is confirmcd through thc languagc ol work and
suffcring rathcr than by rclcrring to thc cmotion ol lovc.´⁹ ! can ccrtainly scc
thc point ol thc statcmcnt, but thc problcm with Pottcrs’ analysis is that it
dichotomizcs “work” and “affcction” as il thcy arc mutually cxclusivc in thc
Chincsc cxpcricncc. Tc rcsult is a doublc rcduction: “work” is strippcd ol its al
lcctivc dimcnsion, and “cmotion,” ol its social significancc. !n lact, good lcclings
(ganqing) arc bcst sccn as unlolding through how onc bchavcs within thc so
cial contcxt. Tis is truc cspccially among intimatc rclations. !n thcsc rclations,
ganqing hao is oltcn dcscribcd as moqi 默契 (tacit coordination bctwccn thc
partics dcvclopcd through intimatc intcractions on a daily basis). Anticipating
thc othcr’s nccds and acting accordingly without bcing cxplicitly told is most
valucd as thc truc manilcstation ol ganqing. !t takcs a lot ol good lcclings to
bc awarc ol thc situation that othcrs arc in and to carc cnough to takc actions
accordingly. !t is in rcciprocation ol doing things lor cach othcr that ganqing
is crcatcd and substantiatcd. “Ganqing cxists only whcn scntimcnt, cmotional
CONTEXTUALI ZI NG QI NGZHI 61
attachmcnt, and good lcclings arc lclt by pcoplc involvcd in social intcrac
tions.”`⁰ As Schocnhals points out, “|h|clping othcrs to do things thcy cannot
do alonc, cvcn mundanc things, has grcat significancc lor thc Chincsc, as it is a
primary mcans ol cxprcssing lricndship and lovc.”`' Tus, thc Chincsc cldcrly
likc to rcccivc gilts and hclp lrom thcir childrcn and arc proud ol thcm bccausc
this not only lcts thcm know that thcy arc lovcd but also cnhanccs thc social
lacc ol thc parcnts and thc lamily. Rclusing to rcciprocatc in sharing work is
considcrcd a “problcm ol cmotions/lcclings” (ganqing wenti 感情问题). Ònc
lcmalc inlormant complaincd that hcr husband ncvcr hclpcd hcr with housc
work, not cvcn whcn shc was sick. Shc summarizcd thc rclationship as “lack ol
good lcclings” (mei ganqing 没感情). For most Chincsc, ganqing is cxprcsscd
through actions takcn and dccisions madc lor cach othcr on an cvcryday basis.
A rctircd tcachcr dcscribcd hcr rclationship with onc ol hcr studcnts as having
good ganqing. Altcr almost thirty ycars had passcd, thc studcnt was still coming
to visit hcr and brought hcr gilts on holidays.
Vhcn Chincsc say that a pcrson docs not havc renqing (human cmotion)
scnsibility, thcy talk about a pcrson’s attitudc and bchavior toward othcrs. A
typical story involvcd a son who upon marriagc took ovcr his parcnts’ apartmcnt
and lorccd thc parcnts to makc a bcdroom out ol thc balcony. Tc story arouscd
cmotional commcnts to thc cffcct that thc son was not a pcrson, and hc did
not havc a scnsc ol qinqing (cmotional attachmcnt bctwccn lamily mcmbcrs),
not to mcntion renqing in gcncral. A positivc cxamplc ol having good ganqing
involvcd a young couplc who livcd in thc samc building whcrc ! staycd whilc
in 8cijing. Tc ncighbors would talk about thcm admiringly as “having rcally
good rclationship/lcclings” (ganqing zhenhao 感情真好), comparablc to saying
that thcy rcally lovcd cach othcr. Tcy would mcntion such things as: cvcry
morning bclorc hc wcnt to work, thc husband would takc thc wilc on thc
back ol his bicyclc to thc bus stop, and in thc cvcning hc would wait at thc bus
stop and takc his wilc back homc on his bicyclc. Vhat makcs thc community
rccognizc this couplc is thc harmony and intimacy cultivatcd in mundanc cv
cryday cxpcricncc. Good lcclings, as rccognizcd by lamilyoricntcd Chincsc,
comc lrom lamiliarity and cmbody undcrstanding that nurturcs spontancous
coordination and coopcration among thc mcmbcrs ol a community.
Òbviously, renqing, bascd on concrctc social rclations, is not conccptual
izcd as somcthing that can bc isolatcd as “inncr lcclings.” Chincsc do havc thc
conccpt ol “nei” 内(insidc), yct nei cxists mcaninglully only whcn it is mani
lcstcd to thc outsidc. Tcrc is no mcaninglul insidc that is without an outsidc
corrcspondcncc in spccch, action, or inaction. Tis insidc and outsidc conccptu
alization is cvidcnt in thc zhongyi modc ol knowing, which is actually bascd on
mcticulous obscrvations ol thc corrcspondcncc bctwccn lunctions ol thc insidc
zang 脏 (visccral systcms) and thc outsidc xiang 象 (outsidc manilcstations).
Tis insidc is not undcrstood as a fixcd cntity, but a proccss constantly in mo
tion. !n this scnsc, thc outsidc manilcstations can bc sccn as an intcgrativc part
ol thc samc lunctional proccss. !ntcrcstingly, introspcction (neixing 内省) in thc
62 TRANSFORMI NG EMOTI ONS
Chincsc scnsc docs not havc thc mcaning ol rcaching dccply into oncscll “lor
discovcring thc rcally rcal”`´ but rclcrs to a morally oricntcd scllcxamination ol
onc’s bchavior. A typical cxamplc ol this typc ol scllcxamination comcs lrom
Zcngzi, Conlucius’ disciplc. Hc oncc said, “¡vcryday ! cxaminc (xing 省) myscll
on thrcc counts: whcthcr ! havc donc my bcst working lor othcrs, whcthcr !
havc kcpt my promisc to lricnds, and whcthcr ! havc appropriatcd and actcd
upon thc tcachings rcccivcd lrom my tcachcr.”``
Renqing is an intcractional phcnomcnon, cstablishcd, confirmcd, and main
taincd through cvcryday rcciprocation ol lavors, labor, carc, lood, assistancc,
kindncss, and undcrstanding. Tc rclationship bctwccn parcnts and childrcn
is markcd by thc typical Chincsc scnsc ol mutual obligations and rcciprocity.
Chincsc parcnts arc known to put a major part ol thcir rcsourccs and cncrgy
into thcir childrcn’s cducation and makc grcat cfforts to satisly thc childrcn’s
nccds. Childrcn arc cxpcctcd to undcrstand thc parcnts’ “laborcd hcart” (kuxin
苦心) and apprcciatc thcir parcnts’ cfforts by bcing good studcnts and honor
ing thc parcnts’ cxpcctations. Tis is vividly capturcd in a ncwspapcr articlc in
which a tcnycarold girl told thc rcportcr about hcr mothcr, whosc job with a
statcowncd busincss had bccn cut:
Ðuring thc two ycars whilc my mothcr was out ol work, shc cndurcd much
hardship. !n thc altcrnoon and at night shc workcd in a rcstaurant. !n thc
morning, shc workcd in anothcr placc. My rclativcs and lricnds all said that
my mothcr sccmcd to bccomc old suddcnly. Not ¡c yct, shc has alrcady lots ol
gray hair. ! know my mothcr workcd this hard lor my sakc. Tc way ! can rcpay
hcr is to study hard, othcrwisc ! am not trcating my mothcr right.`⁴
Tc mothcr’s rcsponsc to thc girl’s words was that knowing thc child chcrishcd
such a hcart, all thc hardship shc suffcrcd had bccn rcwardcd.
Qing as Social Norms and Moral Commcnts
Tc Chincsc conccpt ol cmotion, capturcd in thc cxprcssions ol renqing and
ganqing is not somcthing that is strictly oppositc to rcason (li 理) and moral
significancc (yi 义). Tc common cxprcssions that Chincsc usc to advancc thcir
opinions, such as juede 觉得 or gandao 感到 havc aspccts ol both thinking and
lccling. ¡motion, rcason, and moral appropriatcncss arc intcgratcd in thc Chi
ncsc languagc and cxpcricncc. Vhcn a pcrson is said not to undcrstand human
cmotions (butong renqing 不通人情), thc mcaning may actually bc that thc
pcrson is not rcasonablc or docs not act in accordancc with common scnsc.
!l wc say that renqing is thc human cmotional rcsponsc or scntimcnt cm
bcddcd in a scrics ol concrctc social rclations, thcn it can also bc rcad as “a sct
ol social norms and moral obligations” opcrativc in cvcryday practiccs.`⁵ Tcy
arc somctimcs rclcrrcd to as “affcctivc rcason” (qingli 情理) and “cmotionally
chargcd moral appropriatcncss” (qingyi 情义). Ðiffcrcnt social rclations may
cvokc a diffcrcnt sct ol li (rcasons) and yi (moral significancc/appropriatcncss)
CONTEXTUALI ZI NG QI NGZHI 63
that dcmand stylcs ol bchavior and ol cmotion appropriatc to thc rclational
contcxt. Ðcmonstrations ol qing and thc intcnsity ol such dcmonstrations arc
justificd or unjustificd in thc light ol li and yi, which arc contigcnt on thc
concrctc social contcxts. For cxamplc, a basic typc ol qinqing 亲情 (ganqing
bctwccn lamily mcmbcrs) is qing bctwccn parcnts and childrcn, which is tradi
tionally charactcrizcd as ci 慈 (caring) lor parcnts and xiao 孝 (filial picty) lor
childrcn. !n cvcryday lilc, ci and xiao arc both cmotions and codcs ol conduct.
!n Chincsc cvcryday languagc, idioms ol cmotions arc lrcqucntly uscd in
moral discoursc. Angcr is such an idiom. !t is onc ol thc lrcqucntly cncoun
tcrcd cmotions in thc clinics ol Chincsc mcdicinc. Many paticnts complain
that thcir illncss is “angcr rclatcd” (qide 气的). !l angcr is considcrcd a ncgativc
or stigmatizcd cmotion that prcscnts a potcntial thrcat to thc cxisting social
structurc, why do pcoplc opcnly admit that thcy arc angry to thc cxtcnt ol
injuring thcir hcalth: Tc Chincsc tcnd to associatc angcr (qi 气, nu 怒) with
illncss and cvcn dcath, as rcflcctcd in thc Chincsc saying that “onc docs not
nccd to pay with his lilc il hc ‘angcrs’ a pcrson to dcath” (qisiren bu changming
气死人不偿命). Tis may sccm to bc an cxaggcration, but Chincsc oltcn takc
it quitc scriously. Many ol thcm know thc historical account ol Zhu Gcliang,
thc ministcr ol thc statc ol Shu who trickcd Zhou Yu, thc gcncral ol thc statc
ol Vu thrcc timcs and finally “angcrcd” him to dcath. Claiming to bc angry
is not to say that onc lccls pcrsonal lrustration but to say that somcbody clsc
hurts a pcrson by violating qingli or qingyi. A middlcagcd lcmalc paticnt, a
policc officcr, complaincd about hcr insomnia and thc involuntary trcmbling
ol hcr hands. Tc trcmbling got worsc whcn shc was angry. Altcr giving a
dcscription ol hcr symptoms, shc told thc doctor that hcr illncss rcsultcd lrom
angcr causcd by hcr mothcrinlaw (bei popo qi de 被婆婆气的), who, accord
ing to hcr, was not rcasonablc (bu jiangli 不讲理). According to hcr story, hcr
mothcrinlaw’s husband wcnt to Taiwan just bclorc .µ¡µ and did not comc
back until rcccntly. Now that thc husband had rcturncd, hcr mothcrinlaw
bccamc cvcn morc unbcarablc, as il thc wholc world owcd hcr. ¡vcrybody in
thc lamily had to dclcr to hcr will, and shc lound lault with cvcrybody, cspc
cially with hcr daughtcrinlaw. Tc paticnt commcntcd that “it is truc that my
mothcrinlaw has suffcrcd a lot lrom thc political stigma and raising a child
by hcrscll, but that docs not givc hcr thc right to makc cvcrybody clsc suffcr.”
Shc also said that though shc was vcry angry with hcr mothcrinlaw and rcally
wantcd to shout back at hcr to makc hcr undcrstand what shc was doing, as a
policc officcr (policc officcrs and govcrnmcnt officials arc supposcd to sct good
cxamplcs as civilizcd citizcns), shc could not do it. Òthcrs would say that il shc
could not handlc hcr own lamily problcm appropriatcly, how could shc “takc
control ol ” (guan 管) othcrs: 8y prcscnting hcrscll as angry, shc lormulatcd
hcr illncss and cmotion as a moral commcnt on hcr mothcrinlaw’s violation
ol qingli. So by complaining that thcir illncsscs arc angcr rclatcd, paticnts hold
somcbody clsc morally accountablc lor thcir suffcrings—suffcrings that arc
mcasurablc in thc “body.”
64 TRANSFORMI NG EMOTI ONS
Qing as ¡mbodicd ¡xpcricncc
Tough thc tcrm qingzhi itscll is uscd mostly in thc contcxt ol Chincsc mcdi
cinc in rclcrcncc to thc lunction ol cmotions in rclation to hcalth and illncss,
thc contcnt ol qingzhi, thc so callcd “scvcn cmotions” (qiqing 七情) or “fivc
cmotions” (wuzhi 五志) arc concrctc cmotions that arc part ol cvcryday lan
guagc and cxpcricncc.`⁶ 8y glossing thcsc cmotions ovcr as qingzhi, zhongyi
doctors spccily a mcdical contcxt lor talking about and cvaluating cmotions and
finally translorming an cxpcricncc ol cmotion into a trcatablc disordcr.
Qingzhi, on thc onc hand, is unmistakably rccognizcd as social in na
turc and always undcrstood as thc concrctc cmotions ol xi 喜 (joy, happy),
nu 怒 (angcr, ragc), you 忧 (sorrow, worrics), si 思 (thinking, pcnsivcncss), bei
悲 (gricl ), kong 恐 (lcar), and jing 惊 (lright). Tcsc arc “contcxtualizcd rc
sponscs” ol an individual “in cxpcricncing thc concrctc particularity ol livcd
situations.”`⁷ Tcrclorc, disordcrcd qingzhi, though sccn as having somcthing
to do with thc paticnt’s pcrsonal psychophysiological dispositions (bingfu
秉赋) is oltcn rccognizcd by traditional Chincsc mcdical doctors as closcly
and dircctly rclatcd to a pcrson’s social cnvironmcnt. My zhongyi tcachcr un
cquivocally markcd intcrpcrsonal rclationship (renji guanxi 人际关系) and in
ability to dcal with it (chuli bukai 处理不开) as thc main lactors contributing
to qingzhi disordcrs. Hc strcsscd that thc idcal way to trcat qingzhi disordcrs
is to combinc mcdical trcatmcnt (yaowu zhiliao 药物治疗) and pcrsuasion
(quandao 劝导) or discntanglcmcnt (shuli 疏理) ol thc paticnt’s pcrsonal and
cmotional blockagc in lilc. Hc bclicvcd that il hc did not havc to trcat so many
paticnts cach day, hc would bc ablc to spcnd morc timc with cach paticnt, and
thc cfficacy would havc bccn much bcttcr. Nowadays, this nonmcdical mcthod
is also rclcrrcd to as “psychological counscling” (xinli zixun 心理谘询). Tc
morc traditional mcthod lor such nonmcdical trcatmcnt lor qingzhi disordcrs
is “trcating an cmotion with a countcr cmotion” (yi qing sheng qing 以情胜情).
Howcvcr, thc socallcd xinli zixun (psychological counscling) is diffcrcnt lrom
thc conccpt ol psychological counscling in that it is not aimcd at discovcring
and rcvcaling intrapsychic conflicts, but it is morc sociomorally oricntcd as
lostcring a “corrcct” or adaptivc attitudc and pcrspcctivc in ordcr lor paticnts
to handlc thcir social situations bcttcr. Morcovcr, thcsc “corrcct” insights into
onc’s lilc arc culturally cmbcddcd. Sincc Chincsc mcdicinc routincly incorpo
ratcs nonmcdical aspccts into its clinical intcrvcntion, doctors, though spcnd
ing limitcd timc with thcir paticnts, scldom lcavc out thc nonmcdical part ol
zhongyi in thcir intcraction with paticnts. Tis aspcct will bc discusscd in dctail
in thc lollowing chaptcrs.
Morcovcr, thcrc is no doubt lrom thc zhongyi point ol vicw that qingzhi
is cmbodicd and cxpcricnccd as dispcrscd qi, flarcs ol livcr, stagnatcd digcs
tivc lunctions, palpitations ol thc hcart, and so on. ¡motion and thought arc
sccn as intcgratcd parts ol thc human psychophysiological proccss. As Sivin
points out, Chincsc do makc a distinction bctwccn bodily and psychological
CONTEXTUALI ZI NG QI NGZHI 65
lunctions whcn thcy lccl it ncccssary, but Chincsc physicians “wcrc much
morc intcrcstcd in thcir undcrlying intcgrity and intcraction.”`⁸ For thcm,
changcs in thought/lcclings will havc conscqucnccs in physiological changcs,
and thcrclorc, cxpcricntial changcs. Tc convcrsc is also hcld to bc truc. Òts
bclicvcs that thcrc is a “corrcspondcncc ol cmotions and bodily complaints in
psychosomatic disordcrs and suspccts that through spccific bodily symptoms
or symptom pattcrns, zhongyi doctors may bc ablc to idcntily somc spccific
cmotional changcs.`⁹
Vithout claboratcd zhongyi languagc that connccts cmotivc activitics to
spccific bodily lunctional systcms, ordinary Chincsc talk about thcir cmotions
as thc cxpcricncc ol shenti (bodypcrson), which, as clcar lrom thc last chaptcr,
is both body and pcrson. !t is vcry common lor Chincsc to calm thcir angry
lricnds by saying, “Ðon’t stay angry, or you will harm your shenti,” or pcrsuadc
somcbody in gricl to “rcstrain thc lcclings ol gricl ” (jieai 节哀), or hc will
dcstroy his own shenti. Chincsc bclicvc that onc’s cmotion is cxpcricnccd in
shenti, as thcy say “a smilc makcs you tcn ycars youngcr, whilc worry brings
you gray hair.” Tc cxpcricncc ol a lricnd, an cstablishcd middlcagcd scholar,
may illustratc how cmotion/social/bodily changcs arc intcrtwincd in rcal lilc
cxpcricncc. Tc lollowing is translatcd lrom my notcs ol our convcrsation in
thc summcr ol .µµ¡.
For somc timc, ! lclt my shenti (bodypcrson) was not good. ! had insomnia,
and ! could not lall aslccp at all. ! was in low spirits (qingxu buhao 情绪不好)
and was anxious and irritablc all thc timc. ! was alraid that my shenti might
lall apart, and so ! wcnt to scc zhongyi doctors. ! was told that ! had “ncrvcs
lunctional disordcrs” (shenjing guannengzheng 神经官能症). Tc doctor said
my problcm was rclatcd to “cxccssivc worry and thinking” (silu guodu 思虑过
度) that disturbcd my splccn and stomach systcm (piwei 脾胃) and wcakcncd
my hcart systcm and that ! nccdcd to takc somc Chincsc hcrb mcdicinc to
modulatc (tiao 调) my shenti. ! thought hc was right. Ðuring that pcriod,
Ðcng Xiaoping had just publishcd his spccch on his south inspcction trips,⁴⁰
and thc wholc country was plungcd into an cconomic lrcnzy. ¡vcrything bc
camc commcrcializcd as il moncy was cvcrything. ! was constantly thinking
about what ! was going to do: lollow thc trcnd ol “jumping into thc sca ol
markct cconomy” (xiahai 下海) likc many othcrs, or bc contcnt to bc poor and
do things ! was good at: Vhat would happcn to an acadcmic institution likc
ours that dcfinitcly could not survivc thc ups and downs ol a markct cconomy
by itscll: !n thosc days ! couldn’t slccp wcll and had no dcsirc lor lood. ! was
unccrtain about thc country’s luturc and was worricd about my luturc and
my lamily’s. Tis was thc hardcst pcriod lor mc. ! wcnt to scc zhongyi twicc.
Tc doctor prcscribcd somc hcrbal mcdicinc. Altcr somc timc, ! lorgct how
long. . . . my symptoms mitigatcd. ! am not surc il ! was hcalcd by thc mcdi
cinc or simply bccausc ! had thought things through and madc my dccision
to stay within thc acadcmy.
66 TRANSFORMI NG EMOTI ONS
Tc intcrconncctions bctwccn lcclings/thinking and bodily changcs arc
mcticulously codcd in zhongyi physiology and considcrcd csscntial in ordcr to
undcrstand qingzhi disordcrs.
PHYSI OLOGY OF QINGZHI
As mcntioncd abovc, qingzhi rclcrs spccifically to scvcn cmotions (qiqing
七情): happincss (xi 喜), angcr (nu 怒), worry and anxicty (you 忧), thinking
and obscssion (si 思), sadncss and gricl (bei 悲), lcar (kong 恐), and lright (jing
惊). !n ordcr to corrcspond to thc lunctions ol thc fivc zang visccra, “scvcn
cmotions” arc somctimcs rcduccd to “fivc cmotions” (wuzhi 五志) by consoli
dating you (worry) with si (obscssion) and kong (lcar) with jing (lright). 8oth
‘qing’ and ‘zhi’ can bc translatcd as “cmotions” and arc lrcqucntly uscd in com
bination. Howcvcr, somc Chincsc mcdical prolcssionals rccognizc distinctions
bctwccn qing and zhi.⁴' Tcy arguc that qing arc manilcstcd cmotions and
zhi arc latcnt. Tcy arc somctimcs rclcrrcd to as “intcrnal cmotion” (neizhi 内
志) and “cxtcrnal cmotion” (waiqing 外情). Yct, wc should not mistakc zhi as
somc sort ol subconscious or hiddcn cmotion. Rathcr zhi is undcrstood as
thc “latcnt or ncutralizcd” (zhonghe 中和) statc in thc proccss ol cmotions. !n
othcr words, ‘qing’ and ‘zhi’ arc two tcrms rclcrring to diffcrcnt stagcs ol thc
samc proccss.
Qingzhi and thc \isccral Systcms
Qingzhi is closcly rclatcd to thc lunctions ol thc visccral systcms. Neijing: Suwen
(Tc !nncr Classics: Simplc Qucstions) statcs that “a human bcing has fivc vis
ccral systcms which translorm fivc kinds ol qi, thc fivc kinds ol qi producc xi
(joy), nu (angcr), bei (sadncssgricl ), you (anxicty—sadncss), and kong (lcar).”⁴´
Tc scvcn cmotions arc also thc cxtcrnal manilcstations ol thc lunctions ol thc
fivc visccral systcms. Ðistinctions among thc visccral systcms influcncc changcs
in cmotions, and cmotional changcs inducc physiological changcs. Tcsc cmo
tional activitics whcn kcpt in ccrtain du (dcgrcc ol intcnsity) arc said to bc
normal phcnomcna. Ònly whcn activitics ol any ol such cmotions bccomc cx
ccssivc (guoji 过激) will cmotion bccomc pathological.
Tc visccral lunction systcms in Chincsc mcdicinc lall into two catcgorics:
thc fivc yin visccra (wuzang 五脏) and six yang visccra (liufu 六腑). Tc fivc
zang visccra includc thc hcart (xin 心), thc lungs (fei 肺), thc splccn (pi 脾), thc
livcr (gan 肝), and thc kidncys (shen 肾). Although dcsignatcd as yin organs,
thcy arc thc dominant lunctional systcms in thc holistic physiology ol tradi
tional Chincsc mcdicinc. Tc fivc zang systcms arc paircd with six fu visccra:
thc small intcstinc (xiaochang 小肠), thc largc intcstinc (dachang 大肠), thc
stomach (wei 胃), thc gallbladdcr (dan 胆), thc urinary systcm (pangguang 膀
胱) and thc untranslatablc sanjiao 三焦.⁴` Tc zang and fu arc considcrcd as
complcmcntary in lunctions. !t is charactcristic ol thc physiological lunctions
CONTEXTUALI ZI NG QI NGZHI 67
ol thc zang systcms to translorm (shenghua 生化) and storc (zhucang 贮藏)
vital csscncc and cncrgy (jingqi 精气) and charactcristic ol thc lunctions ol
thc six fu visccra to acccpt, digcst, transmit, and scparatc thc watcr and lood
(shuigu 水谷). As shown in tablc ¡.., thc fivc zang and thc six fu systcms join
cach othcr to lorm a complcx ol lunctions that links “all parts ol thc body in
proccsscs ol producing normal and pathological cffccts.”⁴⁴ Zhongyi physiology
dcpcnds littlc on thc knowlcdgc ol anatomy. Zhongyi thcory ol visccral systcms
is callcd “zangxiangxue” 脏象学 (studics ol visccral systcm imagcry) in which
zang 脏 rclcrs to thc dynamic and rclational proccsscs ol visccral systcms ol a
living body and xiang 象 to bc obscrvablc manilcstations ol thc lunctions ol
thc visccral proccsscs. Tc Chincsc mcdical thcory strcsscs that thc visccra in
zangxiangxue arc not anatomic conccpts. “Most importantly thcy arc thc con
ccpts that gcncralizc thc physiological and pathological lunctions ol thc bodily
systcms.”⁴⁵ Tc phcnomcna that zhongyi invcstigatcs arc diffcrcnt lrom thosc
ol biomcdicinc.⁴⁶ Vhcn a Chincsc mcdical doctor is taking a pulsc (qiemai 切
脉), thc attcntion is not on thc pulsc or thc rhythmic dilating and contracting
ol artcrics but on thc movcmcnt ol mai—thc flow ol qi and xue (blood) that
somctimcs rcscmblcs “a pcarl rolling on a platc” and somctimcs “watcr gush
ing out ol a spring,” rcgistcring thc status ol lunction and coordination ol thc
visccral systcms at thc momcnt.⁴⁷
Tc physiological corrclations claboratcd in zangxiangxue appcar at scv
cral lcvcls. First, cach zang corrcsponds to a particular fu and intcracts with
othcr zang systcms according to thc wuxing scqucncc ol influcncc to lorm a
lunctional nctwork ol physiology. At anothcr lcvcl, cach zang systcm has its
manilcstcd configurations that arc spccifically rclatcd to ccrtain scnsual organs
or surlacc opcnings to lorm continuity lrom thc insidc to thc outsidc. For
cxamplc, thc tonguc (she 舌) is callcd “thc sccdling ol thc hcart.” Changcs in
physiological lunctions ol thc hcart systcm arc said to manilcst not only in
color and coating ol thc tonguc but also in tastc and spcaking.⁴⁸ Vc can still
find anothcr lcvcl ol corrclation. Tc physiological lunctions ol thc fivc zang
systcms arc closcly associatcd with human mcntal or “brain” activitics including
cognition and cmotions. Tc hcart is said to storc shén 神 (spirit/consciousncss)
and is associatcd with thc cmotion ol xi (joy, happincss), thc livcr systcm is said
to storc xue 血 (blood) and hun 魂 (cthcrcal soul) and is associatcd with thc
cmotion ol nu (angcr, ragc). Tcrclorc, zangxiangxue ol Chincsc mcdicinc not
only spccifics that thc physiological lunctions ol thc fivc zang systcms and thc
six fu systcms arc intcrconncctcd and that thcir cquilibrium and harmony arc
csscntial lor a hcalthy proccss ol shenti but also indicatcs that thc physiological
nctwork cxtcnds to includc thc mcntal and social cnvironmcnts through thc
dcmonstratcd continuity lrom insidc to outsidc and lrom zangfu systcms to
mcntal and cmotional aspccts ol a pcrson. Tus, thc zangxiang systcm in lact
implics a largcr physiology ol bodypcrson that gocs bcyond thc boundary ol
“physical body.” Tis holistic physiology is thc basic logic undcrlying zhongyi’s
approach to qingzhi disordcrs.
68 TRANSFORMI NG EMOTI ONS
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CONTEXTUALI ZI NG QI NGZHI 69
Tc physiology ol thc zangfu systcms is systcmatizcd in tcrms ol wuxing
五行 (thc fivc translormativc phascs) into complicatcd cyclcs ol production
(sheng 生) and rcstraint (ke 克). ¡motions, though vicwcd dircctly rclcvant to
thc hcart systcm, arc assigncd scparatcly to cach onc ol thc fivc visccral systcms
and arc thcrclorc subjcct to thc samc logic ol intcractions.
Tc Fivc Translormativc Phascs
Likc yin-yang thcory, “wuxing” is anothcr ancicnt Chincsc philosophical con
ccpt that has bccn intcgratcd into thc thcorctical loundation ol traditional
Chincsc mcdicinc.⁴⁹ Wuxing arc thc charactcristic activitics ol thc fivc phascs:
wood, firc, carth, mctal, and watcr. 8ccausc ol thc matcrialistic appcarancc ol
thc fivc clcmcnts, it was routincly translatcd as thc “fivc clcmcnts” and sccn
as comparablc to thc Grcck lour clcmcnts ol carth, air, firc, and watcr, which
arc thc ultimatc roots ol all natural things. Howcvcr, as Sivin points out, wux-
ing arc not clcmcnts in an “Aristotclian and mcdicval ¡uropcan lorm” but arc
“primarily conccrncd with proccss and changc.”⁵⁰ Vhat links thc fivc matcrials
in naturc to thc fivc translormativc phascs is not what thc fivc matcrials csscn
tially arc but what arc obscrvcd to bc charactcristics ol thc lormcr. Tcrclorc,
thc wood phasc ol wuxing is charactcrizcd by thc lunctions ol growing (sheng-
zhang 生长), dispcrsing upward and outward (shengfa 升发), and strctching
and cxtcnding (tiaoda shuchang 调达舒畅). Tc firc phasc is charactcrizcd by
thc lunctions ol warming (wenxu 温煦) and rising (shengteng 升腾). Tc carth
phasc is charactcrizcd by thc lunctions ol translorming (shenghua 生化), carry
ing (chengzai 承载), and absorbing (shouna 收纳). Tc mctal phasc is notcd lor
thc lunctions ol clcaring (qingjie 清洁) and contracting (shoulian 收敛). Finally,
thc watcr phasc is charactcrizcd as cooling (hanliang 寒凉), moisturizing (zirun
滋润), and moving smoothly downward (runxia 润下). All thc cffccts that arc
pcrccivcd as charactcrizcd by thc similar proccsscs can bc dcscribcd with thcir
rcspcctivc phascs. Tus thc lunctions ol thc fivczang visccral organs arc dc
scribcd in thc languagc ol wuxing.
Sincc thc fivc phascs arc charactcristically undcrstood as proccsscs and
lunctions, what is important is not substancc but rclations: how cach phasc,
in its own way, acts on othcr phascs according to ccrtain scqucnccs. Tc lorms
ol intcractions arc known as production (sheng 生), rcstraint (ke 克), violation
(hui 诲) and cncroachmcnt (cheng 乘). Production mcans promotion ol thc
lunction ol thc ncxt phasc in thc scqucncc. Tc scqucncc ol production ol thc
fivc phascs is thc lollowing: wood produccs firc, firc produccs carth, carth pro
duccs mctal, and mctal produccs wood. !n human physiological tcrms, thc livcr
systcm lacilitatcs thc lunction ol thc hcart systcm, thc hcart systcms lacilitatcs
thc splccn systcm, and so on. Tc scqucncc ol rcstraint is thc lollowing: wood
rcstrains carth, carth rcstrains watcr, watcr rcstrains firc, firc rcstrains mctal, and
mctal rcstrains wood. Again, in physiological tcrms, thc activitics ol thc livcr
70 TRANSFORMI NG EMOTI ONS
systcm rcstrain thc activitics ol thc splccn systcm, thc splccn systcm rcstrains
thc kidncy systcm, and so on.
Tcrclorc, cvcry singlc phasc stands in lourway rclations: producing and
produccd, rcstraining and rcstraincd. For cxamplc, wood produccs firc and is
produccd by watcr, it rcstrains carth but is rcstraincd by mctal. !t is undcrstood
that through thcsc intcractions ol gcncration and rcstraint thc world obtains
its harmony and balancc. Yct Chincsc arc constantly awarc that any ol thcsc ac
tivitics may surpass its du (appropriatc dcgrcc/intcnsity) and bccomc cxccssivc
or may lall short in its du and bccomc insufficicnt. Tis is whcn cncroachmcnt
(cheng) and violation (hui) happcn. For cxamplc, whcn thc wood phasc bccomcs
too strong, it may cxcrcisc too much rcstraint on carth and wcakcn thc lunction
Table 4.2 Wuxing and the Five-Zang Systems
Five Zang Systems Wuxing Characteristics
thc Hcart (xin) Firc Govcrning thc flow ol blood, having a warming
lunction (wenxuzhigong).
thc Splccn (pi) ¡arth Translorming thc watcr & lood (yunhua shuiguo),
translcr rcfincd nutricnts (shusong jingwei), nour
ishing visccra and limbs and boncs. Sourccs ol
gcncration ol blood and qi.
thc Lungs (fei) Mctal Clcaring and drcdging (shujiang).
thc Kidncys (shen) Vatcr Moisturizing, cooling, moving downward, and
constraining.
thc Livcr (gan) Vood ¡xtcnding and rcaching out (xi tiaoda), having lunc
tion ol sprcading, and drcdging (shuxie gongneng).
Tis tablc is bascd on Yin ct al. .µ·¸.
Figure 4.1 The Sequence of Production and Restriction
Production:
Restriction:
wood fire earth metal water
Tis figurc was originally uscd by Frcd 8lakc in his lccturc notcs.
CONTEXTUALI ZI NG QI NGZHI 71
ol thc carth. Tis is known as cncroachmcnt. Tis may also happcn whcn thc
activitics ol a phasc arc not sufficicnt and thus invitc ovcrrcstraint. \iolation
happcns whcn an ovcractivc phasc turns to supprcss thc lunction ol thc phasc
that is abovc it in thc scqucncc ol production. Tc rcsult will bc pathological
imbalancc. !n this nctwork ol mutual influcncc, “a disordcr appcaring in onc
systcm can quickly ramily into othcrs and producc symptoms implicating ad
ditional visccral systcms or cvcn masking thc rolc ol thc visccral systcm that is
its primary sourcc.”⁵' !n any givcn casc, thcrc arc many possiblc positions lor
analyzing thc pathological condition. Tc clinical action in this scnsc is always
pcrsonal and contingcnt on thc doctor’s cxpcricncc and strcngth.
Howcvcr, wuxing rcasoning togcthcr with yin-yang thcory providcs a uni
lying languagc and a practical guidc lor mapping thc illncss condition, an
ticipating thc pathological dcvclopmcnt, and dcsigning a thcrapy to cffcct a
trcatmcnt. !t ccrtainly hclpcd mc to undcrstand thc zhongyi clinical languagc
and to grasp thc logic bchind thc doctors’ clinical actions. ! was imprcsscd by
Ðr. Zhou’s ability to tcll thc paticnts what symptoms thcy might havc bccn
cxpcricncing and to gct wholchcartcd confirmation lrom thc paticnts. Òncc a
surpriscd lcmalc paticnt askcd Ðr. Zhou how hc could possibly know that shc
cxpcricnccd lowcr abdominal pain and irrcgular mcnstruation bclorc shc told
him, cspccially considcring that hc was a malc doctor. Ðr. Zhou laughcd and
said that knowlcdgc camc lrom his cxpcricncc (jingyan 经验). Hc cxplaincd
to mc and his studcnt doctors that an incompctcnt doctor sccs a symptom as
an isolatcd phcnomcnon, but no symptom appcars in isolation. Sincc all thc
visccral systcms arc intcrconncctcd, ccrtain symptoms always appcar in corrcla
tion with othcrs. For cxamplc, whcn thc livcr systcm is stagnant (ganyu 肝郁),
a doctor should pay attcntion to thc symptoms lrom thc hcart systcm. Tis is
bccausc, according to thc wuxing modcl, thc livcr systcm as a wood phasc lacili
tatcs thc lunctions ol thc hcart systcm, which is firc and will thcrclorc possibly
transmit thc illncss to thc hcart systcm. Tis is known as “thc mothcr’s sickncss
transmittcd to thc son” (mu bing ji zi 母病及子)”⁵´ So whcn thc blood in thc
livcr systcm is stagnant, it will lail to nurturc (ruyang 濡养) thc hcart. Sincc thc
hcart storcs shén (spirit, manilcstcd vitalitics), whcn thc hcart yin is dcficicnt,
shén may losc its attachmcnt (shen shi suo gui 神失所归), and thc paticnt may
cxpcricncc insomnia, cxccssivc drcams, or difficulty in conccntration. Similarly,
whcn thc livcr systcm is rcplctc with firc (ganhuo wang 肝火旺), a doctor might
nccd to think about thc kidncy systcm. !t might bc thc dcficicncy ol thc kidncy
yin that rcsults in cxccssivc firc in thc livcr systcm. Tis is callcd “thc watcr lail
ing to immcrsc thc wood” (shui bu han mu 水不涵木).⁵` Ðr. Zhou uscd a pot ol
boiling watcr as an cxamplc:
Vhcn wc hcar thc loud sound ol thc boiling watcr and scc thc cnormous
amount ol stcam coming out ol thc pot, wc tcnd to think ol thc tcmpcraturc
as thc only lactor. 8ut it is vcry likcly that thcrc is littlc watcr in thc pot. !n lact,
lcss watcr will makc a loudcr sound and morc stcam. Vhat wc do is to add
72 TRANSFORMI NG EMOTI ONS
watcr. Tis is callcd “adding watcr to immcrsc thc wood” (zishui hanmu 滋水
涵木). Clinically, this is to nourish thc kidncy yin to soltcn thc livcr systcm.
Wuxing rcasoning has a particular rolc in trcating cmotional disordcrs.
Sincc thc cmotions arc said to bc corrcspondcnt to spccific lunctions ol dil
lcrcnt visccral organ systcms, thcy arc also accountablc in tcrms ol thc wuxing
rclationships. As shown in figurc ¡.¸, sadncss/gricl is thc cmotion ol thc lungs,
thcrclorc, bclonging to thc phasc ol mctal. Angcr is thc cmotion ol thc livcr,
thcrclorc, its modc is “mctallic.” According to thc conqucring or rcstraining
scqucncc that mctallic ovcrcomcs thc woodcn, thc cmotion ol sadncss/gricl is
said to ovcrcomc thc cmotion ol angcr. So whcn a pcrson is cxccssivcly angry,
bringing out thc sadncss may lcsscn thc angcr and thcrcby rcducc thc rclatcd
symptoms. Such an cmotional way ol trcating cmotions is known as “trcating
cmotions with cmotions” (yi qing sheng qing 以情胜情), which can bc lound in
thc carlicst mcdical rccords. According to Neijing: Suwen “angcr hurts thc livcr,
sadncss ovcrcomcs it, . . . joy hurts thc hcart, lcar ovcrcomcs it, . . . worry/think
ing hurts thc splccn, angcr ovcrcomcs it, sadncss hurts thc lungs, joy ovcrcomcs
it, lcar hurts thc kidncys, worry/thinking ovcrcomcs it.”⁵⁴ Zhu Ðanxi (.a·.–¸·),
a lamous Yuan physician, was rccognizcd lor his skill at handling cmotionrc
latcd disordcrs. Ònc ol Zhu’s cascs was rctold by Zhang Jicbin (.¸6c–.6¡c), a
rcnowncd Ming physician, in his mcdical work, Jingyue Quanshu: Yuzheng Mo
景岳全书: 郁证谟 (Complete Collection of Jingyue: Yu Illnesses):
Altcr a girl was cngagcd, hcr fiancé wcnt away on busincss. For two ycars,
hc had bccn away. 8ccausc ol this, thc girl did not cat and was lying in bcd
as il shc was chi (ol dcmcntia). Shc had no othcr symptoms but lying in thc
bcd lacing thc wall. Tis was duc to thc lact that hcr pcrsistcnt longing and
thinking (si) causcd qi to congcal (jie). Mcdicinc could not bc cffcctivc by
itscll. |Tc doctor rcasoncd| that whcn thcrc was joy (xi), thc illncss could bc
rcmittcd, or shc could bc madc angry so that thc qi ol wood could risc and
cxtcnd and thc qi ol splccn would opcn. Tis was bccausc wood could rcstrain
carth. Tcrclorc, thc physician wcnt to thc girl and provokcd hcr into ragc. Shc
cricd lor quitc a long timc and was givcn a bag ol hcrbal mcdicinc. Altcr that,
thc girl askcd lor lood. Tough hcr illncss was rcmittcd, only joy could curc
hcr complctcly. Tcrclorc, an arrangcmcnt was madc lor hcr fiancé to rcturn.
Altcr that, thc illncss did not rccur.
Zhang Congzhcng (..¸6–.aa·), a physician ol thc Yuan, was also known
to bc good at using cmotions to trcat cmotions (scc tablc ¡.¸).⁵⁵ Tc lollowing
arc two cascs lrom his book Rumen Shiqin 儒门事亲 (Tc Conlucian Vay ol
Caring lor Ònc’s Parcnts, compilcd during .a.,–a.):
Guan’s wilc had a strangc illncss. Shc did not cat and had a bad tcmpcr. Shc
was oltcn hcard shouting angrily. Many doctors wcrc invitcd but lailcd to
curc hcr. Zhang was invitcd. Altcr an cxamination, hc told thc husband that
his wilc’s illncss could not bc curcd only by mcdicinc, but had to usc thc
CONTEXTUALI ZI NG QI NGZHI 73
mcthods ol “curing cmotion with an cmotion.” Tcn two actor/danccrs wcrc
invitcd. Tcy put on makcup and pcrlormcd in lront ol thc wilc. Tc paticnt
was induccd to laugh. Tc sccond day, thcsc two actors put on makcup and
pcrlormcd wrcstling. Tis madc thc paticnt laugh unccasingly. At thc samc
timc, thc doctor had two womcn with good appctitcs sitting bcsidc thc wilc.
Vhilc cating joylully, thcy complimcntcd cach coursc ol lood. 8y this, thc
paticnt bcgan to want lood. Altcr a lcw days, hcr appctitc improvcd, and hcr
angcr was curcd too.
Anothcr casc involvcd a wilc lrom a rich lamily who suffcrcd insomnia lor
thrcc ycars. No mcdicinc was cffcctivc.
Ðoctor Zhang Congzhcng was invitcd. Hc diagnoscd that thc illncss was thc
rcsult ol cxccssivc worrying and thinking duc to thc task ol taking carc ol a
largc cxtcndcd lamily. Hc dccidcd that thc illncss could only bc curcd by cmo
tion. Hc arrangcd a curc with thc husband. Tc doctor acccptcd a lot ol moncy
lrom thc husband and in lront ol thc wilc, livcd and lcastcd in thc housc lor
days, and lclt without lcaving a singlc prcscription. Tc wilc was outragcd and
thcn bcgan swcating. Tat vcry night shc lcll into a dccp slccp and did not
gct up lor cight to ninc days. Altcr that, thc wilc was curcd. Tis is thc casc ol
“angcr ovcrcomcs worry.”
Tis ancicnt mcthod ol cmotion bcing curcd by countcrcmotion can still
bc lound in contcmporary zhongyi practicc. An author ol a popularizcd zhongyi
book tclls thc story ol his own cxpcricncc in trcating a prcgnant lcmalc paticnt.
Tc paticnt camc to scck hclp lor hcr obscssion with a past cxpcricncc. Shc was
troublcd by thc imagc ol hcr high school malc tcachcr who had huggcd hcr in
an inappropriatc way. Tc imagc ol this tcachcr rcluscd to go away. Ðrawing
on thcorics that xi (usually translatcd as “joy,” but hcrc is bcttcr translatcd as
“cxcitcmcnt”) that injurcs thc hcart can bc ovcrcomc by lcar and mitigatcd by
angcr, thc author (thc doctor) bcgan by accusing thc tcachcr ol having madc
an unlorgivablc mistakc and bcing irrcsponsiblc. Ðoing this, hc managcd to
makc thc woman angry at thc tcachcr. Tcn hc startcd to point out that shc
had a loving husband and was cxpccting a baby and askcd hcr to think about
thc conscqucncc lor hcr coming baby and hcr lamily il shc indulgcd hcrscll in
Table 4.3 Emotions and Counteremotions
Emotions
Transformative
Phase
Correspondent
Visceral System
Emotion Tat
Overcomes
Angcr (nu) Vood Livcr Vorry
Anxicty/thinking (si) ¡arth Splccn Fcar
Fcar/lright (kong/jing) Vatcr Kidncy Joy
Joy (xi) Firc Hcart Sadncss/gricl
Sadncss/gricl (you/bei) Mctal Lung Angcr
74 TRANSFORMI NG EMOTI ONS
unrcalistic lantasy. 8y rcsorting to thc cmotion ol angcr and lcar, thc author
succcsslully hclpcd thc paticnt to lct go ol thc past.⁵⁶
Qingzhi and Translormativc Qi
Vhat is rcally translormativc in zhongyi physiology is qi which is translatcd
variously as “air,” “brcath,” and “vital cncrgy”. Qi is dcfincd in contcmporary
zhongyi tcxtbooks as “thc matcrial basis ol lilc.” Sincc qi itscll is constantly in
motion and in translormation, and it promotcs (tuidong 推动) thc activitics
ol lilc and lunctions to warm up (wenxu) thc body, zhongyi cxplains human
physiological changcs and activitics in rclcrcncc to thc changcs and translor
mations ol qi.⁵⁷ Although qi is dcfincd as “matcrial,” yct it is not a tangiblc
or mcasurablc cntity. Vhat is ccntral about qi is what it docs—its lunctions.
Tcy arc summarizcd as promoting (tuidong) human physiological activitics,
kccping up (wenxu) thc body’s tcmpcraturc, dclcnding (fangyu 防御) thc body
lrom thc invasion ol “hctcropathic qi” (xieqi 邪气), rcinlorcing and conscrving
(gushe 固摄) thc vital substancc ol thc body, and translorming (qihua 气化¯)
bodily substanccs.⁵⁸ Normal lunctions arc achicvcd through ordcrly motions
ol qi charactcrizcd as moving up, going down, coming in, and going out. Tc
dynamic balancc is upsct il thc ccrtain qi is supposcd to go up but gocs down
instcad, or il ccrtain qi movcs too last or too slow. For cxamplc, thc hcart qi gocs
down, whilc thc kidncy qi is going up. Tc livcr qi sprcads out whilc thc lung
qi clcars downward. Vhcn thc movcmcnt ol qi is obstructcd, thc rcsult is thc
disordcrcd qi mcchanism, such as stagnation, congcstion, blockagc, and closurc
ol qi, which lcad to all kinds ol somatic and psychological symptoms.
Qingzhi lunctions arc also undcrstood in tcrms ol qi translormations. Tc
cmotional impact on bodily proccsscs is not significant in tcrms ol chcmical
changcs but in tcrms ol altcrcd qi movcmcnt. For cxamplc, whcn angry, qi
movcs up, whcn happy, qi is rclaxcd, whcn sad, qi is dissipatcd, whcn scarcd,
qi movcs down, whcn startlcd, qi is disturbcd, and whcn thinking too hard, qi
tcnds to congcal. ¡xccssivc cmotional activitics arc said to upsct thc normal
motion ol qi rclcvant to its spccific visccral lunctions. Òncc cxccssivc cmotions
arc sustaincd lor long, thc circulation ol qi is obstructcd, and thc lunctions ol
visccral systcms arc disturbcd, which rcsults in various physical and psychologi
cal symptoms. Vith cxccssivc cmotions as clcar illncss lactors, thc disordcrs
arc vcry likcly dcscribcd as qingzhi bing (cmotionrclatcd disordcrs). Howcvcr,
thc zhongyi clinical proccss undcrstood as “diffcrcntiating pattcrns and dctcr
mining trcatmcnt” (bianzheng lunzhi 辨证论治) should not bc conluscd with
thc diagnostic proccss lound in biomcdical scttings as labcling thc discasc and
matching it with a standardizcd trcatmcnt. Tc lollowing chaptcrs locus on
thc zhongyi clinical proccss ol bianzheng lunzhi and discuss how a particular
diagnosis is arrivcd at and a trcatmcnt is dctcrmincd.
75
V
Understanding Zhongyi Clinical Classifcation
Vhcn ! first startcd my ficldwork at thc hospital, ! was confidcnt that through
my participant obscrvation in thc actual clinic scttings, thc picturc ol qingzhi
bing 情志病 (cmotionrclatcd disordcrs) would prcscnt itscll clcarly to mc and
that it would not bc difficult lor mc to dcfinc and classily various qingzhi disor
dcrs according to how thcy arc organizcd in actual clinical scttings. ! rcmcmbcr
that ! was anxiously waiting lor thc doctor to givc a diagnosis altcr hc cxamincd
thc paticnts. ! was conccrncd about how a group ol symptoms wcrc associatcd
with a particular illncss and il this particular illncss was considcrcd a qingzhi
disordcr. To my grcat disappointmcnt, dcspitc my diligcnt notctaking, thcsc
two catcgorics ol inlormation rcmaincd mostly blank in my notcs. ! noticcd
that diagnosis in tcrms ol labcling an illncss was not a ncccssary part ol zhongyi
clinical proccss at all, and it did not makc a significant diffcrcncc in dctcrmining
thcrapy il a givcn illncss was a qingzhi disordcr or not. Scvcral timcs, ! dircctly
askcd thc doctor cxactly what illncss hc was diagnosing or trcating. Tis was ap
parcntly a laypcrson’s (waihang 外行) qucstion, lor thc doctor would answcr my
qucstion as hc did thosc paticnts who prcsscd lor an illncss namc. Hc would say
that according to Vcstcrn mcdicinc, it was ncurosis (shenjing guanneng zheng
神经官能症, litcrally, “ncrvcs lunctional disordcr”) or “vcgctation ncrvcs out
ol balancc” (zhiwushenjing shitiao 植物神经紊乱). Answcrs to my qucstion ol
whcthcr a casc bclongcd to thc catcgory ol qingzhi bing wcrc usually ambigu
ous. Frcqucntly, ! was told that a ccrtain casc was rclatcd to qingzhi.
Not until somctimc into my clinical obscrvation did ! bcgin to rcalizc that
thc wholc timc ! was trying to rcad thc zhongyi clinical proccss in tcrms ol thc
“biomcdical way ol thinking” (xiyi siwei fangshi 西医思维方式),” which my
zhongyi tcachcr had cautioncd against at thc vcry bcginning ol my clinical ob
scrvation. ! automatically assumcd that zhongyi clinical work would lcad to thc
diagnosis ol an illncss bascd on thc prcscncc or abscncc ol ccrtain distinctivc
symptoms and thc matching ol thc illncss with an hcrbal prcscription. Appar
cntly, zhongyi diagnosis docs not always involvc crcating a clcarcut taxonomy
by appcaling to a lcw distinctivc lcaturcs that mark phcnomcna bclonging to
76 TRANSFORMI NG EMOTI ONS
thc samc catcgory. Tc classificatory logic ol thc zhongyi clinical proccss that
translorms thc disordcrcd qingzhi into an ordcrcd pattcrn ol an illncss nccds to
bc undcrstood in light ol a diffcrcnt modc or tradition ol knowing. Tc locus ol
this tradition has bccn prccmincntly cvcntlul or proccssual as discusscd in thc
prcvious chaptcrs. !t is not that zhongyi clinicians arc not ablc to undcrstand thc
world structurally, but rathcr that thcir priority has bccn givcn to movcmcnts
(dong 动) and changcs (bianhua 变化). Scicntific rigor and structural intclligi
bility havc to givc way to thc rcadincss ol accounting lor dynamic rclations and
situational concrctcncss.
Tc ccntral part ol zhongyi clinical work is summarizcd as bianzheng lun-
zhi 辨证论治 (pattcrn diffcrcntiation and thcrapy dctcrmination) or bianzheng
shizhi 辨证施治 (pattcrn diffcrcntiation and thcrapy application) in contcmpo
rary zhongyi writings. Bianzheng is to diffcrcntiatc pattcrns ol syndromcs and
thcrclorc is a lorm ol zhongyi classificatory tcchniquc. Ðctcrmination ol an
cffcctivc thcrapcutic action (lunzhi) dcpcnds on accuratc bianzheng. A tcxtbook
starts with:
Ònc distinctivc lcaturc ol zhongyi clinical proccss ol trcating illncsscs is bian-
zheng lunzhi. Tc practicc ol socallcd “trcating samc illncss with diffcrcnt
thcrapics” (tong bing yi zhi 同病异治) and “trcating diffcrcnt illncsscs with
thc samc thcrapics” (yi bing tong zhi 异病同治) takcs zheng 证 (pattcrns/
syndromcs) as its basis. Tcrapics changc whcn zheng changcs. . . . Tc locus
is all on zheng, also known as zhenghou.'
Tc Chincsc mcdical conccpt ol “zheng” is not thc samc as thc biomcdical
conccpt ol “syndromc”. Similarly, bing is not thc zhongyi cquivalcnt ol discasc.
To undcrstand thc pivotal proccss ol bianzheng luzhi, wc nccd to undcrstand a
sct ol rclatcd conccpts: “zheng” 症 (symptoms/signs), “zheng” 证 or “zhenghou”
证候 (pattcrns),´ and “bing” 病 (illncss/disordcr). Judith Farqhuar’s Knowing
Practice (.µµ¡) offcrs a dctailcd and systcmatic analysis ol thc clinical proccss
ol syndromc/pattcrn diffcrcntiation and thcrapy dctcrmination. Hcr analysis
ol thc tcmporal lorm ol kanbing 看病 (looking at thc illncss) is particularly
rclcvant to my dcscription ol zhongyi classification. !n thc lollowing passagcs,
cspccially in thosc discussing symptom and syndromc diffcrcntiation, hcr work
is lrcqucntly rclcrcnccd. Schcid’s rcccnt book has onc chaptcr on bianzheng
lunzhi, which offcrs a dctailcd account ol thc modcrn cvolution ol thc conccpt
and is also an important sourcc ol rclcrcncc lor thc analysis in this chaptcr.`
ZHENG ( SYMPTOMS) , ZHENG ( PATTERNS) ,
AND BING ( I LLNESSES/DI SORDERS)
!n contcmporary zhongyi tcxts, zheng (symptom), zheng (pattcrn), and bing
(illncss/disordcr) arc discusscd as thrcc diffcrcnt but rclatcd mcdical conccpts.
Tcy all rcflcct pathological conditions rcsulting lrom “loss ol yinyang bal
ancc ol livcd body” (renti zishen de yinyang pingheng 人体自身的阴阳平衡)
UNDERSTANDI NG ZHONGYI CLI NI CAL CLASSI FI CATI ON 77
and “disturbcd cquilibrium bctwccn intcrnal and cxtcrnal cnvironmcnts” (nei-
wai huanjing tongyi xing zhang’ai 内外环境统一性障碍) but havc diffcrcntial
significancc in rclation to thc clinical proccss ol diagnosis.⁴
Tc tcrm zheng (symptom) rclcrs to various anomalics (yizhang ganjue 异
常感觉) cxpcricnccd by thc paticnt and cxtcrnal manilcstations (waibu biaox-
ian 外部表现) ol pathological changcs obscrvcd by thc doctor. Tcy providc thc
basis lor thc doctor to diffcrcntiatc pattcrns and diagnosc illncsscs.⁵ Farquhar
makcs a lurthcr distinction bctwccn zheng 征 (signs) and zheng (symptoms).
Not lollowing thc convcntional biomcdical distinction bctwccn “objcctivc
signs” and “subjcctivc symptoms,” Farquhar’s scparation ol zheng (signs) lrom
zheng (symptoms) is rathcr tcmporal. Zheng 征 arc signs initially rcportcd and
prcscntcd to thc doctor by thc paticnt or dircctly clicitcd lrom thc paticnt by
thc doctor. Tc signs ol illncss arc thcn proccsscd by thc doctor and turncd
into “mcdicalizcd” zheng (symptoms), which bcar convcntional mcdical impli
cations. !n a biomcdical sctting, thc distinction might bc morc significant sincc
somc ol thc signs may not bc takcn as rclcvant symptoms ol a particular discasc.
!n a zhongyi clinic, what thc paticnt rcports and what thc doctor takcs as symp
toms arc not significantly diffcrcnt, and thc tcmporal transition lrom signs to
symptoms is usually unmarkcd. Zhongyi physicians do not catcgorically scparatc
(sign) lrom thc symptom, but rathcr usc zheng (symptom) to mcan both signs
and symptoms. Symptoms rccognizcd in a zhongyi clinic, such as “palpitation”
(xinhuang 心慌), “shortncss ol brcath” (qiduan 气短), or “rcstlcssncss” (zuowo
bu an 坐卧不安), arc vcry much dcscriptivc and cxpcricntial, and thc paticnt’s
voicc rcmains authoritativc rcgarding what arc mcdically significant symptoms.
Farquhar also rccognizcs that thc paticnt’s own narrativc ol his illncss “plays a
major rolc in dclimiting thc naturc ol thc illncss lor both doctor and paticnt.”⁶
!n zhongyi clinics, a paticnt is invitcd to rcport on whatcvcr signs and symptoms
shc or hc cxpcricnccs. Any rcportcd symptom is acccptcd as lcgitimatc and
contributing to thc undcrstanding ol thc wholc pathological condition. Tis
contrasts sharply with thc clinical proccss in a biomcdical hospital, whcrc sincc
a discasc is undcrstood as a discrctc cntity with clcar boundarics, only ccrtain
signs and symptoms arc acccptcd as lcgitimatc or rclcvant.
An incidcnt that happcncd to onc ol my lricnds brought mc to this awarc
ncss. Hc had an acutc migrainc and was introduccd to a doctor working at
a prcstigious biomcdical hospital in 8cijing. Altcrward whcn ! talkcd to thc
doctor, thc doctor askcd il my lricnd was rcally a collcgc prolcssor and said
that hc bchavcd likc an old pcasant who did not know how to kanbing (look
at illncss). My lricnd complaincd about a hcadachc and thcn movcd on to talk
about his back pain and thcn jumpcd to complain about his stomach and latcr
mcntioncd his vcxation and irritability and his swcaty hands and lcct. Tc doc
tor had to rcmind him what hc was thcrc lor. !n a discascoricntcd biomcdical
clinic, swcaty hands and lcct arc pcrccivcd as bcaring littlc rclcvancc to a ol
migrainc. Howcvcr, in zhongyi clinics, such paticnt bchavior is pcrlcctly normal
and cxpcctcd. Not just common complaints, but idiosyncratic complaints arc
78 TRANSFORMI NG EMOTI ONS
also trcatcd with thc samc scriousncss. Òncc ! was amuscd by a paticnt who
complaincd that hc could lccl his hcart bcat cvcrywhcrc on his body, and hc
insistcd that whcrcvcr on his body hc touchcd, hc could count his hcartbcat.
Altcrward, thc doctor scriously said to mc that wc hcalthy pcoplc may ncvcr
cxpcricncc what a paticnt cxpcricnccs, but that docs not mcan what thc paticnt
cxpcricnccs is not rcal or rclcvant.
Zheng (symptoms) arc subjcct to lurthcr abstraction and gcncralization
and arc madc “amcnablc to pcrccption as a pattcrn.”⁷ Tis pattcrn is thcn callcd
“zheng” (证). Tc stcp lrom zheng (symptoms) to zheng (pattcrn/syndromc)
is rclcrrcd to as “bianzheng” (pattcrn diffcrcntiation). Tis zheng is also callcd
“zhenghou” 证候, whcrc thc sccond charactcr implics a configuration ol vari
ous lactors obscrvcd ovcr a pcriod ol timc. Tc samc charactcr is uscd in thc
tcrm qihou 气候 (climatc). 8ascd on thc pattcrn ol thc syndromc, a thcrapcu
tic mcthod is dctcrmincd, which is known as lunzhi (thcrapy dctcrmination).
Togcthcr, this proccss is rclcrrcd to as “bianzheng lunzhi” or simply “zhengzhi”
证治 (syndromc diffcrcntiation and thcrapy dctcrmination). Ðiffcrcnt lrom
symptoms and illncsscs, zheng, as syndromc configurations, rclcrs morc to “pat
tcrns ol history” that “charactcrizc a group ol symptoms typical ol a particular
condition or disturbancc” than to thc “structurc ol thc body or discasc.”⁸
Tc classificatory principlcs ol thc clinical proccss ol bianzheng (diffcrcn
tiation ol pattcrns) summarizcd in contcmporary zhongyi tcxtbooks includc
“thc cight rubrics diffcrcntiation” (bagang bianzheng 八纲辨证), “thc visccral
systcm lunctions diffcrcntiation” (zangfu bianzheng 脏腑辨证), “illncss lactors
diffcrcntiation” (bingyin bianzheng 病因辨证), “six typcs diffcrcntiation” (liujing
bianzheng 六经辨证),⁹ and “dclcnsivc, activc, constructivc, and blood qi dil
lcrcntiation” (wei, qi, ying, xue bianzheng 卫气营血辨证). Òl all thcsc aspccts
lor considcration, thc cight rubrics arc basic diffcrcntiation guidclincs known
as dctcrmining “thc corc syndromc pattcrns” (hexin zhenghou 核心症候).'⁰ Tc
cight rubrics consist ol lour pairs ol polaric rclations: yin and yang, cxtcrior
(biao 表) and intcrior (li 里), cold (han 寒) and hot (re 热), and dcplctcd (xu
虚) and rcplctc (shi 实). Tis systcm ol pattcrn diffcrcntiation is said to rcflcct
thc quality or naturc ol an illncss (bing xing 病性). Liu Yanchi summarizcs thc
cight guiding principlcs ol diffcrcntiation as
• yin and yang, which dcscribc thc gcncral typc ol thc illncss.
• intcrior and cxtcrior, which dcscribc thc location ol thc illncss.''
• cold and hcat, which dcscribc thc spccific naturc ol thc illncss.
• dcficicncy and cxccss, which dcscribc thc statc ol thc strugglc bctwccn
antipathogcnic qi and thc pathogcnic lactor.'´
Tcsc guidclincs providc thc prcliminary dimcnsions lor organizing symptoms.
Yct not only do thcsc diffcrcntiation mcthods allow many diffcrcnt combina
tions, but also thc qualitics ol yin and yang constantly shilt so that thc cxtcrior
UNDERSTANDI NG ZHONGYI CLI NI CAL CLASSI FI CATI ON 79
may movc inward and thc intcrior outward, and rcplction may turn into dcplc
tion. !n addition, lrom cithcr cnd ol a polaric pair, thcrc is continuity and diffcr
cncc in dcgrcc. Tcrclorc, any syndromc diffcrcntiation according to thc cight
guidclincs is a dcscription ol an illncss condition in timc. Tc actual clinical
diffcrcntiation ol syndromcs is always flcxiblc. As is gcncrally rccognizcd by
zhongyi doctors, “thc principlc ol suiting thc mcasurcs to thc spccific conditions
ol thc pcrson, thc illncss, thc timc and spacc, . . . is not only clinically ncccssary,
but is also whcrc thc quintcsscncc ol zhongyi’s way ol thinking lics.”'`
!n addition to thc cight rubrics as basic diagnostic mcthods lor thc diffcr
cntiation ol syndromcs, thc statcs ol qi and xue (blood) arc also most lrcqucntly
considcrcd dimcnsions in thc proccss ol pattcrn diffcrcntiation. Togcthcr with
thc cight principlcs, thcy arc considcrcd as rcflccting thc quality and naturc ol
an illncss proccss. For qi, thc considcrations arc on its movcmcnt: dcficicnt (xu
虚), sinking (xian 陷), stagnation (zhi 滞), or advcrsc (ni 逆), and so on. For
blood, similarly, thc qualitics ol its flow and lunctions arc considcrcd, such as
dcficicncy, stagnancy, and congcstion.
A group ol symptoms can also bc subjcct to lurthcr diffcrcntiation accord
ing to thc dimcnsions ol thc visccral lunctions. Tis proccss ol diffcrcntiation
is said to dcscribc thc illncss location (bingwei 病位). A basic namc lor any
syndromc diffcrcntiation at lcast includcs two typcs ol inlormation, that is, thc
naturc and thc location ol a disordcr.'⁴ For cxamplc, thc syndromc ol livcr stag
nation (ganyu 肝郁) uscs two charactcrs to dcscribc thc naturc ol thc disordcr,
which is thc stagnant flow ol qi and thc affcctcd visccral systcm, thc livcr.'⁵
Òthcr aspccts arc also involvcd in thc proccss ol diffcrcntiation ol pattcrns, such
as illncsslactor diffcrcntiation (bingyin bianzheng), which includcs thc lactors
ol thc six cxccsscs (liu yin 六淫): wind, cold, hcat, dampncss, dryncss, and firc,
and thc scvcn cmotions (qiqing 七情). Tcrc arc always morc aspccts to look
at as is ncccssary in thc rcal clinical situation. As wc disccrn morc dimcnsions
lor considcration, it bccomcs morc difficult to construct an unambiguous taxo
nomical hicrarchy. !n lact, thc diffcrcnt mcthods ol zhenghou diffcrcntiation
should not bc undcrstood as taxonomic. Tcy arc bcst undcrstood as practical
and pcdagogical guidclincs lor clinical actions, as Farquhar argucs.'⁶ Tcy offcr
various dimcnsions lor clinicians to think about and to rclcr to whcn mapping
out thc undcrlying conditions ol physiological and pathological changcs and
whcn dcsigning thcrapcutic principlcs and lormula.
Tcrc arc cndlcss possibilitics in tcrms ol clinical manilcstations and thc
dircction ol an illncss’s dcvclopmcnt ovcr timc. Tc doctor’s undcrstanding ol thc
naturc ol a particular pattcrn and its possiblc translormation, and thc mcthods ol
intcrvcntion availablc to dcploy, rcly hcavily on an individual doctor’s knowlcdgc,
cxpcricncc with similar symptom configurations, and flcxibility and crcativity.
As Farquhar points out, thc zhongyi clinical work
cntails a grcat attcntivcncss to tcmporality, an undcrstanding ol illncss dc
vclopmcnts and hcaling tcchniqucs as proccss. Tis stands in contrast to a
80 TRANSFORMI NG EMOTI ONS
mcdicinc ol anatomical structurcs and fixcd lcsions, rcductivc causality, and
mcchanical influcncc. . . . A locus on thc clinical work ol Chincsc mcdicinc
that privilcgcs thc practical and thc tcmporal rcvcals Chincsc mcdical clas
sification as a mcthod ol dcploying matcrial lrom thc mcdical archivc within
spccific projccts ol hcaling, a continuing subordination ol lormalizcd knowl
cdgc to thc concrctc dcmands ol thc momcnt.'⁷
Tc attcntivcncss to tcmporality and proccssual naturc ol diffcrcntiation ol syn
dromc pattcrns also charactcrizcs zhongyi classificatory logic and mcthods. !n
vicw ol thc languagc ol yinyang and thc fivc translormativc phascs that char
actcrizc thc dynamic nctwork ol Chincsc psychophysiology and pathology, any
classificatory statcmcnt is a tcmporal and spatial dcscription ol dynamic con
figurations ol thc manilcstations ol an illncss condition. Such configurations
capturcd at onc timc arc subjcct to constant rcconfigurations. Tus onc zheng
may shilt to anothcr.'⁸
Zhenghou thus conccptualizcd poscs a lundamcntal difficulty lor standard
ization ol pattcrn diffcrcntiations bascd on thc modcrn scicntific classificatory
systcms that undcrlic thc biomcdical diagnosis ol discasc. !n thc last two dc
cadcs, zhongyi scholars havc shown incrcascd conccrns as to how to makc clas
sification ol zhenghou morc scicntifically rigorous and at thc samc timc to rctain
its charactcristics ol flcxibility, concrctcncss, and pragmaticity.'⁹ 8y thc stan
dards ol modcrn scicntific nosological principlcs, thc prcscnt practiccs rcquirc
considcrablc improvcmcnt. !n lact, continuous attcmpts havc bccn madc to
standardizc thc conccpts and classification ol zhenghou.´⁰ Yct it is also rcalizcd
that il zhongyi adopts modcrn nosological principlcs to bring diffcrcntiation
ol pattcrns ol syndromcs closcr to modcrn scicntific classification as has bccn
pushcd and cxpcrimcntcd rcccntly, thcsc highly systcmatic and standardizcd
catcgorics and typcs, though morc acccssiblc to studcnts in modcrn classroom
lcarning, will thcn bc morc arbitrary (renwei xing 人为性), will bc lcss rcflcc
tivc ol thc complcxity ol actual intcrrclatcdncss and translormations among
symptoms and syndromc pattcrns, and most ol all, will dctach thc classification
lrom thc concrctc clinical work that takcs practicc as its guidc.´'
Many contcmporary dcbatcs ol bianzheng involvc distinctions and rcla
tions bctwccn zheng (pattcrns/syndromcs) and bing (illncss/disordcr). Bing is
also callcd “jibing” 疾病, which is morc lormal.´´ Roughly, thcrc havc bccn
about lour thousand illncss namcs rccognizcd in zhongyi.´` Somc ol thcsc ill
ncss namcs still havc valuc and arc uscd in today’s zhongyi clinics. !n lact, a
typical tcxtbook ol zhongyi intcrnal mcdicinc (neike 内科) is organizcd accord
ing to illncss namcs.´⁴ Howcvcr, zhongyi illncss namcs arc not clcarly dcfincd
catcgorics bascd on a sct ol consistcnt critcria and systcmatic mcthods. Bing
(illncss/disordcr), zheng (symptoms), and zheng (pattcrn/syndromcs) in many
cascs arc not mutually cxclusivc catcgorics. For cxamplc, cough (kesou 咳嗽)
and palpitation (xinji 心悸) arc rclcrrcd to as “bing” in zhongyi tcxtbooks, but
thcy arc not complctcly diffcrcnt lrom symptoms. Somctimcs illncss namcs
UNDERSTANDI NG ZHONGYI CLI NI CAL CLASSI FI CATI ON 81
arc uscd to indicatc pattcrns and syndromcs. For cxamplc, thc six cold damagc
illncsscs (shanghan liujing bing 伤寒六经病) arc talkcd about as bing, but many
scholars and physicians scc thcm as zheng (pattcrns) rcminisccnt ol thc cight
rubrics.´⁵ At othcr timcs, thc namcs ol zheng (pattcrns) arc uscd to dcsignatc
bing (illncsscs), such as block ol dampncss (shizu 湿阻) and livcr qi stagnation
(ganyu 肝郁). Òccasionally, onc illncss namc corrcsponds to only onc pattcrn,
and “diffcrcntiation ol illncss” thcn cquals “diffcrcntiation ol pattcrns.”´⁶ Ac
cording to Chcn Xiaoyc, thc distinction bctwccn zheng and bing is rclativc,
and thcy arc not catcgorically diffcrcnt conccpts. Vhcn a condition is talkcd
about as “an objcct ol invcstigation” (renshi duixiang 认识对象), it is habitually
rclcrrcd to as “bing,” but as “thc rcsult ol invcstigation” (认识结果), it is morc
likcly to bc rclcrrcd to as “zheng.”´⁷ Tc diffcrcncc is rathcr positional than
conccptual.
A pathological condition may bc dcscribcd as bing or zheng, but whcn
coming to dctcrmination ol trcatmcnt (lunzhi 论治) and dcsigning drug lor
mulas (nifang yong yao 拟方用药), it is thc diffcrcntiation ol ben 本 (thc root)
ol thc disordcr cxpcricnccd by thc particular paticnt that mattcrs most.´⁸ Tis
ben as “thc rcsult ol a mcdical invcstigation” capturcs thc tcmporal and concrctc
pathological changcs manilcstcd in a particular paticnt and at a particular stagc
and is vcry oltcn prcscntcd in thc languagc ol “yinyang imbalancc” (yin-yang
shitiao 阴阳失调), “thc rclativc advanccs and rctrcats bctwccn thc body’s own
orthopathic and hctcropathic lorccs” (zheng-xie xiaozhang 正邪消长), and
“pattcrns ol bodily lunctional changcs” (jineng bianhua tedian 机能变化特点).
!n this scnsc, thc ben ol a disordcr corrcsponds largcly to contcmporary zhongyi
articulation ol zheng (pattcrns).´⁹ Chcn Xiaoyc, in his articlc on thc unilormity
ol zheng (pattcrn) and bing (illncss), also argucs that thcrc havc not bccn two
scparatc systcms ol bianzheng (diffcrcntiation ol pattcrns) vcrsus bianbing (dil
lcrcntiation ol illncsscs) in zhongyi diagnostics.`⁰ Ðiagnosis in tcrms ol illncss
namcs in zhongyi thcn is not as significant as in biomcdicinc. !t bcars littlc
rclcvancc in dctcrmining a spccific trcatmcnt. As long as thc doctor can rcach
an accuratc bianzheng (pattcrn diffcrcntiation), a thcrapcutic stratcgy can bc
dctcrmincd and a rcmcdy can bc lound.`' \cry oltcn, illncss namcs arc lclt out
ol thc doctor’s writtcn rccords, which routincly includc kcy symptoms, diffcrcn
tiation ol syndromc pattcrns, thcrapcutic principlcs, and hcrb prcscriptions.
REDEFI NI NG BIANZHENG LUNZHI
Nothing is supcrficial about zhongyi’s claim that bianzheng lunzhi (diffcrcntiat
ing pattcrns and dctcrmining thcrapics) is a dcfining lcaturc ol zhongyi clinical
practicc and that bian zheng is lundamcntally diffcrcnt lrom bian bing 辩病
whcn bing is dcfincd in thc biomcdical scnsc ol discasc. Contcmporary zhongyi
scholars tracc thc thcorizcd practicc ol bianzheng lunzhi to Shanghan Zabing
Lun 伤寒杂病论 (Ðiscussions ol Cold Ðamagc and \arious Ðisordcrs) by thc
¡ast Han scholarphysician Zhang Zhongjing (.¸c–a.µ ~b). Tis classic trcatisc
82 TRANSFORMI NG EMOTI ONS
is said to havc cstablishcd thc principlc ol bianzheng lunzhi. Tc proccdurc ol
diffcrcntiating pattcrns and dctcrmining spccific hcrbal lormulas bascd on “liu-
jing” 六经 (thc six typcs)`´ contains corc clcmcnts similar to “ba gang bianzheng”
(thc cight rubrics diffcrcntiation) outlincd in contcmporary zhongyi tcxts.``
Howcvcr, thc usc ol thc tcrms ol bing (illncsscs) and zheng (pattcrns) was not
systcmatically dcfincd. Ðisordcrs wcrc groupcd and namcd gcncrally as bing,
and lormulas wcrc usually dcsignatcd as zheng–spccific pattcrns ol disordcrs
(yi fang ming zheng 以方名证). Tc latc Ming scholarphysician Zhang Jicbin
(.¸6c–.6¸µ) is anothcr historical figurc crcditcd with major contributions to thc
dcvclopmcnt ol thc bianzheng lunzhi principlc. His pattcrn diffcrcntiation thc
ory bascd on “liang gang” 两纲 (two rubrics ol yinyang) and “liubian” 六变 (six
variations ol intcrnal and cxtcrnal, dcplction and rcplction, and cold and hot)
lcd to “bagang bianzheng” (pattcrn diffcrcntiation bascd on thc cight rubrics),
onc ol thc major mcthods ol pattcrn diffcrcntiation uscd today.`⁴ Òthcr lorms
ol diffcrcntiating pattcrns wcrc also practiccd and thcorizcd in thc history ol
Chincsc mcdicinc. Zhang Yuansu (..¸.–.a¸¡), thc scholarphysician ol Jin, is
crcditcd with cstablishing thc thcory ol “zangfu bianzheng” (pattcrn diffcrcn
tiation bascd on thc visccral systcms). Tc Qing scholarphysician Yc Tianshi
(.66,–.,¡6) is rccognizcd lor dcvcloping thc thcory ol “wei, qi, ying, xue bian-
zheng” (diffcrcntiation bascd on dclcnsivc, activc, constructivc, and blood qi).`⁵
!t sccmcd that gcncrations ol Chincsc scholarphysicians uscd ‘bing’ (ill
ncss) and ‘zheng’ (pattcrn) flcxibly in an uncxamincd manncr and conccrncd
thcmsclvcs morc with how to capturc thc tcmporal and spatial changcs ol a
pathological proccss lor thc purposc ol dctcrmining an cffcctivc thcrapy. !n
dccd, bclorc thc Vcstcrn “anatomoclinical mcdicinc” was introduccd and
sprcad in China in thc carly twcnticth ccntury, thcrc sccmcd to bc no compcl
ling nccd to systcmatically distinguish zheng (pattcrns) and bing (illncsscs) and
no apparcnt rcasons lor Chincsc scholarphysicians to rcflcct on distinctivc
lcaturcs ol thcir own prolcssion. For thcm, tracing thc problcm to its sourccs
(qiu ben 求本) through diffcrcntiating yin-yang, intcrior and cxtcrior, dcplction
and rcplction, and cnvironmcntal and othcr lactors constitutcd “thc natural
way ol doing mcdicinc” (yidao 医道). Ònly whcn it was challcngcd by thc
unlamiliar and powcrlul knowlcdgc systcm ol “thc mcdical othcr” did zhongyi
practitioncrs bcgan to “discovcr” what was distinctivc about thc thcory and
practicc ol thcir own prolcssion, and thc distinctivc mcanings ol Chincsc mcdi
cal conccpts, including thc diagnostics ol bianzheng, wcrc thcn madc availablc
to consciousncss.
Similaritics and diffcrcnccs bctwccn zhongyi and xiyi bccamc commonly
dcbatcd issucs in thc .µacs and ¸cs in mcdical circlcs, such as, zhongyi diffcr
cntiatcs pattcrns (zhongyi bian zheng 中医辨证), and Vcstcrn mcdicinc dil
lcrcntiatcs discascs (xiyi bian bing 西医辨病). Zhang Xichun (.·6c–.µ¸¸), thc
carlicst advocatc lor “intcgrating Chincsc and Vcstcrn mcdicinc,” statcd “thc
way wcstcrn mcdicinc uscs drugs is to scck localizcd cffcct and thc cmphasis is
on symptoms ol an illncss |bing zhi biao 病之标|, thc way Chincsc mcdicinc
UNDERSTANDI NG ZHONGYI CLI NI CAL CLASSI FI CATI ON 83
uscs drugs is to scck thc causcs and thc cmphasis is on thc roots ol an illncss
|bing zhi ben 病之本|. Yun Ticjiao (.·,·–.µ¸¸), anothcr carly advocatc lor in
tcgrating Chincsc and Vcstcrn mcdicinc, also pointcd out that thc physiology
ol Vcstcrn mcdicinc is bascd on anatomy (xiyi zhi shengli yi jiepou 西医之生
理以解剖), and thc physiology ol Chincsc mcdicinc originatcd lrom thc !nncr
Classics is bascd on translormation ol qi (“Neijing” zhi shengli yi qihua 内经
之生理以气化).`⁶ Against this historical background, bianzheng lunzhi (dil
lcrcntiation ol pattcrns and dctcrmination ol thcrapics) bcgan to cmcrgc as thc
diagnostic principlc that ccntrally rcflccts Chincsc mcdical thcory (yi li 医理)
and dcfincs its practicc.
Howcvcr, it was not until .µ¸·, in thc first national tcxtbook, Zhongyixue
Gailun 中医学概论 (Òutlinc ol Chincsc Mcdicinc), that bianzheng lunzhi
as thc dcfining lcaturc ol zhongyi was first clcarly statcd. Tc rcconstruction
ol bianzheng lunzhi was madc possiblc by thc lundamcntal translormation in
thc zhongyi prolcssion in thc .µ¸cs. Tis includcd rcorganization ol spacc ol
zhongyi practicc into modcrn hospitals, a ncwly dcfincd status ol zhongyi as
comparablc to biomcdicinc in thc public hcalth systcms, thc cstablishcd rcla
tionship bctwccn thc zhongyi institution and thc statc, and thc ncwly acquircd
vocabulary ol “dialcctics” (bianzhengfa 辩证法) to articulatc zhongyi thcorics
and mcthods.`⁷ Schcid argucs that bianzheng lunzhi bccamc important bccausc
it accomplishcd scvcral goals: allowing zhongyi prolcssionals to dcfinc thcir
prolcssion as catcgorically diffcrcnt lrom Vcstcrn mcdicinc and thus prom
ising a possiblc solution lor thc intcgration ol two mcdicincs, cstablishing a
conncction with thc cultural tradition that is politically appropriatc, and la
cilitating thc systcmatic tcaching ol Chincsc mcdicinc in thc ncwly institu
tionalizcd zhongyi cducation.`⁸ For many vctcran scholarphysicians, who had
bccn instrumcntal to rcdcfining zhongyi bclorc and altcr thc .µ¸cs, thc conccpt
ol bianzheng lunzhi quintcsscntially cmbodics zhongyi siwei fangshi 思维方式
(way ol thinking). From this way ol thinking, illncss is approachcd as an cvcnt
ol loss ol cquilibrium rcsulting lrom dynamic intcractions bctwccn a pcrson’s
own positivc/dclcnsivc ability (zheng 正) and pathogcnic lorccs (xie 邪), and
trcating illncsscs cntails using whatcvcr way to altcr thc dynamics and to lacili
tatc positivc changcs lcading to gaining a ncw balancc, that is, hcalth.
ZHONGYI I LLNESS NAMES AND QINGZHI DI SORDERS
Tc zhongyi illncss catcgorization is still considcrcd valuablc in diagnostics,
dcspitc scvcral cfforts to abolish thc zhongyi illncss nosology and to adopt thc
morc scicntific discasc classifications ol biomcdicinc. Tcn, in what way is a
zhongyi illncss namc lunctional and mcaninglul: !t should bc clcar that a zhon-
gyi illncss namc is not uscd in thc samc way as a is diagnosis in a biomcdical
sctting, whcrc a diagnoscd discasc is gcncrally matchcd with a prcscription
ol thcrapy with littlc considcration lor an individual paticnt’s psychophysical
and social particularitics. Howcvcr, zhongyi lunzhi (dctcrmination ol thcrapy)
84 TRANSFORMI NG EMOTI ONS
rclics prcdominantly on diffcrcntiation ol thcsc particularitics. According to
thc contcmporary zhongyi tcxtbooks, illncsscs (bing) and pattcrns (zheng) arc
practically rclatcd. A corrcctly diagnoscd illncss namc can hclp thc doctor to
gain an ovcrall undcrstanding ol changcs ol an cntirc pathological proccss and
to dctcrminc a gcncral thcrapcutic stratcgy. For instancc, il a pathological con
dition is classificd as “phlcmrhcum illncss” (tanyin bing 痰饮病), a physician
thcn knows that sincc all pattcrns ol phlcmrhcum illncss arc causcd by “yin
pathogcnic lactors” (yin xie 阴邪) and arc cold (han 寒) in naturc, thc gcncral
thcrapcutic stratcgy should bc “using warm drugs to harmonizc it” (yi wenyao
he zhi 以温药和之). Yct whcthcr to usc a warm drug or not or what warm drugs
to usc will havc to bc lurthcr dctcrmincd bascd on diffcrcntiating particular
pattcrns manilcstcd on a particular paticnt.`⁹ !n addition, a corrcctly diagnoscd
illncss can offcr inlormation on thc possiblc dircction ol illncss dcvclopmcnt
so that a physician can anticipatc thc risc ol ccrtain problcms in thc coursc ol
trcatmcnt and takc thc anticipatcd problcms into considcration in dcsigning
thcrapcutic stratcgics. For cxamplc, “stagnation illncss” (yuzheng 郁证 or yubing
郁病) includcs various syndromc pattcrns that arc pcrccivcd as rcsulting lrom
disordcrcd cmotional or mcntal activitics. !t normally starts with thc livcr qi
stagnation (ganqi yujie 肝气郁结), which could lcad to rcstraincd lunctions ol
thc splccn (ganyu yi pi 肝郁抑脾) and cvcntually to thc dcplction ol thc hcart
(xinyin kuixu 心阴亏虚). Vhcn a problcm is classificd as a stagnation illncss,
although thc currcnt manilcstations indicatc that only thc livcr systcm is al
lcctcd, an cxpcricnccd doctor would considcr thc anticipatcd problcms with thc
splccn or thc hcart in dcciding on thcrapcutics.⁴⁰
From thc clinical point ol vicw ol “kanbing” (looking at illncss), an illncss
namc also lunctions as a topic or a point ol locus that both thc paticnt and
thc doctor arc oricntcd to whilc thc doctor cngagcs in studying various mani
lcstations, tracing complicatcd conncctions and mapping out thc pathologi
cal conditions. Vhcn thc doctor translatcs thc paticnt’s complaint ol “unablc
to slccp” (shuibuzhao jiao 睡不着觉) into an illncss namc “insomnia” (bumei
不寐), hc or shc makcs thc “topic” mcdically rclcvant and makcs availablc all
thc prolcssional “commcnts” rclcvant to thc topic, including accumulatcd cx
pcricncc (jingyan 经验) ol thc past. A zhongyi illncss namc thcn is uscd as a
rcsourcc rathcr than a constraint. 8y bringing an illncss namc into thc diag
nostic proccss, thc physician juxtaposcs thc currcnt casc with thc similar oncs
that wcrc cncountcrcd and rccordcd by othcr scholarphysicians and dcrivcs
an appropriatc trcatmcnt stratcgy lor thc concrctc casc at hand through his
pcrsonal synthcsis bascd on all thc inlormation availablc to him. For instancc,
whcn a pathological manilcstation is idcntificd as “thc running pig qi illncss”
(bentunqi 奔豚气) charactcrizcd by an cxpcricnccd scnsation ol a gust ol qi,
likc a running pig, dashing lrom thc lowcr abdomcn up to thc throat, usu
ally accompanicd with a scvcrc stomach achc, thc physician thcn connccts this
particular casc with a pool ol rclcvant discursivc commcnts and practical trcat
mcnts. My zhongyi tcachcr brought in discussions ol “bentunqi” (running pig qi
UNDERSTANDI NG ZHONGYI CLI NI CAL CLASSI FI CATI ON 85
illncss) in Jingkui Yaolue 金匮要略 (¡sscntials) ol Goldcn Caskct⁴' to imprcss
his studcnt doctors about using thc classic knowlcdgc as rcsourccs to lacilitatc
onc’s clinical rcasoning. Yct thc idcntification ol an illncss as bentunqi docs not
obligc thc doctor to usc Zhongjing’s running pig qi lormula (bentun tang 奔豚
汤) or “strcngthcncd cinnamon lormula” (guizhi jia gui tang 桂枝加桂汤). Tc
dctcrmination ol an actual thcrapy dcpcnds on thc physician’s own analysis and
synthcsis ol thc inlormation bascd on thc particular casc and paticnt.⁴´
!n this scnsc, qingzhi bing (cmotionrclatcd disordcrs), somctimcs callcd
“shenzhi bing” 神志病 (mindrclatcd disordcr)⁴`, should not bc undcrstood as a
particular discasc cntity but a zhongyi illncss tcrm that groups various rccurrcnt
manilcstation pattcrns that arc vicwcd as typically having an cxccss ol thc scvcn
cmotions as thc illncss lactors (bingyin 病因) and disturbcd flow ol qi as thc
illncss mcchanism (bingji 病机).
Tc catcgorization ol qingzhi bing rcflccts thc inconsistcncy and plural
ity ol zhongyi classification ol illncss namcs (bing ming). Somc zhongyi tcxts
includc thc illncsscs such as dian 癫 (apathy/dcspondcncc) and kuang 狂
(maniac/madncss) in thc catcgory ol qingzhi disordcrs sincc thcsc illncsscs arc
pcrccivcd as mcntal/cmotional/physiological abnormalitics that also originatcd
lrom disordcrcd activitics ol thc scvcn cmotions.⁴⁴ Òthcrs catcgorizc dian and
kuang scparatcly lrom qingzhi disordcrs.⁴⁵ !n thc tcxtbook Zhongyi Internal
Medicine (Zhongyi Neikexue 中医内科学), qingzhi is not uscd cxplicitly as an
illncss namc, but yuzheng (stagnation illncss) and diankuang (apathy and mad
ncss) arc listcd as scparatc illncsscs.⁴⁶ Howcvcr, in thc chaptcr on yuzheng, othcr
qingzhi disordcrs such as meiheqi 梅核气 (thc plum pit qi syndromc) and ben-
tunqi (running pig syndromc) arc listcd and discusscd. !n othcr words, yuzheng
is uscd in a broadcr scnsc to rclcr to typical qingzhi disordcrs in gcncral.
! can ccrtainly scc thc logic ol this arrangcmcnt sincc thc boundarics
among yuzheng (stagnation illncss), meiheqi (thc plum pit qi syndromc), and
othcr qingzhirclatcd disordcrs arc not clcarcut. Tcy arc sccn as spccific ill
ncss conditions obscrvcd and summarizcd at a spccific point ol a pathological
proccss rclatcd to disordcrcd cmotions. Yu (stagnation ol qi) lrcqucntly domi
natcs thc initial stagc ol this proccss. As has bccn rcpcatcdly dcmonstratcd, in
thc Chincsc world ol constant changc and translormation, diffcrcnccs arc sccn
morc in tcrms ol position in timc and placc. !n lact, cvcn dian (apathy/dcspon
dcncc) and kuang (maniac/madncss) arc not csscntially diffcrcnt lrom yuzheng.
Tc stagnant qi may procccd to producc pathological phlcgm that could “blind
thc hcartmind” (mengbi xinshen 蒙蔽心神) and causc “chaotic mind” (shenzhi
niluan 神志逆乱) and “agitation and rcstlcssncss” (kuangzao buning 狂躁不宁)
charactcristics ol diankuang. Tcrclorc, in thc coming chaptcr ! choosc to locus
on yu 郁 (stagnation ol qi) as thc corc mcaning ol qingzhi disordcrs and show
how othcr mcanings in conncction to yu arisc whcn thc syndromc manilcsta
tion changcs. Tc ncxt chaptcr dcscribcs various clinical manilcstations ol yu
rclatcd pattcrns ol qingzhi disordcrs.
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87
VI
Manifestations of Yu (Stagnation)
Ðuring thc coursc ol my clinical obscrvation, ! startcd to associatc thc spccific
pattcrns ol disturbcd qi movcmcnt, particularly thc livcr qi stagnation (ganqi
yujie 肝气郁结) with qingzhi disordcrs (scc tablcs ¸.a and ¸.¸ lor rclcrcncc). !t
is also abbrcviatcd as “ganyu.” Somctimcs it is rclcrrcd to dircctly as “stagnation
syndromc” (yuzheng 郁证). A typical dcscription ol ganqi yujie syndromc in a
zhongyi tcxtbook starts:
|Main symptoms|: dark complcxion, low spirit, miscrablc lacial cxprcssion,
dcprcsscd mood, no aspiration, pcssimistic, withdrawn, avoiding talking with
pcoplc, lccling loncly, avcrsion to loud sound, rcstlcss, short tcmpcrcd and
lccling ol lullncss and swclling in thc chcst, lowcr abdomcn discomlort and
pain, prcssurc in stomach arca, poor digcstion and no appctitc, irrcgular bowcl
movcmcnt, (lcmalc) irrcgular mcnstruation, mcnstruation pain and lcclings
ol brcasts swclling and pain, tonguc coating thin and whitc somctimcs with
grcasc, pulsc strung.'
Tc clustcrs ol thc symptoms arc prcscntcd as having thcir origins in human
conditions, as thc author’s analysis gocs on to show:
Tis syndromc pattcrn originatcs lrcqucntly lrom onc’s disappointmcnt in
gctting what onc sccks (suoqiu busui 所求不遂), or onc’s lailurc to achicvc
his/hcr goals (zhiyi buda 志意不达), or lrom wrongs with no channcl ol rc
drcss (yinqu nanshen 隐曲难申), thoughts and lcclings tanglcd up without a
solution (quyi nanjie 曲意难解), or lrom bcing constantly worricd, sad, and
pcnsivc (youchou silu 忧愁思虑), or lrom angcr and indignation (fenmen naonu
愤懑恼怒).
Tcsc illncss lactors, in lact, accompany qingzhi disordcrs in gcncral. Zhang
Jingyuc (.¸6a–.6¸µ) wrotc that an illncss ol stagnation causcd by cxccssivc wor
rics and conccrns (youyu 忧郁) has cvcrything to do with daily worrics and
conccrns rclating to lood, clothing, and pcrsonal intcrcst.´ Tis chaptcr locuscs
particularly on yu as thc corc mcaning ol qingzhi disordcrs and cxplorcs various
88 TRANSFORMI NG EMOTI ONS
clinical manilcstations associatcd with thc pathological condition ol stagnation
ol cmotions.
UNDERSTANDI NG THE CONCEPT OF “YU” ( STAGNATI ON)
As discusscd in chaptcr ¸, a pcrsistcnt tcndcncy in Chincsc thinking is to scc
motion and changc (dong 动) as gcncrativc ol “thc myriad things” ol thc world.
!n this world ol ccasclcss translormations, hcalth is maintaincd by ordcrly flow
and cxchangcs ol thc lilc lorccs ol jing 精(finc csscncc), qi 气 (lilc/vital cncrgy),
and xue 血 (blood). According to Chincsc mcdical thcory, whcn thc ordcrlincss
ol bodily proccsscs is upsct (dong shi qi chang 动失其常)—lor cxamplc, what
is supposcd to go up lails to go up and what is supposcd to movc down lails
to movc down—thc physiological circulations would bc obstructcd, and illncss
would arisc. Scvcn unchcckcd cmotivc activitics arc thc common rcasons lor
thc loss ol dynamically maintaincd cquilibrium ol human physiology.
Neijing: Suwen (): “Vhcn thinking cxccssivcly (si 思), thoughts arc storcd
in thc hcart, conccntratcd in onc placc, whcrcby thc orthopathic qi stops
moving and bccomcs static. Tat’s why qi is congcalcd (jie 结).”`
Neijing: Lingshu: “Vhcn sad and worricd (youchou 忧愁), passagc ol qi
closcs and its movcmcnt stops.”
Zhubing Yuanhou Lun: “Qi congcstion illncss (jieqi bing 结气病) is pro
duccd by sadncss and worry (yousi 忧思). Vhcn thoughts wcigh in thc
hcart, spirit stops, qi gcts stuck and thcrclorc congcalcd insidc.”⁴
Gujing Yitong Daquan: “Yu rclcrs to thc blockagc ol thc scvcn cmotions,
which lcads to congcstion ol qi. Òncc qi gcts stagnatcd, it gradually turns
into various pathological lorms.”⁵
Apparcntly, yu, and jie, in carlicr zhongyi tcxts, rclcrs lrcqucntly to thc
pathological condition ol qi congcstion and stagnation rcsulting lrom an cx
ccss ol thc scvcn cmotions.⁶ Ðcscriptions and conccpts ol illncsscs rclatcd to
cmotioninduccd qi stagnation and congcstion can bc lound in thc carlicst
zhongyi classics. Tc plum pit qi illncss (meiheqi 梅核气) discusscd in Zhang
Zhongjing’s Jingkui Yaolue (¡sscntials ol Goldcn Cabinct), rclcrs to thc patho
logical condition rclatcd to stagnation ol cmotions (qingzhi yujie 情志郁结)
that rcsults in qi congcstion and conscqucntly coagulation ol phlcgm. Tis ill
ncss is still commonly prcscnt in contcmporary zhongyi clinics. A similar disor
dcr is callcd “qi congcstion illncss” (jieqibing 结气病 or qibing 气病) in Zhubing
Yuanhou Lun (Òn thc Sourccs and Òrigins ol \arious !llncsscs).⁷
Yu bccamc a morc locuscd conccrn ol thc Ðanxi School ol mcdical ap
proach originatcd by thc lamous Yuan scholarphysician Zhu Ðanxi (.a·.–.¸¸·),
who cmphasizcd “thc intcrnal injurics” (neishang 内伤) as causcs ol illncss and
was wcll known lor trcating various difficult illncsscs (za bing 杂病) such as yu.
MANI FESTATI ONS OF YU 89
Hc maintaincd that “human illncsscs largcly rcsult lrom yu.”⁸ Hc dividcd thc
yu disordcr into six subtypcs. Tcy arc “stagnation ol qi” (qiyu 气郁), “stagna
tion ol dampncss” (shiyu 湿郁), “stagnation ol hcat” (reyu 热郁), “stagnation
ol mucus” (tanyu 痰郁), “stagnation ol blood” (xueyu 血郁), and “stagnation
ol lood” (shiyu 食郁).⁹ Although thc six typcs show diffcrcnt syndromc con
figurations, thcy arc rclatcd tcmporally. Typically, stagnation ol qi is thc initial
problcm that progrcsscs into othcr typcs ol yu. Vang Andao (.¸¸a–µ.), a studcnt
ol Zhu Ðanxi, lollowing thc Ncijing languagc, classifics yu disordcr into fivc
pattcrns according to thcir associations with fivc translormativc phascs (wuxing
五行), thus connccting yu with thc fivc visccral systcms. Vang namcd thcm
“wood stagnation” (muyu 木郁) manilcstcd in thc livcr systcm, “firc stagnation”
(huoyu 火郁) manilcstcd in thc hcart systcm, “carth stagnation” (tuyu 土郁)
manilcstcd in thc splccn systcm, “mctal stagnation” (jinyu 金郁) manilcstcd in
thc lung systcm, and “watcr stagnation” (shuiyu 水郁) manilcstcd in thc kidncy
systcm and also talkcd about diffcrcnt mcthods to rclcasc diffcrcnt typcs ol
stagnations.'⁰ Ðanxi’s othcr studcnt, Ðai Sigong (.¸a¡–.¡c¸), lollowcd Ðanxi’s
classification ol six typcs ol yu but argucd that stagnation ol qi in thc splccn
and stomach systcm wcrc most common. Hc dcvotcd a chaptcr to discussing
yubing 郁病 (yu illncss).'' Tc disordcr ol yu was undcrstood by physicians ol
thc Ðanxi school in a much broadcr tcrm, namcly, obstructions ol thc flow ol
qi in any lorms and in all visccral systcms causcd by any pathogcnic lactors
including cxccssivc cmotions.
Ðuring thc Ming and Qing pcriods, discussions ol yubing or yuzheng
tcndcd to ccntcr morc on cmotions as illncss lactors. Zhao Xiankc (.¸,¸–.6¡¡),
a Ming physician, who also had a chaptcr on yubing in his book, Yiguan 医贯
(Òn Unilormity ol Mcdicinc), lclt it ncccssary to arguc against thc narrow
dcfinition ol yu. Hc argucd that yu should not bc intcrprctcd narrowly as “stag
nation ol sadncss/worrics” (youyu zhi yu 忧郁之郁). Hc insistcd on a broadcr
dcfinition ol yu as simply “blockagc” (butong 不通), which includcd “stagnation
ol sadncss/worrics” (youyu 忧郁), an illncss ol thc scvcn cmotions (qiqing zhi
bing 七情之病).'´ Zhang Jicbin (.¸6c–.6¡c), anothcr Ming scholarphysician,
was thc first to makc a distinction bctwccn “stagnations originating lrom physi
ological disordcrs” (yin bing er yu 因病而郁) and “illncss duc to stagnation ol
cmotions” (yin yu er bing 因郁而病),or simply “stagnation ol cmotions” (qingzhi
zhi yu 情志之郁). Zhang pointcd out that sincc thc lattcr originatcd lrom thc
hcartmind (zong you hu xin 总由乎心), drugs (yaoshi 药石) alonc might not bc
ablc to dissolvc thc stagnation.'` Miu Xiyong (.¸¡6–.¸a,), a latcr Ming scholar
physician, also cautioncd about thc limitations ol using only drugs to trcat
illncsscs rcsulting lrom cxccssivc scvcn cmotions. Hc argucd that cvcn il thc
hcrbal rcmcdy could hclp unblock thc stagnant qi and activatc thc circulation
ol thc blood, thc problcm would rclapsc il thc illncss ol thc hcartmind (xin
bing 心病) pcrsistcd. Hc suggcstcd using “mcdicinc ol thc hcartmind” (xin yao
心药) to trcat “an illncss ol thc hcartmind” (xin bing), that is, “usc thought to
dispcl/changc thought and usc rcason to dissolvc/translorm cmotions” (yi shi
90 TRANSFORMI NG EMOTI ONS
qian shi 以识遣识, yi li qian qing 以理遣情).'⁴ Yc Tianshi (.666–.,¡¸), in his
chaptcr on yuzheng, madc a clcar rcmark that hcaling yuzheng “all dcpcnds on
thc paticnt’s ability to translorm cmotions and changc pcrsonalitics” (quan zai
bing zhe neng yi qing yi xing 全在病者能移情易性).'⁵
Apparcntly, oncc qingzhi zhi yu (stagnation ol cmotions) was scparatc lrom
othcr lorms ol stagnation disordcrs, affcctivc aspccts ol yu bcgan to rcccivc
morc locuscd attcntion, not just in thc dcscription ol illncss lactors (bing yin 病
因), illncss mcchanisms (bing ji 病机), but also symptoms and signs (bing zheng
病症) and thcrapcutic mcthods (zhifa 治法). At lcast in thc latc Ming pcriod,
thc scmantics ol yu gradually acquircd a distinctivc affcctivc dimcnsion ol sad
ncss, unhappincss, and mclancholy. Vhcn Vcstcrn psychology and psychiat
ric mcdicinc was introduccd to China, “stagnation ol sadncss/worrics” (youyu)
was uscd to translatc thc Vcstcrn conccpts ol “dcprcssion” and “mclancholy.”
Tc commonly uscd psychiatric discasc namc ol dcprcssion (yiyu 抑郁) also
has thc charactcr ‘yu’ in its Chincsc translation. As thc zhongyi conccpt ol yu
was appropriatcd lor modcrn usc, thc phcnomcnological scnsc ol “blockagc ol
flow” (butong 不通) inhcritcd in thc Chincsc conccpt ol yu would incvitably bc
slippcd into thc Chincsc commonscnsical undcrstanding ol dcprcssion (youyu
or yiyu). Convcrscly, thc modcrn usc ol yu as a psychological and psychiatric
tcrm has dcfinitcly influcnccd its mcaning in contcmporary zhongyi discoursc
and practicc and rcinlorccd its zhongyi conccption as qingzhi rclatcd, thus al
lowing a possiblc rclcrcntial conncction bctwccn a qingzhi disordcr and a Vcst
crn psychological disordcr. Yuzheng in contcmporary zhongyi tcxtbooks and
practiccs rclcrs prcdominantly to thc narrowcr scnsc ol qingzhi zhi yu (stagna
tion ol cmotions).'⁶ !n today’s zhongyi tcxtbooks, yuzheng is uscd to includc a
group ol illncsscs and pattcrns ol syndromc that originatc lrom “thc blockcd
flow ol cmotions” (qingzhi bu shu 情志不舒) and “thc impcdcd qi mcchanism
(qiji yuzhi 气机郁结).
CLI NI CAL CONFI GURATI ONS OF YU ( STAGNATI ON)
!n zhongyi clinics, as discusscd prcviously, diffcrcntiation ol pattcrns is thc ccn
tral locus ol thc clinical work and is dircctly rclcvant to thc dctcrmination ol
thcrapcutic mcthods. Òltcn an illncss namc, such as yuzheng is implicd in thc
proccss ol diffcrcntiation ol pattcrns (bianzheng) and thcrapy dctcrmination
(zhifa). Yuzheng, likc all othcr zhongyi illncsscs, is pcrccivcd as a disordcrcd
psychophysiological proccss, and hcncc attcntion is always givcn to thc tcm
poral and spatial qualitics ol thc dynamic rclations ol thc symptoms. As shown
in tablc 6.., yuzheng in gcncral may appcar as various pattcrn configurations
and may cvcn acquirc diffcrcnt illncss namcs. Òn thc onc hand, thcsc pattcrn
configurations can bc sccn as diffcrcnt stagcs ol thc samc illncss proccss. From
qi stagnation, to firc, to phlcgm, and to dcplction, wc can casily rccognizc thc
tcmporal and spatial continuitics among thcsc pattcrns. Òn thc othcr hand,
thcy arc uniquc configurations ol particular social and psychophysiological
MANI FESTATI ONS OF YU 91
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92 TRANSFORMI NG EMOTI ONS
cnvironmcnts ol thc timc that call lor diffcrcnt namcs and diffcrcnt thcrapics.
¡motion stagnation affccts thc thrcc visccral systcms ol thc livcr, thc splccn,
and thc hcart most lrcqucntly.
Tc pattcrns listcd in tablc 6.. arc by no mcans all ol thc configurations
that arc pcrtincnt to qingzhi or yu disordcrs, but thcy arc thc most common
oncs that ! cncountcrcd during my clinical obscrvations ol a particular physi
cian who is known as cspccially adcpt at trcating various yu illncsscs.'⁷ Tc cascs
! prcscnt bclow dcmonstratc both thc sharcd clinical knowlcdgc ol trcating
yu disordcrs by zhongyi physicians in thc past and prcscnt and thc particular
physician’s cxpcricncc, stylcs ol doctoring, and pcrsonal synthcsis ol various
sourccs ol knowlcdgc in his approach to cmotionrclatcd illncsscs.
Òccasionally, qingzhi bing or yuzheng is dircctly rclcrrcd to in thc clinics,
but vcry oltcn it is implicd in a particular pattcrn ol syndromc manilcstation
and unloldcd in thc proccss ol pattcrn diffcrcntiation and thcrapy dctcrmina
tion. Tcn, lor thc rcscarchcr, rccognizing a qingzhi-rclatcd disordcr itscll is
an intcrprctivc proccss involving thc making out ol mcaninglul conncctions
among symptoms (zheng 症), syndromc pattcrns (zhenghou 证候), thcrapcutic
principlcs (zhifa 治法), hcrbal lormulas (fangyao 方药), and rclcrcnccs to thc
matcrials ol thc mcdical classics, and most ol all involving thc undcrstanding ol
clinical communications bctwccn thc doctor and thc paticnt.
Ganqi Yujie (thc Livcr Qi Stagnation)
As discusscd abovc, clinically yuzheng (stagnation illncss) starts whcn imbal
anccd cmotions upsct thc qi circulation. Òncc cxccssivc angcr causcs thc qi
Table 6.2 Distribution of Qingzhi Disorders According to Zheng (Patterns)
Among 150 Patients
Differentiation of Zheng
(Syndromes)
No. of
cases
 of the
cases Liver Heart Spleen Kidney
Gall
Bladder
Tc livcr qi stagnation 23 15 23 7 4 1
Stagnant qi turncd into
firc
11 7 11 3 3
Qi stagnant and
phlcgm congcstion
28 19 23 22 1
Tc hcart yin dcplction 27 18 1 27 2 1
8oth hcart and splccn
dcplction
17 11 17 17
Yin dcplction and
dcplctcd firc
30 20 9 23 10
Òthcr 14 9 4 5 1 2 7
Total 150 100 71 104 27 14 8
Ðiffcrcntiation ol zhcng is bascd on thc first diagnosis as qingzhi rclatcd.
MANI FESTATI ONS OF YU 93
movcmcnt to rcvcrsc and to block thc circulation, it hurts thc livcr systcm first
sincc thc livcr lunctions to dispcrsc qi. !t is vcry likcly that thc accumulatcd
stagnant qi in thc livcr systcm cncroachcs on thc stomach systcm (ganqi fan
wei 肝气犯胃). Tcrclorc, thc manilcstations also includc thc symptoms pcr
taining to thc splccn and thc stomach systcm, such as “lcclings ol prcssurc in
thc stomach arca and lrcqucnt hiccups,” “abdominal gas and loss ol appctitc,”
“vomiting,” and “abnormal bowcl movcmcnt.” For a lcmalc paticnt, sincc qi is
thc driving lorcc ol thc movcmcnt ol blood in circulation (qi wei xue zhi shuai
气为血之帅), and whcn qi gcts stagnant, thc blood tcnds to congcal, thc paticnt
may cxpcricncc disordcrcd mcnstruation. Yuzheng, in its narrow scnsc, rclcrs
particularly to thc illncss manilcstation at this stagc ol livcr qi stagnation. Tc
tcmporal and spatial dimcnsion is markcd by an cxtcnsion lrom thc livcr sys
tcm to thc stomach systcm and to thc congcstion ol thc blood. !n my clinical
obscrvation, ganyu was a lrcqucnt initial manilcstation ol thc qingzhi disordcr.
As shown in tablc 6.a, among thc .¸c paticnts who suffcrcd qingzhi disordcrs,
.¸ pcrccnt suffcrcd purcly lrom livcr qi stagnation. 8ut, il wc considcr thc cascs
ol livcr qi stagnation combincd with livcr firc and pathological phlcgm, thc
pcrccntagc ol thc livcr qi stagnation is ¡. pcrccnt.
!n my first illustrativc casc, a ¸¸ycarold woman camc to thc clinic origi
nally lor a hcadachc. Shc was diagnoscd as suffcring lrom a hcatrclatcd disor
dcr and was prcscribcd mcdicinc to nourish thc blood and clcar hcat (yangxue
qingre 养血清热) . Shc camc back a wcck latcr. Shc lookcd cvcn morc dcprcsscd
and unhappy. Shc told thc doctor that altcr taking six bags ol hcrbal mcdicinc,
hcr hcadachc sccmcd to improvc, but shc lclt qi prcssurc in hcr hcart (xinli bieqi
心里憋气), and thcrc was a scnsc ol blockagc (fadu 发堵) in hcr chcst. Shc gavc
long sighs as il by doing this shc could hclp hcrscll rclcasc somc ol thc qi stuck
insidc hcr chcst. Shc also had cxpcricnccd a bloatcd stomach and abdomcn and
complaincd ol hcart vcxation (xinfan 心烦) and bad tcmpcr. Vhilc talking, shc
brokc into tcars. Shc bcgan to tcll thc doctor that shc had movcd to 8cijing
lrom Shandong provincc in .µ·¸ lollowing hcr husband’s translcr. Shc had not
had a pcrmancnt job sincc. Shc rcgrcttcd moving to 8cijing. !n Shandong shc
was a high school tcachcr and hcr work was mcaninglul and rcspcctcd by oth
crs. Now shc workcd as a tcmporary clcvator opcrator. Shc lclt hcr lilc was
complctcly mcaninglcss. Hcr mothcr had dicd scvcral months bclorc at thc agc
ol ·µ. Altcr that, shc cricd almost cvcry day. Hcr son had bccn admittcd into
8cijing Collcgc ol Political Scicnccs, and shc hatcd thc idca that hcr son was
going to study somcthing rclatcd to politics, which, shc thought, was usclcss,
cmpty, and potcntially dangcrous. Shc wantcd him to bc an cnginccr.
Tc doctor procccdcd with his cxamination whilc listcning to thc paticnt.
Tc paticnt’s pulsc was hcavy and thin (chenxi 沉细), thc color ol hcr tonguc
was dark, and thc coating was whitc and thin. According to thc syndromc dil
lcrcntiation, thc paticnt suffcrcd livcr qi stagnation (ganqi yujie). Tcrapcutic
principlc was dctcrmincd to dispcrsc thc livcr systcm and rcvitalizc thc flow
ol qi and to dissolvc thc stagnancy and climinatc vcxation (shugan liqi, jieyu
94 TRANSFORMI NG EMOTI ONS
chufan 疏肝理气, 解郁除烦). Tc paticnt was prcscribcd thc modificd Chaihu
Shugansan 柴胡舒肝散 (thc lormula ol buplcuri lor dispcrsing thc stagnant
livcr qi).” Fivc morc hcrbs wcrc addcd to thc original lormula.
Tc paticnt’s illncss was obviously qingzhi rclatcd and had a clcar social
origin. Tc first timc shc camc in, shc mainly complaincd about thc hcad
achc and thc scnsation ol hcat in fivc hcarts (wuxin fanre 五心烦热). Tc tip
ol hcr tonguc was rcd, and thc coating was ycllow. All symptoms pointcd to
hcat damagc. Òn thc sccond visit, thc symptoms wcrc diffcrcnt, and thc wholc
pathological configuration changcd. Tcrclorc, a ncw diagnosis was rcquircd.
Tc doctor commcntcd that thc paticnt’s illncss camc lrom a situation in which
cvcrything was going against hcr hcart’s will (zhushi bushunxin 诸事不顺心),
and thcrclorc hcr hcartcmotion was constraincd (xinqing yayi 心情压抑),
which causcd thc impcdcd qi mcchanism lcading to qi accumulation in thc livcr
systcm. ! cxprcsscd doubts that thc hcrbal mcdicinc would bc cffcctivc, sincc
wc alrcady kncw that thc paticnt’s problcm rcsultcd lrom hcr social situations
and cmotional cxpcricnccs. Tc doctor rcspondcd positivcly without hcsitation:
“!t will dcfinitcly work” (kending guanyong 肯定管用). Hc cxplaincd that thc
hcrbs hclp attunc thc bodily lunctions. Òncc thc bodily lunctions improvc,
thc symptoms will rcccdc, thc paticnt’s bodily cxpcricncc will bc altcrcd, and
thc paticnt’s hcartcmotion (xinqing) will ccrtainly changc lor thc bcttcr. For
zhongyi doctors, thc symptoms, such as blockagc in thc hcart, prcssurc in thc
chcst, and cmptylullncss (piman 痞满) in thc stomach arc not imagincd or
sccondary to anything. Tcy arc rcal cxpcricnccs that can bc trcatcd by taking
hcrbal mcdicinc. ! pcrsonally hcard many timcs that a paticnt camc back to
thc clinic and claimcd, “My hcartcmotion is lccling much bcttcr” (xinqing hao
duo le 心情好多了). Tc doctor also agrccd that thc paticnt suffcring lrom a
qingzhi disordcr tcndcd to rclapsc. “Òncc you scc a paticnt coming lor trcat
mcnt and rccovcrcd, and thcn coming back again, you immcdiatcly know that
thcrc must bc problcms in hcr social cnvironmcnt. 8ut a doctor can only do as
much as hc can.”
Ðoctors do much morc than just prcscribc hcrbal mcdicinc. !n thc abovc
casc, thc doctor was cngaging thc paticnt in a convcrsation whilc cxamining hcr
and composing a hcrbal lormula. Hc showcd his sympathy with thc paticnt and
agrccd with hcr that it was not always good to givc up cvcrything just to gct
into 8cijing. Hc thcn wcnt on to say that thcrc wcrc still thousands ol pcoplc
on thc waiting lists lor a rcsidcntial quota in ordcr to movc into 8cijing, and shc
would bc considcrcd lucky by thosc who wcrc still waiting. Vhcn thc paticnt
talkcd about thc dcath ol hcr mothcr, hc askcd about thc agc ol hcr mothcr.
Tc doctor thcn said that thc mothcr had livcd a “long lilc” (gaoshou 高寿), was
somcthing, in thc ancicnt timcs, worth cclcbrating. As lor thc paticnt’s com
plaint about hcr son’s choicc ol school, thc doctor commcntcd that cvcrybody,
cvcn thc paticnt’s son, has a piccc ol his own sky abovc his hcad and shc could
not livc lor him. Hc spokc ol his cxpcricncc with his own son who, against his
will, insistcd on going into busincss. Finally, hc said jokingly to thc paticnt,
MANI FESTATI ONS OF YU 95
Vho knows, somcday your son might bccamc an important political figurc.”
Tc paticnt could not hclp but smilc.
QIYU HUAHUO 气郁化火
( STAGNANT QI TRANSFORMED I NTO FI RE)
According to thc zhongyi physiology, oncc thc stagnant qi is accumulatcd and
condcnscs lor somc timc without an opcn passagc to channcl it out, it turns into
firc (yu jiu hua huo 郁久化火). Ðiffcrcnt symptom configurations rcflcct this
physiological changc. Sincc livcr firc tcnds to flarc upward, thc paticnt may cx
pcricncc hcadachcs and dizzincss, and thc lacial complcxion tcnds to bc slightly
rcd. Sincc thc livcr is conncctcd with thc gall bladdcr, thc firc togcthcr with thc
qi ol thc gall bladdcr movcs upward and thc paticnt may cxpcricncc dry throat
and bittcr mouth. Vith thc wood (thc livcr systcm) losing its clasticity (ability
to cxtcnd) (tiaoda 条达), thc paticnt may bc short tcmpcrcd and irritablc. As
thc livcr firc disturbs thc lunctions ol thc stomach, thc paticnt may also cxpcri
cncc gastric discomlort with acid rcgurgitation (caoza tunsuan 嘈咂吞酸) and
dry stool. Tc livcr firc also cxtcnds to thc hcart systcm (which is ncxt to thc
wood phasc in thc wuxing production scqucncc) and disturbs thc hcartmind
(xinshen 心神), and thc symptoms ol vcxation and agitation appcar. Tc tonguc
is rcd, thc coating ycllow, and thc pulsc strung and last. All thcsc symptoms
show that thc stagnation ol qi has translormcd into firc. Howcvcr, cxccssivc
angcr and ragc damagc thc livcr systcms dircctly and may lcad to livcr firc with
out an initial pcriod ol livcr qi stagnation. Somc clinicians scc this syndromc as
a prcludc to morc scrious mcntal illncss, sincc il thc condition worscns, it can
lcad to “crazincss” (kuangluan wuzhi 狂乱无知).'⁸
!n my sccond illustrativc casc, a woman ol a¸ ycars old, was marricd scvcral
months bclorc shc camc to thc clinic. Shc complaincd that shc had disturbcd
slccp. !t was difficult lor hcr to lall slccp, and shc wokc up casily. Shc was ir
ritablc and bad tcmpcrcd (piqida 脾气大). Shc said shc did not know why shc
had such a “big firc” (huoqida 火气大) and bccamc angry so casily. Shc had an
urgc to brcak things and had alrcady smashcd thc mirror and thc casscttc playcr
at homc. !n rcply to thc doctor’s qucstion whcthcr shc lclt wrongcd (weiqu
委屈) and tcndcd to cry a lot, thc paticnt said that shc had scldom cricd bclorc
shc was marricd, but lound hcrscll constantly crying altcr shc was marricd. Shc
complaincd about hcr husband’s narrowmindcdncss (xiao xinyan 小心眼) and
said that hcr husband lound lault with hcr ovcr trifling things. Tc doctor told
hcr that insomnia was not hcr problcm, thc problcm was hcr vcxation. Hcr casc
bclongcd to thc catcgory ol insomnia causcd by vcxation ol thc hcartmind
(xinfan bude mian 心烦不得眠), so thc trcatmcnt should locus on hcr hcart
mind problcm. Tc doctor thcn askcd about thc paticnt’s background, such as
il shc was thc youngcst in hcr lamily and il shc was considcrcd to bc spoilcd
(jiaoqi 娇气). Tc paticnt was actually thc oldcst child with a youngcr sistcr and
a brothcr. Shc also dcnicd that shc was spoilcd but said bclorc hcr marriagc
96 TRANSFORMI NG EMOTI ONS
shc was gcncrally considcrcd nicc and good tcmpcrcd (piqi hao 脾气 好). Shc
brokc into tcars. At thc cnd ol thc consultation, thc doctor rclcrrcd thc paticnt
to mc, saying that shc should talk with mc and that ! was doing rcscarch on
cmotionrclatcd problcms.
Tc paticnt’s complcxion was slightly rcd. Shc had a bittcr mouth and dry
throat, suggcsting thc livcr firc and thc gallbladdcr qi moving up. Tc tip ol hcr
tonguc was rcd, but thc coating was whitc, which did not totally support thc
othcr symptoms. Hcr pulsc was strung and last. Hcr syndromc was diffcrcnti
atcd as “thc stagnant livcr qi turning into firc” (ganyu huahuo 肝郁化火), though
thc doctor pointcd out that somc ol thc symptoms did not totally support thc
syndromc diffcrcntiation. For cxamplc, thc whitc coating ol thc tonguc did not
support thc prcscncc ol thc firc. Howcvcr, thc doctor, in considcration ol thc
wholc symptom configuration, camc to thc conclusion that thc stagnant qi had
just startcd to turn into firc. Hc cxplaincd that thc paticnt’s main problcm was
ganyu that had alrcady shown thc sign ol firc. Tcrclorc, thc thcrapcutic prin
ciplc was to dispcrsc thc livcr qi, dissolvc thc stagnation, and climinatc vcxation
(shugan, jieyu, chufan 疏肝解郁除烦). Tc paticnt was prcscribcd xiaoyao san 逍
遥散 (xiaoyao powdcr), with two othcr hcrbs addcd to strcngthcn thc lunction
ol climinating vcxation.
!n this casc, thc paticnt and thc doctor both rccognizcd that thc paticnt’s
suffcring was not a simplc physical discomlort. Tc paticnt complaincd mainly
about hcr insomnia but pointcd to hcr angcr and hcr dissatislaction with hcr
marriagc as thc sourcc ol hcr suffcring. Tc doctor’s qucstions wcrc also dircctcd
to thc social origin ol thc illncss and hc concludcd that insomnia was not thc
problcm, but ganyu (thc livcr qi stagnation). Livcr qi stagnation is undcrstood
as an cmotion disordcr coming lrom thc blockcd circulation in an cmotional,
social, and physical scnsc. Vhcn this qi is blockcd lor a pcriod ol timc, it starts
to turn into livcr firc that manilcsts itscll in a pcrson in thc lorm ol cxccssivc
angcr and irascibility. Tis zhongyi conccpt has long bccomc “commonscnsc.”
!n cvcryday languagc, whcn somcbody is irritablc and tcnds to bccomc angry
casily, shc is said to bc “having a big firc qi” (huoqi da)or “having a big livcr firc”
(ganhuo wang 肝火旺).
Tc paticnt and ! walkcd out ol thc clinic togcthcr and lound a rclativcly
quict corncr in thc waiting arca lor a convcrsation. !t was not a strict intcrvicw
lormat. My rolc as an anthropologist at thc momcnt was dubious. ! was incor
poratcd into thc clinical proccss, morc to listcn and offcr my support than to
clicit answcrs to anthropological qucstions. Vhcn ! camc back to thc clinical
room and supplicd thc doctor with morc dctailcd inlormation about thc pa
ticnt, hc said that thc zhongyi tradition has cncouragcd thc doctor to considcr
inlormation that gocs bcyond thc immcdiatc physical symptoms. For cxamplc,
Neijing: Suwen (,,) cmphasizcs that a doctor, whcn trcating a paticnt, has to
takc into considcration changcs in thc natural cnvironmcnt (tianshi 天时), thc
social and cconomic situation (renshi 人事), and thc visccral (zangxiang 脏象)
and pulsc (maise 脉色) manilcstations. !t is considcrcd a mistakc (guo 过) lor
MANI FESTATI ONS OF YU 97
thc doctor not to cnquirc about thc paticnt’s social background and cmotional
changcs, such as il thc pcrson has cxpcricnccd changcs lrom a high status to a
lowcr status, financial changcs, ambition lor powcr or suddcn joy, sadncss, or
angcr. Traditionally, such inlormation was morc rcadily acccssiblc to thc doctor,
who, usually, was a knowlcdgcablc and wcllrcspcctcd mcmbcr ol thc com
munity and was routincly callcd to thc paticnt’s homc to trcat thc paticnt.
Howcvcr, thc doctor said that today’s zhongyi practicc is organizcd in a way
diffcrcnt lrom what it uscd to bc and that a doctor has to makc a dclibcratc cl
lort to gct pcrsonal inlormation bcyond a paticnt’s immcdiatc illncss conccrns.
Yct a modcrn zhongyi doctor is cautious about asking scnsitivc qucstions. Hc
or shc dcpcnds morc on pcrsonal cxpcricncc and intuition as wcll as communi
cation skills to undcrstand thc paticnt’s situation. !n addition, unlikc a typical
psychologist, who dcpcnds on insight into thc paticnt’s intrapsychic conflicts
lor cffcctivc trcatmcnt, a zhongyi doctor docs not nccd to know cvcry dctail ol
thc paticnt’s pcrsonal lilc and social rclations to diffcrcntiatc a syndromc or
dcsign an hcrbal lormula.
Qizhi Tanyu 气滞痰郁
(Qi Stagnation Lcading to Congcstion ol Phlcgm)
Tc syndromc is also known as “congcstion ol phlcgmatic qi” (tanqi yujie 痰气
郁结). Vhcn thc livcr qi is stagnant, it cncroachcs on thc splccn systcm that
bclongs to thc carth phasc. !t intcrlcrcs with thc splccn’s lunctions ol trans
lorming and transmitting (yunhua 运化) nutricnts and watcr throughout thc
body. Tc dampncss is thcn accumulatcd to lorm phlcgm, which lurthcr blocks
thc movcmcnt ol qi in thc body. Tis particular doctor offcrcd a diffcrcnt cx
planation lor thc phcnomcnon ol phlcgmatic qi congcstion. His logic was that
ganyu lcads to firc, which drics up thc bodily fluid (jinye 津液) and turns it
into rclativcly thick phlcgm. Tis pathological proccss is known as “burning
thc bodily fluid into phlcgm” (zhuojin huatan 灼津化痰), which points to two
physiological conscqucnccs. Ònc is thc potcntial dcplction ol vital fluid, which
will lcad to thc condition ol yin dcplction, thc othcr is thc blockagc ol circula
tion which is much hardcr to trcat than thc stagnation ol qi.
Vhcn thc blockagc lormcd by congcalcd phlcgm is abovc thc thoracic
arca, thc paticnt cxpcricnccs thc scnsation ol an alicn objcct stuck in thc throat,
which cannot bc spit out or swallowcd. Tis manilcstation typc has acquircd thc
rathcr vivid illncss namc, “thc plum pit qi” (meiheqi 梅核气). Tis illncss tcrm
was first uscd by thc Han dynasty physician, Zhang Zhongjing to rclcr to an
illncss that was latcr includcd in yu disordcrs. Ðuring my clinical obscrvation, !
noticcd two cascs ol thc plum pit qi. Ònc such casc was particularly intcrcsting.
Tc paticnt lrcqucntly clcarcd hcr throat and lound a thrcad ol blood in hcr
phlcgm. Shc lcarcd that thcrc was somcthing growing in hcr throat. Tc doc
tor, altcr cxamining hcr, told hcr that thcrc was nothing growing in hcr throat
and that hcr illncss was actually “qi congcstion” (qi bing) originating lrom angcr
98 TRANSFORMI NG EMOTI ONS
(shengqi 生气).'⁹ Hcaring this, thc paticnt agrccd complctcly with thc doctor
that hcr illncss all startcd lrom hcr rcscntmcnt about hcr husband’s intimatc
rclationship with onc ol his lcmalc collcagucs. Shc askcd thc doctor to tcll
hcr husband cxactly what hc had told hcr whcn hcr husband callcd to inquirc
about thc clinical rcsult. !n a scnsc, by involving thc doctor in an intcraction
with thc lamily mcmbcrs, thc paticnt succcsslully cmploycd thc doctor’s hclp
in manipulating hcr social rclations. Tc paticnt latcr told mc admiringly that
thc doctor was so cxpcricnccd (you jingyan 有经验) that hc could immcdiatcly
dctcct what thc rcal problcm was.
!l thc hctcropathic qi ol phlcgm continucs to block thc passagc, it may
finally disturb “thc clcar opcnings” (shangrao qingqiao上扰清窍) and “blind thc
hcartmind” (mengbi xinshen 蒙蔽心神). Tis particular stagc ol thc patho
logical coursc is callcd “thc phlcgm blocking thc opcning ol thc hcartmind”
(痰迷心窍). Tc symptom configuration thcn may includc “dcprcsscd mood,”
“indiffcrcnt cxprcssions,” “quictncss and motionlcssncss,” “illogical spccch,”
“sclltalk,” and “unprcdictablc changcs ol mood bctwccn happincss and angcr.”
Tis manilcstation ol syndromc configuration is also known as “dian 癫,” char
actcrizcd by quictncss, abscntmindcdncss, incohcrcnt languagc, and a pcrpctual
“happy lacial cxprcssion.” Dian is also discusscd in rclation to “kuang 狂,” char
actcrizcd by “loudncss and rcstlcssncss,” “violcnt bchavior,” and bcing “lull ol
angcr.” Tcsc two illncsscs cannot bc strictly scparatcd in symptoms and arc
ablc to translorm into cach othcr. Tcrclorc, dian and kuang arc somctimcs
discusscd togcthcr as onc illncss, diankuang.´⁰
Sincc thc mcntal and cmotional disturbancc ol dian is scrious cnough to
bc rccognizcd as lullblown mcntal illncss (jingshen bing 精神病), in many tcxt
books dian is not includcd in thc discussions ol qingzhi (cmotionrclatcd) dis
ordcrs.´' Yct thc diffcrcncc bctwccn a qingzhi disordcr and dian is sccn mainly
as a diffcrcncc ol “du” (dcgrcc, position).´´ Paticnts suffcring lrom dian do comc
to scc doctors ol zhongyi. Ðuring my cntirc pcriod ol clinical obscrvation, thcrc
wcrc only two cascs lor which thc doctor uscd dian as thc illncss namc. !n onc
casc, a young lcmalc paticnt visitcd thc clinic with hcr husband. Troughout
thc intcrvicw, thc paticnt rcmaincd cmotionlcss and motionlcss. Shc did not
say a singlc word. Hcr husband did all thc talking. Tc paticnt was a managcr
ol a swcatcr lactory. Shc had signcd six contracts with clicnts within scvcral
months and had bccomc cxtrcmcly worricd about hcr lactory’s ability to lulfill
thc contracts. Shc had dcvclopcd insomnia and was constantly rcstlcss. Tc
symptoms wcrc gctting worsc. Shc was suicidal, wccping, and bccamc incrcas
ingly abscntmindcd, to thc point that shc was not ablc to work at all. Tc
doctor’s diagnosis was “thc opcning ol thc hcartmind blockcd by congcalcd
phlcgm” (tan mi xin qiao). Hc addcd, “according to zhongyi, this is dian.” Tis
paticnt did not rcturn to thc clinic altcr hcr first visit. No lurthcr inlormation
on this paticnt was obtaincd.
Tc sccond casc was a aaycarold malc univcrsity studcnt. Hc camc to thc
clinic thrcc timcs, showing stcady improvcmcnt cach timc. Tc first timc hc
MANI FESTATI ONS OF YU 99
camc, hc did not talk at all. Hc was cxprcssionlcss and withdrawn. His mothcr
did most ol thc talking. According to his mothcr, hc was a studcnt in a prcsti
gious univcrsity in 8cijing. Hc was traumatizcd and bccamc ill.´` Hc cxpcri
cnccd dclusions, was dcprcsscd, and wantcd to kill himscll. Tc doctor said that
in zhongyi languagc, thc paticnt was suffcring dian illncss or tan mi xinqiao. Tc
third timc, ! saw him, though hc still lookcd passivc, hc talkcd about his illncss
himscll and told thc doctor that hc had lclt an improvcmcnt. At lcast hc could
slccp lor scvcral hours at a timc. Òthcr cascs that wcrc rclatcd to “hctcropathic
phlcgm that disturbcd thc hcartmind” (tan rao xinshen 痰扰心神) wcrc not
as scrious as tan mi xinqiao. Tcrclorc, thc doctor did not cxplicitly talk about
thosc cascs as dian.
!n thc third illustrativc casc, a ¸cycarold man accompanicd by his wilc
camc to scc thc doctor. Hc was thc last paticnt ol that morning. Hc sccmcd
vcry rcluctant to comc into thc clinic, and his wilc litcrally pushcd him into thc
consulting room. Hc lookcd mclancholy and diffidcnt. His voicc was solt and
low. Hc complaincd about dizzincss, hcartmind not togcthcr (jingshen huan-
ghu 精神恍惚), difficulty slccping, thinking too much, suspiciousncss (duoyi
多疑), and lack ol confidcncc (zuoshi weisuo 做事畏缩). Hc said that hc crc
atcd troublc lor himscll (ziji gen ziji guo buqu 自己跟自己过不去). and that hc
was ovcrscnsitivc (xiao xinyan 小心眼). Hc thought his problcm startcd with
worry ovcr thc hcalth ol his son, who was diagnoscd as having myocarditis just
bclorc thc paticnt had lclt homc on a pcrlormancc tour (hc was a musician).
Hc was worricd about his son and callcd homc almost cvcry day. Hc was scll
rcproachlul and lclt guilty lor his son’s illncss. His wilc addcd that thc paticnt
had his only son at thc agc ol ¡¸. Tc paticnt talkcd about his son inhcriting his
own wcakncss ol ovcrscnsitivity. Hc blamcd himscll lor influcncing his son’s
pcrsonality. Hc talkcd about his difficulty in conccntration and said that hc
constantly madc mistakcs whilc playing on stagc. Hc told thc doctor that hc
lound his fingcrs involuntarily brushing against things without control.
Syndromc diffcrcntiation pointcd to livcr qi stagnation lcading to phlcgm
congcstion. Tc turbidity ol phlcgm obscurcs thc paticnt’s hcartmind (shen-
ming 神明). Tc doctor told thc paticnt that his problcm was mainly mcntal in
naturc (jingshen xing de 精神性的). A thcrapcutic trcatmcnt was sct to clcar thc
hcart, dispcrsc thc phlcgm, calm thc mind, and stabilizc thc intcllcct (jingxin
huatan, anshen dingzhi 清心化痰, 安神定志). Hc was prcscribcd dccoction ol
pinclliac and magnoliac officinalis (banxia houpu tang 半夏厚朴汤) with scv
cral morc hcrbs addcd to it to strcngthcn thc lunction ol climinating thc hcat.
Tc doctor thought thc paticnt’s illncss showcd thc tcndcncy ol dian but not to
thc lull cxtcnt ol dian, but il thc condition wcnt on without appropriatc trcat
mcnt, thc illncss could dcvclop into a scrious mcntal disordcr.
!n many cascs, cxccssivc thinking and worrying (silu guodu 思虑过度) can
bc thc dircct causc ol thc syndromc ol phlcgm congcstion. As known in zhongyi,
thinking and worrying (silu) arc cmotions ol thc splccn systcm. Vhcn a pcrson
thinks and worrics too much, thc splccn systcm is dircctly affcctcd. Ðampncss
100 TRANSFORMI NG EMOTI ONS
is collcctcd to lorm thc pathological phlcgm, which convcrgcs with thc phlcgm
problcm causcd by livcr qi stagnation. Tc pathological proccss ol yu up to this
point dcmonstratcs thc pattcrn ol rcplction. Tc body’s orthopathic qi (zhengqi
正气) is not yct significantly consumcd, and thc hctcropathic qi (xieqi 邪气) is
dominantly prcscnt.
Xinyin Kuixu 心阴亏虚 (thc Hcart Yin Ðcplction)
As can bc sccn lrom thc abovc, whcn thc pathological condition ol thc stag
nation ol qi continucs, it turns into firc. Tc firc consumcs thc hcartblood
(haoshang xinxue 耗伤心血), and thc yin aspcct ol thc hcart bccomcs dcplctc.
Òncc thc hcart yin blood is dcplctcd, it is not ablc to nourish (ruyang 濡养)
thc hcartmind (xinshen 心神). Tc mind and spirit that rcsidc in thc visccra
ol thc hcart losc thcir homc (shen bu shou she 神不守舍), and thc symptoms ol
hcartmind uncasincss (xinshen buning 心神不宁), abscntmindcdncss (jing-
shen huanghu), lorgctlulncss, insomnia, and cxccssivc drcaming appcar. Òncc
thc hcart yin is dcplctcd, thc unchcckcd hcartfirc riscs up to disturb thc hcart
mind, and thc paticnt lccls upsct and pcrturbcd (xinfan yiluan 心烦意乱) and
unablc to sit still (zuowo buan 坐卧不安). Òncc hcartmind lacks nourishmcnt,
thc ability to makc judgmcnts and solvc problcms is scriously impcdcd, and thc
paticnt shows slowncss in rcsponsc and a dcprcsscd mood. Sincc thc dcplctcd
yin is not ablc to constrain or balancc thc yang (yin bu lian yang 阴不敛阳), thc
firc duc to dcplctcd yin bccomcs rampant (xuhuo wangdong 虚火妄动), and
somatic manilcstations appcar, such as hotncss in thc fivc hcarts (wuxin fanre
五心烦热), swcating palms, dry mouth and throat, slightly rcd complcxion, rcd
tonguc with littlc coating, and thin and last pulsc.
Tis syndromc is also rclcrrcd to in thc mcdical classics and in prcscnt day
zhongyi clinics as “zangzao 脏躁” (thc visccral agitation) charactcrizcd by thc
symptoms ol rcstlcssncss, sadncss, and a tcndcncy to wccp and sigh. Tc illncss
namc zangzao appcars carly in Shanghan Zabing Lun 伤寒杂病论 (Discussion of
Cold Damages and Various Disorders), which dcscribcs thc illncss as “constantly
lccling sad and wccping” (xi beishang yuku 喜悲伤易哭). Tc samc author,
Zhang Zhongjing, in Jingui Yaolue 金匮要略 (Essentials of Golden Casket), in
cludcd zangzao bing in his discussion ol womcn’s illncsscs: “A woman who sul
lcrs zangzao is sad and likcs to wccp, as il posscsscd by a spirit, and tcnds to yawn
lrcqucntly.”´⁴ Tc mcaning ol zao 躁 is lairly clcar, suggcsting disturbancc and
rcstlcssncss ol cmotions. Tcrc havc bccn discussions as to what in thc visccral
systcm thc charactcr zang 脏 rclcrs. Somc bclicvc that sincc zangzao was origi
nally sccn as a woman’s illncss, zang may stand lor “womb” (nuzibao 女子胞).
Òthcrs insist that it rclcrs to thc hcart systcm, sincc thc hcart systcm is rcspon
siblc lor shenming (consciousncss, intcllcct). Sincc zangzao dcscribcs a mcntal
and cmotional disturbancc, zang must stand lor thc hcart. Tis was clcarly statcd
in Yi Zong Jinjian 医宗金鉴 (Standard Collcction ol Mcdical Vorks), cditcd by
Vu Qian and othcrs (.,¡a): “Zang, rclcrs to thc hcart (xin). Vhcn thc hcart is
MANI FESTATI ONS OF YU 101
tranquil, shén (thc mind, consciousncss) is containcd. Vhcn thc hcart systcm is
injurcd by thc scvcn cmotions, it loscs its pcacclulncss, and shén would bccomc
agitatcd and rcstlcss.”´⁵ Yct, in actual practicc, doctors tcnd not to limit thcir
scopc to a singlc visccral systcm. Tang Rongchuan (.·¡6–µ,), a Qing physician,
statcd that doctors should not bc rcstrictcd to a singlc visccral systcm, whcn thc
symptoms ol zao (cmotional agitation or disturbancc) arc obvious. “Vhcn thcrc
arc symptoms ol sadncss and wccping as il thc paticnt is posscsscd by ghosts, it
is clcar that thc hcart has bccn afflictcd, whcn thcrc arc symptoms ol cxccssivc
yawning and strctching, it is clcar that thc kidncy has bccn affcctcd.”´⁶
!n modcrn zhongyi clinics, zangzao is lound in both malcs and lcmalcs.
Tc paticnt suffcring zangzao is dcscribcd as “lccling likc to walk but could
not, lccling likc to slccp but could not” (yuxing bude xing, yuwo bude wo 欲行
不得行, 欲卧不得卧).
!n my lourth illustrativc casc, a ¸¸ycarold malc paticnt who camc across
thc manulacturcd “hcrb concoction to dispcrsc stagnation and stabilizc thc
mind” at a pharmacy tricd it and lound it hclplul. So hc camc to scc thc doctor
who dcvclopcd thc mcdicinc, hoping hc could bc curcd ol thc illncss that had
bothcrcd him off and on lor morc than filtccn ycars. Hc complaincd that hc
was lccling rcstlcss (zuowo buan 坐卧不安) and hcartmind disturbcd (xinshen
buning 心神不宁). Hc had to walk outsidc constantly rcgardlcss ol whcthcr it
was raining or snowing. Hc also complaincd that his vision was not clcar and
that hc had a runny nosc. Hc had difficulty in slccping,. and oltcn had to takc
slccping pills. Hc first bccamc ill during .µ,, and .µ,· whcn hc was busy study
ing ¡nglish in prcparation lor going abroad. Hc thought that his illncss must
havc bccn causcd by anxicty and strcss. Vhilc hc was talking to thc doctor, his
hands wcrc trcmbling slightly. Tc tccth marks on his tonguc wcrc clcarly vis
iblc, indicating thc dcplction ol qi that had lcd to a dcplction ol yin. Tc coat
ing ol his tonguc was ycllow and thin. Tc pattcrn ol syndromc was dcscribcd
as cxccssivc thinking and worrying (silu guodu) that had injurcd thc hcart and
splccn and lcd to hcart yin dcplction. Tc thcrapcutic indication was to rcplcn
ish yin and nourish thc blood (ziyin yangxue 滋阴养血) and to supplcmcnt thc
hcart and calm thc mind (buxin anshen 补心安神). Hc was prcscribcd tianwang
buxin dan 天王补心丹 (king ol hcavcn tonic lor thc hcartmind) with addi
tions and subtractions, and thc concoction to dispcrsc thc stagnation and to
stabilizc thc mind to bc takcn bclorc going to bcd.
Tc paticnt camc back again altcr six doscs ol thc mcdicinc. Hc lclt lcss
agitatcd, and his slccp had improvcd. 8y taking his pulsc thc doctor surmiscd
that thc stagnation was still prcscnt. Two morc hcrbs wcrc addcd to thc origi
nal prcscription. Tc doctor said that il thc prcscription workcd, hc would not
changc thc lormula. Unlikc thc prcvious discusscd syndromcs, in this casc “thc
stagnation” (yu) was trcatcd as a dcplction syndromc. Tat is bccausc whcn thc
stagnation is causcd intcrnally by thc scvcn cmotions, it starts damaging thc qi
movcmcnt, and whcn thc stagnation continucs, thc illncss hurts thc blood and
subscqucntly consumcs thc vital substancc and lilc lorcc.
102 TRANSFORMI NG EMOTI ONS
Xinpi Liang Xu 心脾两虚 (Ðcplction ol thc Hcart and thc Splccn)
As thc yin aspcct ol thc hcart is lurthcr dcplctcd, thc rcsult can bc dcplc
tion in both thc hcart yin and splccn qi. Tc dcplction ol thc hcart and thc
splccn can also bc undcrstood as rcsulting dircctly lrom thc cxccssivc cmo
tion ol “thinking/worrying” (silu). Sincc si dircctly affccts thc splccn systcm, it
rcstrains its lunction to transmit and translorm nutricnts (thc sourcc ol both
qi and blood) and to providc nourishmcnt to thc hcart. !n turn, thc dcplctcd
hcart yin is not ablc to lacilitatc thc lunction ol thc splccn and thc stomach
systcm. Tc rcsult is that both blood that is yin and qi that is yang arc dcplctcd.
Tc manilcstation includcs “cxccssivc worrying and thinking” (duosi shanlu 多
思善虑), “palpitation and lcarlulncss (xinji danqie 心悸胆怯), “insomnia and
lorgctlulncss” (shaomei jianwang 少寐健忘). !n lact, in zhongyi clinics, bumei
(insomnia) and xinji (hcart palpitation) arc two lrcqucnt symptoms that bring
thc paticnts to thc doctors. Chincsc paticnts oltcn complain ol xinji and bumei,
two illnesses rccognizcd in zhongyi. Tcy ovcrlap with qingzhi disordcrs, cspc
cially with thc pattcrn ol dcplction in thc hcart and thc splccn.
!n thc filth illustrativc casc, thc paticnt was a 6¡ycarold rctircd malc. His
ncighbor, a young woman, accompanicd him to thc clinic. Tc paticnt com
plaincd about a dry and bittcr mouth. Hc had no appctitc and no tastc lor lood.
Hc was in a bad mood and lclt vcxcd all thc timc. Hc had low cncrgy (jingshen
buhao 精神不好) during thc day. His hcad was hcavy, and his ncck was stiff, and
hc had slccping problcms. Hc had bccn to a biomcdical doctor bclorc hc camc
to thc zhongyi clinic and was givcn two typcs ol tranquilizcrs to hclp him slccp.
Tc color ol his tonguc was palc, and thc coating was whitc, which indicatcd
dcplction ol qi in thc splccn. Hc was givcn hcrbal mcdicinc to strcngthcn thc
splccn systcm. Hc camc back altcr a wcck and told thc doctor that somc ol his
symptoms, such as dizzincss and thc hcavincss ol his hcad, sccmcd allcviatcd.
8ut othcr symptoms, lor cxamplc, his dry and bittcr mouth, poor appctitc, low
cncrgy, and poor slccp rcmaincd thc samc. Hc also had ncw symptoms—flut
tcring hcart , palpitation, and shortncss ol brcath—which also suggcstcd dcplc
tion in his hcart systcm. Tc tonguc manilcstation rcmaincd thc samc.
Tc paticnt had an angry and dcprcsscd look. Tc doctor askcd him il hc
lclt “wrongcd or scllpity” (weiqu 委屈), and thc paticnt rcplicd with an al
firmativc nod. Tcn thc doctor said, as il to himscll, that a pcrson nccds to lccl
gratclul (zhizu 知足) and that cvcrybody occupics a placc in lilc whcrc hc was
bcttcr off than somc and was worsc off than othcrs. At this point, thc doctor
turncd to thc young woman standing bchind and told hcr that shc should takc
hcr lathcr out morc to lct him rclax (sansan xin 散散心). Tc young woman
answcrcd that shc was his ncighbor. Tc paticnt was living by himscll. His wilc
had dicd not long ago, and his only son was abroad. Listcning to thc young
woman’s words, thc paticnt lookcd cvcn morc miscrablc. Vc thought that thc
paticnt’s son had scttlcd in a lorcign country and would not comc back. Ask
ing lor morc inlormation, wc lcarncd that thc son was scnt out to work lor
MANI FESTATI ONS OF YU 103
two ycars and would bc back in lcss than a ycar. Tc doctor thcn bccamc morc
cncouraging, assuring thc paticnt that his illncss was not scrious and that hc
nccdcd to bc morc activc. Hc told thc paticnt not to stay at homc by himscll
dwclling on his own unhappincss but to visit ncighbors (cuancuan men 窜窜门)
and play chcss (xiaxia qi 下下棋) or play cards (dada pai “打打牌).
Tc syndromc was dcscribcd as dcplction in both thc hcart and thc splccn.
Tc cxccssivc silu (sadncss and worrics) dircctly dampcd his splccn lunction
to translorm and transmit vital matcrials ol thc body and lcd to thc dcplction
ol thc hcart sincc thc splccn systcm lailcd to providc yin to nourish thc hcart.
Tc thcrapcutic indication was to strcngthcn thc splccn and rcplcnish thc qi
(jianpi puqi 健脾补气) and to nourish thc hcart and calm thc mind (yangxin
anshen 养心安神). Tc paticnt was prcscribcd guipi tang 归脾汤 (dccoction lor
invigorating splccn and nourishing hcart).
Tc paticnt camc back oncc morc sccming a littlc improvcd. Tc doc
tor told mc that thc paticnt might not bc totally hcalcd bclorc his son camc
back. Hc rclcrrcd to thc zhongyi saying “an illncss duc to cmotion can only
bc complctcly curcd by cmotion” (Yi qing bing zhe, fei qing bu jie 以情病者非
情不解).´⁷
Yinxu Huowang 阴虚火旺
(Yin Ðcplction Lcading to thc Rampant Firc)
Vhcn thc illncss is prolongcd, thc yin ol thc visccral systcms continucs to bc
dcplctcd. Tc hcart yin is dcplctcd, thc livcr yin is dcplctcd, and finally thc
kidncy yin is dcplctcd. Vith thc dcplctcd visccral yin, thc “lalsc yang” (fuyang
浮阳) manilcstcd as rampant firc ariscs. My zhongyi tcachcr uscd thc mctaphor
ol boiling watcr to illustratc thc situation. Hc cxplaincd that whcn thc watcr
in a pot is gctting lcss and lcss, wc hcar a loudcr sound and scc a largc amount
ol stcam coming out ol thc pot as il thc tcmpcraturc is vcry high. Tc cxccssivc
activity insidc thc pot is actually duc to insufficicnt watcr rathcr than thc actual
incrcasc ol thc tcmpcraturc intsidc. Similarly, whcn a pcrson suffcrs lrom a
chronic illncss, and thc visccral yin in various lorms ol vital fluids (blood, watcr,
scmcn, and so on) is consumcd without rcplcnishmcnt, thcrc will bc ovcrcxcitc
mcnt ol “lalsc yang” or “firc.” Sincc this cxccssivc activity ol firc is not causcd
by actual hctcropathic invasion, it is also rclcrrcd to as “firc ol dcplction” (xuhuo
虚火). Tc paticnt may dcmonstratc symptoms that suggcst “livcr firc or hcart
firc,” such as a rcd lacc and cycs, agitation and angcr, dizzincss, palpitation,
insomnia, rcd tonguc with dry coating, dry mouth and throat, and so on. Tc
morc scrious dcplction involvcs thc kidncy systcm. According to thc wuxing
(fivc translormativc phascs) rclationship, thc kidncy systcm is said to bclong
to thc watcr phasc and it storcs jing 精 (vital csscncc) that is cithcr inhcritcd
lrom onc’s parcnts or translormcd lrom thc nutricnts takcn into thc body. Tc
kidncy is thc storagc ol thc lilc lorcc and also thc sourcc ol marrow (sui 髓)
104 TRANSFORMI NG EMOTI ONS
and thc brain sincc thc brain is sccn as “a sca ol marrow” (suizhihai 髓之海).
Tcrclorc, whcn thc dcplction has draincd thc kidncy jing, thc paticnt may cx
pcricncc symptoms ol mcmory dccrcasc, cxccssivc drcams, tinnitus, back pain,
scminal cmission (in malcs), irrcgular mcnstruation (in lcmalcs), and coldncss
in thc lowcr limbs. Tis illncss configuration may havc variations. !t can appcar
as kidncy watcr not sufficicnt to moisturizc thc livcr wood (shui bu hanmu 水
不涵木) or as thc hcart firc not conncctcd to thc kidncy watcr (xinshen bujiao
心肾不交). Tc thcrapcutic proccdurc usually involvcs rcplcnishing yin and
clcansing thc hcat.
!n thc sixth illustrativc casc, thc paticnt was a aµycarold malc. Hc com
plaincd about difficulty slccping during thc night, latiguc and slccpincss during
thc day, ncrvousncss, agitation, and abnormal swcating. His hcad sccmcd hcavy
and cloudcd. His cycs wcrc tircd, and his vision was blurrcd. Hc also had lowcr
back discomlort. Hc thought that his illncss had startcd with a routinc physi
cal cxamination tcn months bclorc. !t was lound that onc ol his physiological
indcxcs was highcr than normal, which indicatcd thc possibility ol hcpatitis 8.
Hc had bccn worricd about bcing ill with hcpatitis 8 cvcr sincc. Hc said his
work was strcsslul, involving constant busincss trips. Although hc had bccn
taking somc manulacturcd Chincsc mcdicinc, thc cffcct was littlc. At most hc
was ablc to slccp only lour hours a day. Tc cxpcricncc was painlul, and hc said
hc would rathcr havc hcpatitis 8 than his prcscnt disordcr that rcndcrcd him
dyslunctional and dcprcsscd. Tc paticnt’s symptom configuration suggcsts
both thc unchcckcd “cmpty firc” that disturbcd thc hcartmind and dcplction
ol thc livcr and kidncy yin. Tc doctor cxplaincd to thc paticnt that his cxccssivc
obscssion with his shenti (hcalth) actually lcd to thc stagnation ol qi, which in
turn was translormcd into firc that consumcd and harmcd thc visccral yin.
Tc syndromc diffcrcntiation was yin dcplction lcading to rampant “cmpty
firc.” Tc thcrapcutic indication was “rcplcnishing thc kidncy yin and rcducing
thc livcr firc” (ziyin pinggan 滋阴平肝). Tc paticnt was prcscribcd qiju dihuang
tang 杞菊地黄汤 (thc dccoction ol rchmanniac with lructus lycii and chrysan
thymi) with additions and subtractions.
Yuzheng (stagnation illncss) as thc corc mcaning ol qingzhi disordcr dcm
onstratcs variations lrom stagnation to dcplction, lrom thc disordcrcd livcr
lunction to thc disordcrcd splccn and stomach lunction, and to thc disordcrcd
hcart and kidncy lunction. Such variations as shown abovc appcar in diffcrcnt
cascs, yct thcy also appcar in thc samc pathological proccss. A paticnt’s illncss
condition may go through diffcrcnt syndromc configurations rcsponding to
thc dynamic clinical proccss ol attuning (tiao 调), which will bc analyzcd in
thc ncxt chaptcr.
105
VI I
Clinical Process of Tiao (Attuning)
!n thc prcvious chaptcrs, ! havc discusscd various cultural, sociohistorical, and
cthnomcdical contcxts in which qingzhi 情志 (cmotion) disordcrs arc conccp
tualizcd, talkcd about, and cxpcricnccd. My analysis has covcrcd sociocultural
and mcdical constructions ol Chincsc bodypcrson, cmotions, cmotionrclatcd
disordcrs, and particularly stagnation (yu 郁). Tc prcscnt chaptcr, locusing on
thc zhongyi clinical proccss, cxamincs how thc pattcrn (zheng 证) ol a particular
qingzhi disordcr casc is dcfincd through ordinary clinical work and how thc
proccss ol attuning/adjusting (tiao 调) works to translorm thc paticnt’s cxpcri
cncc'. An undcrlying idca is that a closc look at an actual lacctolacc clinical
communication maintaincd jointly by both doctor and paticnt can providc an
important insight into thc clinical construction ol qingzhi disordcrs and thc
dynamics ol zhongyi clinical actions and intcractions. !n this chaptcr, ! dclibcr
atcly incorporatc tcchniqucs ol microanalysis as an cthnographic tool in placc
ol an ordinary casc study that normally docs not account lor intcractional as
pccts ol clinical activitics. ! usc actual rccordcd clinical intcractions transcribcd
according to thc convcntions ol convcrsation analysis (CA)´, cxaminc closcly
thc intcractivc lcaturcs and structurcs ol communication bctwccn a zhongyi
doctor and his paticnt, and tracc how a particular syndromc pattcrn is dctcr
mincd and thc path to cfficacy is ncgotiatcd among thc multiplc clinical rcali
tics ol Chincsc mcdicinc.
MI CROANALYSI S AND I TS RELEVANCE
TO ZHONGYI CLI NI CAL ENCOUNTERS
Tcrc has bccn an cxtcnsivc ¡nglish litcraturc on studics ol clinical communi
cation and intcractions bctwccn doctor and paticnt. Particularly, ovcr thc last
two dccadcs, various cmpirical studics havc bccn dcvclopcd lor analysis ol ac
tual mcdical cncountcrs.` Ònc sharcd aspcct ol thcsc studics is thc mcticulous
cxamination ol thc actual communication bctwccn doctor and paticnt. Labov
and Fanshcl’s book Terapeutic Discourse is an carly cxamplc, which is bascd
106 TRANSFORMI NG EMOTI ONS
on a closc sociolinguistic analysis ol a filtccnminutc scgmcnt lrom a scssion
bctwccn a paticnt and hcr psychothcrapist.⁴ !n addition to sociolinguistic and
othcr various lorms ol discoursc analysis, thc approach ol CA has bccn widcly
uscd in microanalysis ol actual clinical intcraction. As thc namc itscll suggcsts,
CA is thc study ol “rccordcd, naturally occurring talkinintcraction” with thc
goal to uncovcr “thc tacit rcasoning proccdurcs and sociolinguistic compctcn
cics” that undcrlic thc production and intcrprctation ol such intcractions.⁵ My
analysis in this chaptcr is particularly inlormcd by thc CA approach, which,
morc than othcr approachcs to discoursc, locuscs on scqucntial organization
ol social intcractions and dcscribcs thc proccdurcs through which participants
thcmsclvcs cngagc onc anothcr “to producc cohcrcnt and intclligiblc courscs ol
action.”⁶ Sincc talkinintcraction is also rccognizcd as cmbodicd social prac
ticc, CA has bccn appropriatcd to invcstigatc thc visual as wcll as thc vocal
clcmcnts ol mcdical intcractions.⁷
Convcrsation analysis (CA) has bccn widcly applicd in closc analysis ol
talk in institutional scttings including clinical intcractions.⁸ CA trcats talk as
scqucntially organizcd social activitics and pays ultimatc attcntion to intcrac
tional mcanings. From this pcrspcctivc, convcrsation is organizcd and man
agcd locally—uttcrancc by uttcrancc—in an ordcrly manncr. Tc mcaning ol
an uttcrancc is not attributablc to “what is rcally mcant” by its spcakcr in tcrms
ol his/hcr intcntion or motivation, but can bc uncovcrcd lrom thc pcrspcctivc
ol how thc participants display lor onc anothcr thcir undcrstanding ol what is
going on in thcir rcsponsc to a prcvious uttcrancc. Tis turnbyturn unlolding
ol intcraction thcn providcs rcsourccs lor thc rcscarchcr to invcstigatc what
has bccn accomplishcd through thc mundanc lacctolacc intcraction. Con
scqucntly, lor an analyst, mcaning is lundamcntally ncgotiatcd, contcxtualizcd,
and contingcnt to thc spccific intcractional history. Tis chaptcr takcs CA’s
intcrprctivc stancc toward mcaning in gcncral and cxamincs closcly thc intcrac
tivc lcaturcs and structurcs ol communication bctwccn a scnior malc zhongyi
doctor and his paticnt in a casc ol stagnation ol cmotions.
A typical convcrsation analysis ol clinical intcraction systcmatically cx
amincs thc “intcraction bctwccn doctors and paticnts as a topic in its own
right.”⁹ Tc purposc ol CA in such invcstigations is “to dctcrminc gcncral rulcs
govcrning thc bchavior ol spcakcrs that rcsult in thc apparcnt ordcrlincss and
structurc ol thc intcrvicw.”'⁰ Tis is ccrtainly not my goal as an cthnographcr.
! do not attcmpt to discovcr gcncral rulcs that account lor thc ordcrlincss ol
doctorpaticnt intcractions in zhongyi clinics. Rathcr, my intcntion is to do
cthnography ol thc zhongyi clinical proccss in dcaling with a particular casc ol
qingzhi disordcr. !t is bcst dcscribcd as a microanalytically oricntcd casc study.
Tc objcctivc is to uncovcr what was practically accomplishcd through thc joint
cffort ol lacctolacc intcraction bctwccn thc doctor and his paticnt. Ðiffcrcnt
lrom morc convcntional cthnographic writing on Chincsc mcdicinc, thc CA
inlormcd cthnography uscs thc transcribcd tapc rccordings ol naturally occur
ring intcractions situatcd in an ordinary unlolding ol zhongyi clinic proccss
CLI NI CAL PROCESS OF TI AO 107
as data. Using lacctolacc intcraction “as a stratcgic sitc”'' lor thc analysis
ol zhongyi clinical cncountcrs, this approach providcs a mcchanism to tracc
and dcmonstratc how and at what point various clinical dccisions wcrc madc
and thcrapcutic translormations wcrc markcd, cxprcsscd, and acknowlcdgcd.
!n addition, by locusing on how thc participants thcmsclvcs makc scnsc ol and
rcspond to onc anothcr, such analysis hclps rcvcal thc tacit oricntation ol thc
spcakcrs to thc sharcd cultural norms and institutional cxpcctations. Finally,
microanalysis can bc a proccss ol discovcry. As dcmonstratcd by Jack 8ilmcs in
his microanalysis ol thc mcdiator’s rolc in a northcrn Tai ncgotiation, a closc
analysis ol spccch as a tool ol cthnography “can bring us into most intimatc
contact with our data and givc us insights ol a sort that wc cannot achicvc with
traditional mcthods.”'´
Te zhongyi clinical proccss appcars in various lorms, and cach actual cvcnt
ol doctorpaticnt intcraction is situatcd in a particular contcxt involving dil
lcrcnt participants. My intcntion is not to givc a gcncral account ol zhongyi
clinical intcraction, nor to offcr a standard dcscription on how a qingzhi dis
ordcr is diffcrcntiatcd and handlcd in a zhongyi clinic. Vhat is dcvclopcd hcrc
is rathcr an analysis ol a particular casc with all its intcractional dctails. Tc
locus is not vcry much on discovcring what most zhongyi doctors would do
whcn lacing similar problcms, but rathcr on how a particular doctor and paticnt
actually cvokc thc prolcssional knowlcdgc and cxpcricncc, institutional compc
tcncics, and cultural and commonscnsical logic in thc coursc ol intcraction to
makc scnsc ol onc anothcr and to ncgotiatc mcanings and actions. Morcovcr,
this scqucntial unlolding ol a particular proccss is also bcing rccognizcd as a
normal and ordinary zhongyi practicc. !n othcr words, zhongyi conccpts and
thcorics, such as bianzheng lunzhi (pattcrn diffcrcntiation and thcrapy dctcr
mination), arc approachcd not as a sct ol wclldcfincd principlcs rcprcscntcd in
thc tcxts and cxplaincd by thc scholarphysicians, but arc cxamincd bascd on
how thcy arc actually and diffcrcntially oricntcd to in a rcaltimc clinical ac
tion and intcraction. Tc CAinlormcd microanalytical approach is ultimatcly
a mcaningccntcrcd intcrprctivc cntcrprisc. Tc scqucntial unlolding ol thc in
tcraction is also an intcrprctivc rcsourcc lor thc analyst to makc scnsc ol what is
accomplishcd by thc intcractional movcs. My undcrlying assumption is that it
is in thcsc cvcryday social intcractions that cmbodicd cultural valucs and social
norms arc prcsupposcd, cvokcd, transactcd, and rcinlorccd and that cultural
traditions arc transmittcd.
Òn prcparing lor this chaptcr, ! listcncd rcpcatcdly to thc clinical cncoun
tcrs that ! tapcd during my ficldwork. As ! listcncd to cxchangcs among doc
tors, paticnts, lamily mcmbcrs, and myscll thc anthropologist, as wcll as othcr
sounds ol activitics in thc clinic—coughs, thc banging ol doors, thc moving ol
chairs—thc sccncs ol thc clinical activitics oncc morc bccamc alivc to mc, as il
! was translcrrcd back to thc clinic. Yct any lorm ol transcription ol a naturally
occurring intcractional cvcnt into a writtcn tcxt is a lorm ol rcndcring. Al
though ! usc various signs and markcrs to indicatc intonation, pausc, prolongcd
108 TRANSFORMI NG EMOTI ONS
pronunciation, rcpctitions, ovcrlaps or lalsc starts, thc distancc bctwccn an ac
tual cvcnt and a transcribcd tcxt is incvitablc. My analysis rclics vcry much on
my ficld cxpcricncc and my scnsc ol thc placc, as wcll as ycars ol rcscarch on
Chincsc mcdicinc. ! usc transcripts as tools to hclp mc “scc” intcraction clcarly
and to cnablc “rcadcrs to ‘scc’ what is bcing rclcrrcd to in analysis.”'` For this
lattcr purposc, ! also makc thc doctor and paticnt spcak ¡nglish. Tc ¡nglish
translation ol thc transcription is a rcndcring ol a rcndcring, my intcrprctation
ol what is communicatcd bctwccn thc doctor and thc paticnt.
A lacctolacc intcraction involvcs coordination ol morc than just spccch.
! do bclicvc that lor clinical intcraction, vidcorccordcd intcractions may do
a bcttcr job. Howcvcr, in thc situation ol my ficldwork, vidco rccording was
too intrusivc to bc ol practical usc. Tcrclorc, rcadcrs havc to dcpcnd on my
dcscriptions ol what was visually going on in thc clinic. Frcqucntly, silcncc is
not rcal silcncc in tcrms ol no action. For instancc, in thc casc that is analyzcd
in this chaptcr, altcr thc paticnt sat down, thc doctor took hcr mcdical rccords
(bingli 病历 in thc lorm ol a small bluc booklct) and silcntly pushcd ovcr a solt
pad. Tc paticnt put hcr wrist on thc pad. Tc doctor thcn startcd to takc hcr
pulsc. Vith his fingcrs on thc paticnt’s wrist, hc lookcd at thc paticnt with a
smilc. Tcn thc paticnt startcd to talk. Òn thc tapc, wc do not hcar thc doctor’s
qucstion. Yct, by his gazc, smilc, and his display ol rcadincss, hc communi
catcd his inquiry “Vhcrc is your discomlort: (nar bu shufu 哪儿不舒服). 8oth
doctors and paticnts constructivcly usc silcncc. Undcrstanding lics not only in
somcthing said but lrcqucntly in somcthing unsaid. Howcvcr, sincc ! do not
havc rccordcd visual data to account lor thc silcncc cxccpt lor my own mcmo
rics and notcs, ! locus my microanalysis morc on scgmcnts ol convcrsation that
wcrc carricd out morc intcnsivcly and morc tightly structurcd.
Microanalysis ol lacctolacc clinical intcractions has bccn prcdominantly
rcstrictcd to thc ¡nglishspcaking contcxt and noncthnographic writing. Tis
raiscs thc issuc as to what cxtcnt this approach ol cxamining “talk” bctwccn
doctor and paticnt is applicablc in thc undcrstanding ol zhongyi clinical work,
which is oltcn charactcrizcd as involving littlc talk.
A clinical cncountcr in China, known as “kanbing” (looking at illncss by
both doctor and paticnt) in both zhongyi and xiyi (Vcstcrn biomcdicinc) con
tcxts, is an intcractional proccss.'⁴ !n zhongyi clinics, this proccss is spccifically
undcrstood as tiao (attuning, adjusting, balancing). Although not an officially
dcfincd zhongyi conccpt, tiao is charactcristically cmploycd by both doctor and
paticnt to dcscribc zhongyi thcrapcutics. For cxamplc, paticnts likc to talk about
finding a zhongyi doctor to hclp “attunc” thcmsclvcs a littlc (zhao ge zhongyi
daifu tiao yi tiao 找个中医大夫调一调), similarly a doctor may suggcst that
a paticnt takc somc hcrbal mcdicinc to rcgain hcr balancc (chi dianr zhongyao
tiao yi tiao 吃点儿中药调一调). Tc usc ol tiao implics that zhongyi thcrapy is
a gradual and carclully managcd proccss. !t involvcs diffcrcntiation ol a group
ol physical, cmotional, and social dyslunctions and flcxiblc usc ol availablc
tcchniqucs, both mcdical and nonmcdical, to “bring about thc conditions” in
CLI NI CAL PROCESS OF TI AO 109
which dcsirablc changcs in human cxpcricncc and rclationship can takc placc
spontancously.'⁵
Ðiffcrcntiation ol a particular pattcrn is not arrivcd at simply within thc
doctor’s hcad, and it docs not always work according to tcxtbook logic. A pat
tcrn diffcrcntiation cmcrgcs through thc proccss ol intcractions bctwccn a
particular doctor and his/hcr paticnt and as a rcsult ol ncgotiations bctwccn
multiplc pcrspcctivcs and diffcrcnt cxpcricnccs. Ðuring thc clinical proccss ol
“pattcrn diffcrcntiation and thcrapy dctcrmination” (bianzheng lunzhi 辨证论
治), a zhongyi doctor dcpcnds on “lour cxaminations” (sizhen 四诊):” (.) gazing
(wang 望), (a) listcning/smclling (wén 闻), (¸) qucstioning (wèn 问), and (¡)
lccling pulsc (qie 切) to gathcr inlormation, idcntily symptoms, and diffcrcnti
atc pattcrns ol syndromcs. Tcorctically, only thc wèn (qucstioning) cxamina
tion involvcs talking, thc othcr thrcc cxaminations can bc donc in complctc
silcncc. Howcvcr, thc lour cxaminations arc not scparatc proccdurcs. Tcy
ovcrlap to lorm a cohcrcnt proccss ol kanbing, which is a lacctolacc intcrac
tivc phcnomcnon. \cry oltcn, whilc thc doctor is asking qucstions, hc is also
taking thc pulsc or obscrving thc paticnt. Hc may rcchcck thc paticnt’s pulsc
whilc talking to thc paticnt. Tus, wèn (qucstioning), as a proccdurc to gathcr
inlormation and a way to cngagc a paticnt, continucs through thc wholc clini
cal proccss. A zhongyi tcxtbook particularly points out thc myth ol thc popular
imagc that a rcally good doctor nccds only to rcad a paticnt’s pulsc to comc to
a lull diagnosis.'⁶ An cxpcricnccd doctor may bc quick at making conncctions
bctwccn obscrvcd signs, or hc/shc may bc morc skilllul in cngaging paticnts
without posing as an intcrvicwcr.
How much thc vcrbal cxchangc wcighs in a clinical cncountcr varics ac
cording to thc situation. Vith somc cascs, doctorpaticnt talk may bc minimal.
!n othcr cascs, thc doctor and paticnt may cngagc in lcngthy discussions. !n
standard zhongyi tcxtbooks, doctors arc cncouragcd to usc appropriatc languagc
to clcar out (shudao 疏导 litcrally “drcdgc”) blockagcs in cmotion and think
ing and to givc suggcstions (anshi 暗示) in ordcr to accomplish thc purposc ol
trcatmcnt.'⁷ Tis approach is particularly cmphasizcd in thc casc ol qingzhi dis
ordcrs. Vith a paticnt suffcring a qingzhi disordcr, a doctor tcnds to spcnd morc
timc talking to thc paticnt, and such a paticnt also tcnds to prcscnt morc social
and cmotional problcms and ask morc qucstions. !n a casc ol a qingzhi disor
dcr, many symptoms cannot bc dircctly obscrvcd. For cxamplc, in onc paticnt’s
mcdical filc, thc symptoms that thc doctor wrotc down includcd “vcxation ol
hcart,” “lccling wrongcd and having tcndcncy to wccp,” “lack ol intcrcst,” “pal
pitation and short brcath,” “tonguc palc,” “coating thin and ycllowish,” “pulsc
strung” and so on. !t is notablc that, cxccpt lor thc symptoms rclatcd to thc
tonguc and pulsc, all thc othcr symptoms, particularly thosc about cmotions,
camc lrom thc paticnt’s scllrcport.
Although a scnior zhongyi doctor is rcspcctcd lor his or hcr clinical cxpcri
cncc, as notcd by Judith Farquhar, paticnts in a zhongyi clinic scldom submit
thcmsclvcs complctcly to thc authority ol thc doctor. Tcy also activcly cngagc
110 TRANSFORMI NG EMOTI ONS
thc doctor in thcir pcrspcctivcs, hclp dcfinc thcir own illncss, and cvcn ncgoti
atc thcir own trcatmcnt.'⁸ To scc thc clinical cncountcr only as a modc ol action
in which thc doctor mastcrlully dcploys knowlcdgc and rcsourccs to cffcct a
curc is to miss a basic lact ol kanbing. Tc dctcrmination ol whcthcr a ccrtain
complaint is an illncss, what illncss it is, what thcrapcutic stratcgy should bc
adoptcd, and what lormula should bc uscd arc vcry much intcractivcly intcrprc
tivc and ncgotiatcd mattcrs contingcnt to thc clinical momcnt. !n addition, thc
doctorpaticnt rclationship in a zhongyi clinic is gcncrally lcss structurcd, as
both doctor and paticnt initiatc topics and bring in thcir own pcrsonal cxpcri
cncc. For a paticnt, this may not sccm uniquc sincc a paticnt is cxpcctcd to talk
about his/hcr illncss cxpcricncc.
THE CASE OF STAGNATI ON OF EMOTI ONS
Tc microanalysis ol a clinical cncountcr in this chaptcr is bascd on a casc ol
stagnation ol cmotions. Tc paticnt was a lcmalc middlcschool tcachcr in hcr
latc twcntics. Shc first camc to thc clinic in Junc .µµ¡. Shc had bccn to a psy
chiatric hospital lor hcr insomnia and had bccn prcscribcd somc lorm ol tran
quilizcrs. Vhcn shc camc to thc zhongyi clinic, shc was still taking biomcdicinc
but was anxious to gct rid ol thc drug complctcly. 8ascd on my obscrvation,
paticnts try diffcrcnt ways to trcat thcir illncsscs, using both biomcdicinc and
zhongyi. A common cxplanation thcy givc is that thcy scck biomcdical hclp lor
immcdiatc rclicl ol symptoms but comc to zhongyi lor a slowcr proccss ol tiao
to rcdrcss thc root(s) ol thcir problcms. Tis docs lcnd somc crcdcncc to thc
popular bclicl that Vcstcrn mcdicinc trcats immcdiatc symptoms (xiyi zhibiao
西医治标) and Chincsc mcdicinc trcats thc root ol thc problcm (zhongyi zhi-
ben 中医治本).
Likc a typical paticnt with a qingzhi disordcr, thc paticnt complaincd about
hcr distrcsscd “hcart,” such as “vcxcd hcartcmotions” (xinqing fanzao 心情烦
躁), “uncasy lccling in thc hcart” (xinli bu tashi 心里不塌实), and “thc lccling ol
blockagc in thc hcart” (xinli du de ganjue 心里堵的感觉), as wcll as thc physi
cal discomlorts ol lccling prcssurc in thc chcst and numbncss in thc hcad. Shc
had bccn divorccd lor two ycars. Although shc insistcd that thc divorcc itscll
was not a big trauma lor hcr, and that shc lclt it was a rclicl, shc lclt hcr hcart
cmotion not flowing smoothly (xinqing bu shuchang 心情不舒畅) sincc shc had
not satislactorily rcsolvcd hcr “pcrsonal problcm” (mcaning not bcing ablc to
find somconc to datc or marry) in thc cnsuing two ycars.
!n my convcrsation with hcr, ! also lound that shc, togcthcr with hcr two
ycarold son, livcd with hcr lathcr. Somctimcs hcr lathcr hclpcd hcr to takc carc
ol hcr son. Shc did not go into dctail about this part ol hcr lilc, nor did thc doc
tor ask any dctailcd qucstions about hcr pcrsonal lilc, such as hcr rclationship
with hcr lathcr and mothcr, hcr childhood, and so on. Such inlormation is not
pcrccivcd as intrinsically important in zhongyi clinical practicc. Vhat thc zhon-
gyi doctor looks lor arc thc gcncral cffccts and impacts ol thc particular social
CLI NI CAL PROCESS OF TI AO 111
conditions in thc paticnt’s lilc that may contributc to and account lor various
cmotional and physical difficultics. Tc doctor is morc intcrcstcd in things likc
financial loss, an unsatislactory job cxpcricncc, strcss in thc workplacc and in
school, problcms in intcrpcrsonal rclationships at work or within thc lamily,
divorcc, and othcr changcs in lilc. At thc samc timc, a zhongyi doctor trics to
rcdrcss or rcdircct thcsc cffccts and impacts.
Tc paticnt talkcd morc about hcr problcms at work. Shc was disinclincd
to tcach thc subjcct that shc had bccn traincd to tcach in collcgc. Shc lound
thc work ol homcroom tcachcr (ban zhuren 班主任), vcry strcsslul. Shc told hcr
school principal that shc did not want to continuc tcaching, prclcrring to do
administrativc work thc lollowing scmcstcr. Howcvcr, thc school principal was
not happy about hcr asking lor a changc in hcr work assignmcnt. As a rcsult, thc
paticnt had not bccn assigncd any work lor thc lollowing scmcstcr. Tc suspcn
sion lrustratcd hcr. Shc summarizcd that both hcr work and hcr pcrsonal lilc
wcrc not going smoothly as hcr hcart dcsircd (shunxin 顺心).
Tc paticnt’s unhappy pcrsonal and social lilc was accompanicd by various
physical discomlorts such as dry and bittcr mouth, numbncss ol thc scalp, prcs
surc in thc hcad, wcakncss in hcr shouldcrs and arms, and somctimcs stomach
discomlort. Tc doctor did not spccifically usc thc tcrm yuzheng (stagnation
syndromc) to labcl thc illncss, but it was implicd in thc proccss ol diffcrcntia
tion ol syndromcs and in thc thcrapcutic principlc and thc hcrbal lormulas thc
doctor dcsigncd lor thc paticnt. For thc first visit, thc thcrapcutic principlc was
to drcdgc thc livcr systcm, rcordcr thc circulation ol qi (shugan liqi 疏肝理气)
dissolvc thc stagnation, and climinatc vcxation (jieyu chufan 解郁除烦). Tc
paticnt was givcn thc rcadymadc Tca ol Ðissolving thc Stagnation and Calm
ing thc Mind (jieyu anshen chongji 解郁除烦冲剂) and a prcscription ol hcrbal
mcdicinc ol modificd dccoction ol 8uplcuri lor dispcrsing thc dcprcsscd livcr
qi (chaihu shugan san 柴胡疏肝散).
Ònc wcck latcr, thc paticnt camc back lor a sccond visit. Shc lookcd brightcr
and claimcd that hcr hcalth had improvcd. Shc lclt lcss vcxcd. Howcvcr, hcr
othcr symptoms, such as palpitation (xinhuangh 心慌), lccling ol prcssurc in
thc chcst (xiongmen 胸闷), and dry and bittcr mouth (zui gan kou ku 嘴干口苦)
wcrc pcrsistcnt. Hcr slccp was disturbcd, too. !n addition, shc complaincd about
bcing casily scarcd and jumpy (danxiao 胆小). Shc mcntioncd that shc lclt ncr
vous and rcstlcss whcn shc was talking to an old lady who, whilc talking, was
constantly flapping a lan. Shc lclt hcr hcart was bcating last and that shc had an
urgc to stop talking and run away, though shc undcrstood clcarly thcrc was no
rcason to bc lccling that way. ¡xamination lound hcr pulsc “thin and last” and
thc coating ol hcr tonguc ycllow. Tc doctor concludcd thc syndromc ol livcr qi
stagnation had alrcady translormcd into “firc,” which causcd phlcgm congcs
tion. Tc prcvious prcscription was modificd, and ncw clcmcnts wcrc addcd to
targct thc rcccnt illncss dcvclopmcnt. Powdcrcd chengxiang (Chenxiang mo 沉
香末) was addcd to bring down thc qi and dissolvc thc phlcgm (jiangqi huatan
降气化痰). Tc doctor also suggcstcd that thc paticnt takc somc rcadymadc
112 TRANSFORMI NG EMOTI ONS
hcrbal mcdicinc lor hcr woman’s (fuke 妇科) problcms. Hc cxplaincd that in thc
paticnt’s casc thc “wct hcat” might havc movcd downward and causcd cxccssivc
or ycllowish vaginal dischargc. To this thc paticnt confirmcd that shc did havc
such symptoms.
Òn hcr third visit, thc paticnt claimcd that shc lclt much bcttcr. Altcr thc
two prcvious scssions, thc paticnt sccmcd to bc morc conlormablc and rclaxcd
with thc doctor. Hcr xinqing (hcartcmotion) had improvcd, shc lclt lcss yayi
压抑 (dcprcsscd), and hcr hcad was not as tight and numb as bclorc. Yct, shc
was anxious to know il shc could complctcly dispcnsc with thc biomcdicinc
that shc had bccn using, but somchow worricd that hcr condition would rclapsc
il shc suddcnly discontinucd using it. Tc doctor assurcd hcr that gradually shc
could rcducc hcr dosc ol biomcdicinc, but thcrc was a proccss, and shc should
bc paticnt. From thc symptoms collcctcd and pattcrn diffcrcntiation shown,
thc doctor concludcd that thc paticnt’s syndromc configuration movcd lrom
a purc rcplction typc to a combination typc, mcaning that thc paticnt still rc
taincd somc ol thc hctcropathic lactors (xieshi) in hcr systcm and at thc samc
timc thc vital qi had bccn consumcd and dcplctcd. Tc thcrapy was dcsigncd to
attack xieshi and also to rcplcnish qi (gongbu jianshi 攻补兼施). Tc principlc
was to rcplcnish qi, nourish thc blood (yiqi yangxue 养气补血), lurthcr dissolvc
stagnation, and climinatc vcxation. Tc paticnt did not comc back to thc clinic
altcr thc third visit.
Tc wholc proccss can bc casily idcntificd as thrcc stagcs. At thc first stagc,
thc symptom configuration was summarizcd as yu (stagnation), and thc thcrapy
was dcsigncd to dissolvc thc stagnation by activating circulation ol qi. At thc
sccond stagc, thc syndromc configuration changcd and was summarizcd as huo
(firc), and thc thcrapy was changcd accordingly to clcar firc. At thc last stagc,
thc syndromc typc was idcntificd as having xu (dcplction) clcmcnts, and thc
thcrapcutic dccision was madc to incorporatc rcplcnishing mcasurcs. ! was
prcscnt at all thrcc ol hcr visits and was ablc to tapc rccord thc first and thc last
ol hcr clinical visits. Tc analysis in this chaptcr is bascd mainly on thc clinical
intcraction rccordcd in thc paticnt’s first visit.
DI AGNOSI NG YU ( STAGNATI ON OF EMOTI ONS)
Tc clinical proccss ol tiao starts with thc diffcrcntiation ol syndromc pattcrn
among an array ol physical, cmotional, and social dyslunctions and difficultics.
Tcrc arc many possiblc ways that symptom manilcstations can bc groupcd and
diffcrcntiatcd in practicc. Zhongyi classification sccks to summarizc or charac
tcrizc an illncss condition at a particular momcnt, and it ccrtainly opcns up to
a rangc ol possiblc intcrprctations that arc influcnccd by a particular doctor’s
strcngth, training, and stylcs. Somc doctors arc good at using various rcplcnish
ing mcthods, and othcrs may tcnd to usc mcthods ol activating blood and dis
solving coagulation vcry oltcn. Physicians may also cmphasizc diffcrcnt visccral
systcms. Ðcaling with thc samc illncss manilcstations, onc doctor may choosc
CLI NI CAL PROCESS OF TI AO 113
to start with “harmonizc thc stomach systcm” (hewei 和胃), and anothcr may
choosc to “climinatc livcr hcat” (qing ganre 清肝热). Somctimcs thc samc doc
tor may arrivc at morc than onc charactcrization ol a syndromc configuration
and havc scvcral possiblc thcrapcutic mcthods prcparcd. !l onc thcrapy lails, hc
will switch to anothcr lormula.
Howcvcr, it is in thc intcractional proccss ol “looking at illncss” that all
thcsc diffcrcnt lactors and possibilitics arc playcd out. !n thc paticnt’s illncss
rccord booklct, in thc cntry lor thc first visit, thc doctor wrotc down thc dil
lcrcntiatcd syndromc pattcrn as ganqi yujie (livcr qi stagnation) induccd by
“cmotionmind not flowing lrccly and smoothly” (ingzhi bushu 情志不舒) “thc
livcr systcm losing its ability to strctch and cxtcnd” (an shi tiaoda 肝失条达),
and thc thcrapcutic principlc ol “drcdging thc livcr and rcordcring thc flowing
ol qi” (shugan liqi) and “dissolving stagnation and climinating vcxation” (jieyu
chufan). Anyonc with a littlc zhongyi knowlcdgc can rccognizc that thc casc
is diagnoscd and trcatcd as a particular qingzhi disordcr, yuzheng (stagnation
illncss). !n thc transcript, thc most obvious rcvclation ol this diffcrcntiation ol
pattcrn comcs lrom turn 6· (Scc transcript scgmcnt ,.¡),'⁹ in which thc doctor
says: “Lct’s do dissolving stagnation and climinating vcxation. |Hcr casc is that|
hcartcmotion is quitc dcprcsscd.” Ònc intcrcsting qucstion thcn is how thc
doctor comcs to this spccific rcvclation at this particular point in thc convcrsa
tion. !l wc acccpt that diffcrcntiation ol pattcrns is also an intcractional proccss,
thcn through an cxamination ol intcractional cxchangcs bctwccn thc doctor
and paticnt, wc should bc ablc to discovcr thc intcractional history lcading to
this spccific diagnosis and to tracc how this particular diagnosis cmcrgcd lrom
a proccss ol dynamic intcraction bctwccn thc doctor and thc paticnt.
Tc paticnt starts hcr rcport without waiting lor thc doctor to qucstion
hcr. From thc transcript (scc transcript scgmcnt ,..),´⁰ wc can scc hcr first turn
covcrs a rangc ol symptoms including both cmotionoricntcd complaints and
somatic symptoms. Hcartcmotion vcxcd and uncasincss in hcart sccm morc
psychological, whilc hcart flustcring and tightncss and numbncss ol thc scalp
arc morc obviously somatic. !n turn a, thc doctor simply rcsponds to thc pa
ticnt’s multiplc complaints by rcpcating a singlc symptom, “vcxation,” using a
morc mcdically significant tcrm xinfan than xinqing lao fanzao (心情老烦躁), a
tcrm uscd by thc paticnt. Apparcntly, what thc doctor is doing hcrc is rclormu
lating thc paticnt’s illncss cxpcricncc into a morc mcdically rclcvant symptom
(zheng 症). !t is noticcablc that out ol thc scvcral complaints, only xinfan is im
mcdiatcly mcntioncd, but not any othcr symptoms. A zhongyi doctor routincly
jots down thc symptoms that arc most intcrcsting to him whilc listcning to thc
paticnt’s narrativc ol illncss. Tc doctor might just simply vocalizc what hc is
writing down in thc paticnt’s illncss rccord booklct. 8ut thc scqucntial placc ol
thc uttcrancc makcs it an official rcsponsc to thc prcvious turn, which is undcr
stood and addrcsscd by thc paticnt as such in thc ncxt turn. !ntcractivcly, turn
a may havc scvcral possiblc intcrprctations. !t can bc a qucstion dircctcd to thc
paticnt lor confirmation. !t can also bc an acknowlcdgcmcnt thc doctor offcrs
114 TRANSFORMI NG EMOTI ONS
to show that hc is lollowing thc paticnt’s rcport. And it may bc both. Turn ¸
shows that thc paticnt is oricntcd to thc scqucntial organization and rcads thc
doctor’s uttcrancc as asking lor confirmation. !n thc first thrcc turns, xinfan
bccomcs thc most conspicuous symptomatic componcnt ol thc illncss.
Hcart flustcrs (xinhuang 心慌), a somatic complaint, is not mcntioncd
again in thc wholc intcrvicw. !l thc doctor in thc sccond turn picks up xin-
huang instcad ol xinfan, thc wholc intcractivc coursc may bc diffcrcnt. At lcast,
thc lourth turn,“lccling wrongcd,” would not bc thcrc. !nstcad, thc most logical
symptoms to look lor would bc “shortncss ol brcath” (qiduan 气短) or “tircd
ncss or latiguc” (fali 乏力), or othcr rclatcd somatic symptoms. !l confirmcd, thc
pattcrn will point to a possiblc configuration ol a dcplctcd pattcrn rathcr than a
stagnation pattcrn as this casc is dcfincd. So, in a scnsc, thc sccond turn shows
a doctor’s pcrsonal judgmcnt whcrc his pcrsonal cxpcricncc (jingyan 经验) is
displaycd. !n this casc, hc unambiguously dircctcd his attcntion to thc cmo
tional aspcct, rathcr than a somatic onc, ol thc paticnt’s suffcring at thc vcry
carly stagc ol thc clinical intcraction. !t is also noticcablc that xinfan is thc first
symptom that thc paticnt rcports. To an cxpcricnccd doctor, this initial position
adds importancc to that particular symptom. Howcvcr, thc paticnt in discussion
shows shc is also “cxpcricnccd” and pcrccptivc in rcgards to hcr own illncss, and
hcr illncss narrativc is consistcntly oricntcd to “hcartcmotion” vcxation.
¡xpcricnccd clinicians look lor thc rclationships ol symptoms to cach
othcr. !ndividual symptoms by thcmsclvcs mcan littlc. !t is thc symptoms ap
pcaring togcthcr that cnablc onc pattcrn to bc diffcrcntiatcd lrom anothcr.
Xinfan by itscll docs not tcll much about what syndromc pattcrn thc paticnt is
suffcring. Vhat mattcrs is with what group ol symptoms it appcars. !n a way,
at lcast to an cxpcricnccd doctor, it suggcsts whcrc to look. Vhcn an cxpcri
cnccd doctor sccs onc symptom, hc makcs thc conncction to othcr symptoms.
So in turns ¡ and 6, thc doctor asks il thc paticnt lccls wrongcd and lrustratcd
(weiqu 委屈). Tc doctor is looking lor an association ol symptoms to discovcr
an undcrlying pattcrn. Tc doctor’s inquiry rcccivcd a strong confirmation lrom
thc paticnt in turn ,.
Turn · “anxious” (jiaolu 焦虑)” is not articulatcd in a clcar qucstion lorm
and sccms ambiguous.´⁰ 8ut sincc wc undcrstand that thc doctor is looking
lor pattcrns ol symptoms, thc uttcrancc could bc rcasonably sccn as a gucss,
subjcct to confirmation or dcnial. !n contrast to turn ,, thc first part ol thc
paticnt’s turn µ givcs an ambiguous noncommittal “uhn” and thcn procccds to
a ncw inlormation scqucncc by “ranhou” (and).´' Analysis ol thc uttcrancc ol
“uhn” is significant lor undcrstanding turn · and thc lollowing convcrsational
dcvclopmcnt.
¡xamining closcly thc scqucntial organization, turns · and µ arc clcarly
produccd as an adjaccncy pair in that whcn · is produccd, µ bccomcs condi
tionally rclcvant to ·. Tc uttcrancc ol “uhn” is indccd produccd and apparcntly
acccptcd as a rcsponsc to ·. As ! listcncd rcpcatcdly to this part ol thc convcr
sation, ! was puzzlcd by this uttcrancc ol “uhn.” !l · is a qucstion produccd lor
CLI NI CAL PROCESS OF TI AO 115
cliciting inlormation, µ should bc an answcr. Howcvcr, “uhn” is too vaguc to bc
a rcal answcr. !n addition, thcrc is no rcason lor thc paticnt not to givc a clcar
ycs or no answcr. !l thc paticnt has no problcm talking about vcxation, lccling
wrongcd, and wccping, shc should havc no rcason to bc vaguc about lccling
anxious. Howcvcr, thcrc is no rcason lor thc paticnt to hcsitatc in giving a ncga
tivc answcr to a qucstion cliciting symptomatic inlormation. !n lact, paticnts
undcrstand thc importancc ol giving accuratc inlormation. Tcn, why is “uhn”
thcrc: Tc logical inlcrcncc is that thc paticnt docs not rcad thc doctor’s uttcr
ancc in · as a simplc qucstion.
Transcript Segment 7.1
.. P: a:mm (.) jiùshì xīnqīng lăo
fánzào: mm: ránhòu (. . .) xī:nhuā:
ng (. .) jiùshi (. . .) nèige xīnl gănjué
bù tāshi (.) jiùshi (. . .) năoguā pí
zhèidiănr fāj n (. .) fāmá: de gănjué
(.) ah:: (.) jiù zhèdiănr (.) hòumian
zhèr
a. Ð: xīnfán
¸. P: àh: xīnfán: (.)//ránhòu:-
¡. Ð: //ěiqu me
¸. P: -áh:
6. Ð: w iqū: ma:
,. P: wĕiqū:: jiù xiăng kū::he::hh:
((laugh))
·. Ð: jiāol
µ. P: ahn (.) ránhòu ehm:::jiùshi: ehm:
(.) z nme shuō ne (.) duì shénme shì
ba: (. .) ehm hăoxiang
.c. Ð: -méi shénme xìngqu
... P: -bù găn shénme xìngqu:bù găn
shénme xìngqu:
.a. Ð: y umeiy u shénme búliáng cìji (.)
y umeiy u ah: zuìjìn
.¸. P: ahmm:
.¡. Ð: huòshi shēnghuó shang (.)
y umciy u shénmc bù yúkuai
dc shiqing (.) shēnghuó shang
y umciy u āh:
.. P: Umm: (.¸) Just that my hcart
cmotion has bccn lccling vcxcd.
Mm: And (. .) my hcart lccls
flustcrcd (. .), and !’vc bccn lccling
uneasy in my hcart. And, thc skin ol
my hcad lccls tight and (. .) numb (.)
ah:: (.¸) !t is right hcrc (.) back hcrc.
a. Ð: Hcart vcxcd.
¸. P: Ycah:: hcart vcxcd (.) //an:d -
¡. Ð: //Fccling wrongcd:
¸. P: -wha:t:
6. Ð: Fccling wrongcd:
,. P: Yes:: just lccl likc crying hc::hh:
((laugh))
·. Ð: Fccling anxious.
µ. P: Uhn (.¸) and thcn uhm::: tha:t
um:(.¸) how can ! say (.) lor
anything: (. .) um sccms
.c. Ð: -Ðo not havc that much intcrcst
... P: -Not that intcrcstcd: not that
intcrc:stcd.
.a. Ð: Havc you bccn through any
trauma (.) Havc you ah: rcccntly:
.¸. P: Uhm::
.¡. Ð: Òr in your cvcryday lilc (.) arc
thcrc any unhappy things happcning
(.) in your cvcryday lilc arc thcrc
any::
116 TRANSFORMI NG EMOTI ONS
Tc doctor’s uttcrancc · is similar in lorm to turn a. As is mcntioncd, a
dcmonstratcs thc doctor’s judgmcnt as an cxpcricnccd clinician. Tc · docs a
similar thing. 8y simply saying jiaolu, thc doctor is claiming that thc paticnt is
cxpcricncing thc symptom ol “jiaolu.” Tc symptoms to which thc doctor pays
attcntion, such as xinfan (vcxation), weiqu (lccling wrongcd/sad), and jiaolu
(anxicty/ncrvousncss) all havc a “psychological” implication and arc rccognizcd
by cxpcricnccd doctors as symptoms that possibly go togcthcr. My zhongyi
tcachcr likcd to say that a good doctor, whcn sccing onc phcnomcnon, is ablc
to tracc it to a diffcrcnt but rclatcd phcnomcnon. So in a way, a doctor tcnds
to display hcr virtuosity ol hcaling by making inlormcd and intclligcnt gucsscs
about what a paticnt may bc cxpcricncing whilc moving along with clinical
cxaminations. Tis clinical clcmcnt has always bccn important in zhongyi prac
ticc. Tis is whcrc thc popular bclicl comcs lrom that a rcally grcat doctor can
grasp thc wholc condition ol illncss just by looking at a paticnt or taking thc
pulsc. Tcrc havc bccn many lcgcndary storics about physicians who idcntily
illncsscs and thcir intcnsity by just obscrvation and pulsc taking.´´ !n thc casc
undcr discussion, with thc symptoms ol xinfan and weiqu confirmcd, jiaolu is
vcry likcly to cocxist. Tc doctor in · is making an inlormcd gucss and display
ing his knowlcdgc and cxpcricncc.
Tcn, a rcply to · in a social scnsc is a commcnt on thc doctor’s cffcctivc
ncss and virtuosity. !n tcrms ol convcrsational structurc, turn · is a claim about
anothcr participant’s cxpcricncc, which incvitably makcs thc ncxt turn rclcvant
to thc claim as cithcr a confirmation or a dcnial. Any answcr is conscqucntial
in both a social and a convcrsational scnsc. Tcn, thc paticnt’s ambiguous “uhn”
bcgins to makc scnsc.
From turn µ, wc scc that thc paticnt is vcry rcluctant to rcjcct thc doctor’s
claim dircctly but at thc samc timc docs not lccl strongly cnough to admit it.
Considcring that both thc doctor and thc paticnt havc bccn into thc intcrvicw
lor just a lcw minutcs, a dircct rcjcction to thc doctor’s claim, which has a spc
cial social implication in thc zhongyi contcxt, would bc somcwhat abrupt to a
muchdcsircd, smooth clinical intcraction. Yct, to thc doctor, thc convcrsation
participant, µ may bc indircct but not tcrribly ambiguous. According to thc
conccpt ol “prclcrcncc” in convcrsation analysis, not all thc possiblc sccond part
to a first part ol an adjaccncy pair is ol cqual standing. Rcsponscs to a ccrtain
first action or part arc organizcd by a prclcrcncc systcm. According to 8ilmcs:
Prclcrcncc opcratcs with thrcc (or morc) altcrnativcs: a prclcrrcd (X), a non
prclcrrcd (Y), and no mcntion ol X or Y (N). Tc principlc is simply that,
il X is prclcrrcd, N implics Y. !t is this principlc that, in all cascs, dcfincs
prclcrcncc.´`
!n thc casc ol · and µ, wc may say that altcr a claim, a confirmation is
prclcrrcd. !l no clcar confirmation or dcnial takcs placc, it is confirmation that
is officially abscnt, and a dcnial is thcrclorc implicd. Tc doctor must havc
intcrprctcd thc mcaning ol thc first part ol µ as a dcnial to his claim. Altcr
CLI NI CAL PROCESS OF TI AO 117
“uhn” thcrc is a short pausc that could bc a potcntial transitional point lor thc
ncxt turn. 8ut unlikc what hc did with his prcvious turns (¡ and ·) altcr thc
confirmation, thc doctor docs not takc his turn at thc immcdiatc transitional
point. Givcn thc doctor’s intcractional pattcrn shown in thc prcvious turns, il,
in any casc, thc doctor rcads thc “uhn” as a confirmation, hc would probably
continuc tracing thc symptoms that arc likcly to go togcthcr with jiaolu such as
“rcstlcss” (zuowo buan 坐卧不安),” “insomnia” (shimian 失眠), and so on. Tcsc
symptoms il occurring with ccrtain tonguc and pulsc diagnosis may suggcst a
syndromc configuration ol dcplction or an illncss ol visccral agitation (zangzao
脏躁). Yct, lrom turn µ thc convcrsational coursc sccms to stccr away lrom that
linc ol inquiry.
Turn µ docs two things: it rcsponds to · and introduccs ncw inlorma
tion. Vith many pauscs and hcsitations, as wcll as a prcscqucncc “how can
! say,” thc paticnt is trying to lormulatc an apparcntly not quitc comlortablc
statcmcnt about hcr own cxpcricncc. Anticipating what thc paticnt is likcly
to say, thc doctor in turn .c says, “not havc much intcrcst.” Hc actually com
plctcs thc scntcncc lor thc paticnt. Again, turn .c has thc quality ol displaying
thc doctor’s judgmcnt and undcrstanding, which is thcn confirmcd by turn ...
From thc uttcranccs ol µ to .., thc doctor and paticnt achicvc a rcncwcd align
mcnt. Troughout thc convcrsation, wc scc that both thc doctor and paticnt arc
closcly oricntcd to cach othcr, cngaging thcmsclvcs in intcrprcting thc prcvi
ous turns, adjusting and rcpairing thcir uttcranccs, and projccting thc coursc ol
intcraction.
8y turn .., it has bccn confirmcd that thc paticnt has cxpcricnccd thc
symptoms ol vcxation, lccling wrongcd and sad, wccping, and lack ol intcrcst.
!t should bc lairly clcar to thc doctor that thc paticnt suffcrs lrom a qingzhi
rclatcd disordcr. 8ut it is still not sufficicnt to cnablc a particular pattcrn to bc
diffcrcntiatcd lrom othcr pattcrns. Sincc a zhongyi pattcrn ol syndromc is a
charactcrization ol a spccific illncss condition with an array ol physical, cmo
tional, and social dyslunctions and difficultics, lor an obvious qingzhirclatcd
casc, a doctor’s cxaminations oltcn includcs qucstions about a paticnt’s social
cxpcricncc. !t is also thc pattcrn ol thc paticnt’s social cxpcricncc that is in
lormativc to thc task ol pattcrn diffcrcntiation lor a likcly cmotionrclatcd
disordcr.
Turn .a initiatcs a ncw dircction in thc convcrsation. 8y asking il thc pa
ticnt has cxpcricnccd any trauma (buliang ciji 不良刺激) in hcr lilc, thc doctor,
on thc onc hand, cvokcs thc sharcd cthnomcdical assumption that thc quality
ol a pcrson’s social lilc is also an important part ol onc’s hcalth by suggcsting
that thc symptoms that havc sincc bccn discusscd havc somcthing to do with
hcr social cnvironmcnt. Òn thc othcr hand, turn .a providcs a spacc lor thc
paticnt to talk about hcr social lilc.
Turn .¸ shows that thc paticnt is hcsitating and is not quitc surc how to
answcr thc qucstion. Tc doctor thcn rclormulatcs his qucstion by rcplacing thc
morc tcchnical tcrm buliang ciji with ordinary languagc, “unhappy things” (bu
118 TRANSFORMI NG EMOTI ONS
yukuai de shi 不愉快的事). Tc diffcrcncc bctwccn “buliang ciji” and “bu yukuai
de shi” is not just that onc is morc tcchnical and thc othcr is morc colloquial. Tc
word ciji, mcaning litcrally “stimulation,” is not a zhongyi tcrm but a popular
izcd tcrm ol psychology. Vhcn a pcrson is said to bc “shou ciji” (traumatizcd),
shc or hc is bclicvcd to dcmonstratc abnormalitics as a rcsult ol quick and
strong psychophysiological rcactions. Tc cxprcssion also implics somc lorm ol
wcakncss in pcrsonality. Tc paticnt’s hcsitation in .¸ is not a rcsult ol hcr ig
norancc that shc did not grasp thc mcaning ol thc morc tcchnical tcrm buliang
ciji, but as should bc clcar in hcr narrativc in turn .6, it is rathcr a rcjcction to
lormulating hcr cxpcricncc in tcrms ol a passivc “mcchanical” rcaction to an
unlavorablc cnvironmcnt. !n contrast, “bu yukuai de shiqing” (unhappy things)
is thc languagc ol cvcryday lilc, which docs not cntail a drastic rcdcfinition ol
thc paticnt’s social cxpcricncc with a ncgativc implication ol wcakncss. So thc
paticnt rcsponds to thc doctor’s rclormulatcd qucstion with a strong confirma
tion that thcrc havc bccn too many unhappy things in hcr lilc.
Tc paticnt’s narrativc ol hcr pcrsonal lilc and social situations mainly
comcs in thrcc rclativcly long turns (scc transcript scgmcnts ,.a and ,.¸). Tc
first such turn is .,. Tc first unhappy thing thc paticnt mcntions is hcr divorcc
two ycars bclorc. 8ut, quickly rclcrring back to thc doctor’s turn .a, shc claims
that thc divorcc was not rcally a “trauma” but rathcr a rclicl. Tc paticnt rcjccts
thc imagc ol suffcring lrom ciji. Howcvcr, thc lact that two ycars altcr shc
was divorccd, shc is still alonc, is what thc paticnt sccs as an “unhappy thing”
that nccds to bc solvcd. !n today’s China, divorcc, though not somcthing to bc
cncouragcd, is tolcrablc, particularly il onc is ablc to gct rcmarricd and rcin
tcgratcd into thc “normal” flow ol social lilc, so to spcak. !t is thc conccpt ol
bcing singlc that is somcwhat alicn to thc cultural convcntions. Tc paticnt
uscs “geren wenti” 个人问题 (pcrsonal problcm), which is a cuphcmism lor
“thc mattcr ol finding a spousc.” !n hcr own prcscntation, “thc unhappy thing”
is thc lack ol changc in hcr pcrsonal lilc altcr hcr divorcc. Tc imagc shc uscs
to lormulatc hcr cxpcricncc is blockagc and stagnation (butong 不通). 8ccausc
ol thc blockagc in hcr social lilc, hcr hcartcmotion “is always lccling blockcd”
(bu shuchang不舒畅).
Òn top ol blockagc and stagnation in hcr pcrsonal lilc, anothcr important
topic that cchocs through thc cntirc convcrsation is hcr unhappincss with hcr
job. Tc paticnt tclls thc doctor that shc is not just a middlc schooltcachcr.
Shc is a homcroom tcachcr (ban zhuren 班主任) who tcachcs two subjccts. Tc
rcpcatcdly uscd scntcncc structurc “ranhou ba wo you . . . (thcn . . . ! also)” pilcs
up onc job on anothcr, communicating lcclings ol prcssurc and strcss, cspccially
considcring thc sharcd assumption about what it is likc to bc an clcmcntary or
middlcschool tcachcr in China. Tcy arc sccn as having too many rcsponsi
bilitics, too littlc pay, and too much work. !n a Chincsc school, studcnts in onc
class (ban), usually lorty to sixty, stay togcthcr lor all thcir classcs and many
cxtracurricular activitics throughout thcir ycars in that school (in clcmcntary
school thcy stay togcthcr in onc ban lor six ycars, in middlc school thrcc ycars,
CLI NI CAL PROCESS OF TI AO 119
and in high school thrcc ycars). A homcroom tcachcr is ultimatcly rcsponsiblc
lor all conccrns ol thc ban—acadcmic, social, and cmotional—but hc or shc
scldom tcachcs morc than onc subjcct. !n turn .·, thc doctor’s rcpctition ol “two
subjccts” in a rising tonc at thc cnd shows his surprisc that thc paticnt bcsidcs
bcing thc homcroom tcachcr also tcachcs two subjccts. !n a way, thc uttcrancc
shows that thc doctor is paying particular attcntion to thc paticnt’s rcport and
is sympathctic with hcr situation.
Altcr scvcral cxchangcs about what subjccts thc paticnt tcachcs and whcrc
shc graduatcd, thc paticnt continucs hcr narrativc in turn aµ. Tc continuation
is clcarly markcd by thc samc scntcncc construction (ranhou ba wo you . . .). Shc
pilcs on top ol hcr job strcss thc strcss ol bcing a singlc mothcr. For thc sccond
timc in hcr narration shc says “My hcartcmotion has bccn lor a long timc
lccling blockcd” (not flowing smoothly and lrccly). Tcn shc charactcrizcs hcr
social situation by saying, “8oth my pcrsonal lilc and work havc not bccn going
too smoothly” (not lollowing my hcart’s dcsirc). Latcr, in turn ¸,, altcr talking
about hcr unhappy cxpcricncc at thc workplacc, thc paticnt again claims: “! lccl
vcry uncomlortablc in my hcart. (.¸) !: lccl (. .) cxtrcmcly wrongcd and vcxcd.”
Tc Chincsc tcrm is wonang 窝囊. !t is a combincd lccling ol bcing wrongcd
without a channcl to vcnt thc lrustration and hcartcmotion not flowing lrccly.
A consistcnt mctaphor in thc paticnt’s narrativc is “not flowing” (bu shuchang
不舒畅), and thc imagc is blockagc and stagnation.
!n zhongyi clinical contcxt, wc scc that illncss cxpcricncc rccognizcs no
boundarics bctwccn what is social, psychological, or physical. !n lact, thc
Transcript Segment 7.2
.¸. P: tài duō le (. .) hăoxiàng shi:: hci:
hh ((laugh))
.6. Ð: uh: ha hh ((laugh))
.,. P: yīnwéi (.) w ba: en:: jiùshi:
(.) liăng nián qián (.) líhūn le ()
qíshí ba:: líhūn ba:: búshì shénme
cìji (.) w juéde shì yì zh ng jiětuō
ha: dànshì jiùshi:: guò yí duàn
shíjiān ba:: w jué: de: jiùshi:: en::
zŏngshì bùnéng:: yuănmăn de
jiějué w de gèrén wèntí (.) xīnl
ba:: lăoshì bù shūchàng (.) ránhou
w búshi dāng jiàoshī me (.) ránhòu
w yòu zuò bānzh rèn gōngzuò (.)
ránhòu w yòushì:: jiāo: liăng mén
kèchéng (.) ah::n
.·. Ð: liăng mén kèchéng
.¸. P: Too many (. .) ! supposc :: hci::hh:
((laugh))
.6. Ð: uh: ha hh ((laugh))
.,. P: 8ccausc (.¸) ! um:: tha:t (.¸) two
ycars ago (.¸) was divorccd (.¸) Actually
uh:: divorcc was not that much a
trauma (.·) ! feel it’s a kind ol rclicl
uh:: But that:: altcr somc timc uh::
! lc:lt that:: uh:: ! just can not solvc
my pcrsonal problcm satislactorily
(.¸) My hcartcmotion uh:: is always
lccling blockcd ((not flowing smoothly
and lrccly)) (.) And thcn ! am also
a tcachcr. And thcn ! am also a
homcroom advisor (.) and thcn ! also::
tcach: two subjccts (.¸). Ah::n
.·. Ð: Two diffcrcnt subjccts:
120 TRANSFORMI NG EMOTI ONS
languagc thc paticnt uscs to talk about hcr cxpcricncc docs not rcquirc thcsc
distinctions. For cxamplc, cxprcssions such as “not flowing lrccly” (bu shuchang),”
“blockcd” (du 堵),” “prcsscd and suffocatcd” (bie 憋),” and “not smooth” (bu shun
不顺), arc uscd in dcscribing cmotional, social, and physical cxpcricncc. Com
plaints in any ol thcsc aspccts arc all rccognizcd as symptomatic and contributc
to an ovcrall picturc ol thc illncss. Tc much talkcd about zhongyi “holism” is
not a conccptual abstract but a concrctc rcality unloldcd in zhongyi clinical
intcractions.
Altcr thc paticnt’s uttcrancc (aµ) that both hcr pcrsonal lilc and hcr work
havc not bccn going smoothly, thc doctor’s ncxt qucstion (¸.) is, “Ðo you havc a
stuffy chcst:” Tc doctor is now rcady to dircct his inquiring gazc to thc physi
cal symptoms that corrcspond to thc paticnt’s social and cmotional cxpcricncc.
Tc paticnt answcrs, “just lccl likc:: suffocatcd//difficult in drawing a brcath
(¸a).” Tc paticnt uscs colloquial words lor “suffocatcd” (bie 憋) and “difficult in
drawing a brcath” (shangbulai qi 上不来气). Again, thc diffcrcncc bctwccn thc
doctor’s tcrminology and thc paticnt’s is not that thc lormcr is morc tcchni
cal, and thc latcr is morc colloquial. !n lact, thc word that thc doctor uscs “thc
stuffy chcst” (xiongmen 胸闷) is also a common tcrm. Sincc uttcrancc ¸a is not
clcarly indicatcd as a ncgativc answcr to thc doctor’s qucstion, thc paticnt must
havc pcrccivcd hcr cxpcricncc as somchow similar or at lcast comparablc to
that ol thc symptom ol “thc stuffy chcst.” Yct, by using hcr own cxprcssions,
shc charactcrizcs hcr cxpcricncc as somcthing that docs not totally conlorm to
thc doctor’s charactcrization lrom an apparcntly mcdical pcrspcctivc. Xiongmen
(thc stuffy chcst) is a common symptom in yuzheng (stagnation illncss). !t is
undcrstood by zhongyi doctors as originating lrom a disordcrcd qi circulation
that causcs qi to accumulatc and to bc trappcd in thc livcr systcm, and thc
paticnt thcn cxpcricnccs a lccling ol lullncss and prcssurc in thc chcst. Xiong-
men, thcrclorc, as zhongyi tcrminology, is morc a mcdicalizcd dcscription ol
qi gathcrcd insidc without an outlct, or ol qi blockcd lrom flowing out. How
cvcr, thc paticnt uscs bie (suffocatcd) and shangbulai qi (difficult brcathing) to
dcscribc hcr cxpcricncc ol obstructcd brcathing. Tc cmphasis is morc on thc
blockagc that obstructs thc vital qi ol lilc lrom coming insidc. Tc doctor’s
charactcrization locuscs morc on disordcrcd intcrnal mcchanism that is ccntral
to thc paticnt’s illncss, whilc thc paticnt’s dcscription sccs thc cxtcrnal prcssurc
(litcrally and figurativcly) as a morc significant lactor.
Vhcn thc doctor hcars thc paticnt say “bie de,” hc immcdiatcly cuts in
and asks il thc paticnt tcnds to cxhalc a long brcath (¸¸), bccausc bie has both
mcanings ol “supprcss” and “suffocatc.” !l thc paticnt uscs thc lormcr mcaning
ol thc tcrm, ¸a would bc a lully positivc answcr to turn ¸.. Tc imagc ol wanting
to givc out long brcaths is an cxtcnsion ol “xiongmen,” sincc il qi is supprcsscd
insidc thc chcst, thc paticnt tcnds to hclp qi out by brcathing out hard and long.
A morc tcchnical tcrm is giving constant sighs (xi taixi 喜太息).” Tc doctor’s
qucstion in turn ¸¸ ovcrlaps thc paticnt’s sccond hall ol turn ¸a, which shows
that “bie” is actually uscd in its sccond scnsc as “suffocatc.” Tcrclorc, although
CLI NI CAL PROCESS OF TI AO 121
by uttcrancc ¸¡ “uh” thc paticnt givcs a confirmation to thc doctor’s turn ¸¸,
thc doctor hcars thc paticnt’s sccond hall ol ¸a “difficult in drawing a brcath”
as somchow contradictory to hcr confirmation in ¸¡. Hc quickly adds anothcr
qucstion to lollow up, this timc by dcmonstration. Hc draws in a dccp brcath
first and thcn lcts it out slowly. !ntcrcstingly, thc paticnt says “uh” to confirm
thc doctor’s dcmonstration, but at thc samc timc, insists on “shangbulai qi” (dil
ficult brcathing in). Tc lccling ol blockagc at any point normally docs involvc
twoway movcmcnt: in and out. Howcvcr, zhongyi doctors scc as thc ccntral
illncss mcchanism thc stagnant qi stuck within onc’s systcm and thus blocking
thc flow ol both in and out. Zhongyi rccognizcs that it is crucial to activatc thc
pcrson’s own systcms to movc thc stagnant qi first. Tis stratcgy is rcflcctcd in
Transcript Segment 7.3
aµ. P: Uh:: (.) ránhòu ba: w
zìj yòu dài háizi: uh: jiùshi
xīnqíng chángqī de lăo::shi bù:
shūchàng (.) jiùshi shēnghuó
shang: gōngzuò shang dōu:: bú
tài shùnxīn::
¸c. Ð: ((talk to a previous patient
who came back to ask some
questions about how to take the
medicine)) ()
¸.. Ð: xiōng mèn bu mèn ah::
¸a. P: jiùshi:: biē de //shàngbulái qì
¸¸. Ð: //x huān cháng chūqì shìma:
¸¡. P: ah:::
¸¸. Ð: -shì zhèyang me ((thc
doctor draws a dccp brcath
and lcts it out as il giving out
a sigh))
¸6. P: àh: shàngbulái qì: (.) a:
h: ránhòu zhè dìfang d
de tè nánshòu::: a:h y u
shíhou ba: jiùshi xīn l fán
de shíhou ba:: w jiù juéde
wèicháng gōngnéng ba: jiùshi
hăoxiàng::(.) y u diănr yòu
xiăng lā dùzi dànshì yòu
méiy u
aµ. P: : Uh:: (.) thcn: ! also takc carc ol my chi:
ld by myscll. Uh: that my hcartcmotion
has bccn lor a long: timc lccling blockcd
and unhappy (.¸) and both my pcrsonal
lilc: and work arc not going satislactorily::
¸c. Ð: ((talk to a prcvious paticnt who camc
back to ask somc qucstions about how to
takc thc mcdicinc)) (.¸)
¸.. Ð: Ðo you havc a stuffy chcst ah:::
¸a. P: Just:: lccl likc suffocatcd// difficult
drawing a brcath.
¸¸. Ð: //Tcnd to givc out a long brcath, right:
¸¡. P: Ych:::
¸¸. Ð:- Likc this: ((Tc doctor draws a dccp
brcath and lcts it out as il giving out a
sigh.))
¸6. P: Yeh: have difficulty in drawing a brcath.
Uh: thcn hcrc lccls likc somcthing stuck
and very uncomlortablc::: u:h ((thc paticnt
prcsscs onc hand on thc arca that Chincsc
usually call “thc mouth ol thc hcart”)).
Somctimcs: whcn:: my hcart lccls vcxcd,
! lccl thc lunction ol my stomach and
bowcls sccms to bc: (.) sort ol likc diarrhca
but actually it is not.
122 TRANSFORMI NG EMOTI ONS
many zhongyi thcrapcutic mcthods, such as “drcdging” (shu 疏),” “rclcasing”
(xie 泄), “dispcrsing” (jie 解), and “draining” (tong 通). Howcvcr, this particular
paticnt locuscs almost stubbornly on thc difficulty ol brcathing in. Hcr rcpcatcd
usc ol thc cxprcssion shangbushanglai qi (can’t brcathc) sccms to bc hcr bodily
commcnt on hcr stagnant pcrsonal lilc and supprcssivc social cnvironmcnt. !n
cvcryday Chincsc languagc, pcoplc oltcn usc similar cxprcssions, such as chuan
buguo qi lai to dcscribc suffocation and supprcssion ol onc’s social and political
cnvironmcnt.
Finally, thc doctor gcts a clcarcr confirmation whcn thc paticnt prcsscs hcr
hand on hcr uppcr stomach arca saying shc lccls uncomlortablc as il thcrc is
somcthing stuck thcrc. Tis in somc way supports thc doctor’s analysis, bccausc
according to zhongyi physiology and pathology thc accumulatcd stagnant qi in
thc livcr systcm is vcry likcly to cncroach on thc stomach systcm and causc a
lccling ol lullncss and prcssurc. !n thc rccord booklct thc doctor uscd “lccling
lullncss and blockagc in thc chcst and stomach arca” (xiongwan biemen 胸脘
憋闷). Hc managcd to combinc both men (stuffy) and bie (suffocation) in onc
symptom and was ablc to accommodatc thc paticnt’s point ol vicw.
8y now, thc cmotional symptoms, social difficultics, and physiological
symptoms havc bccn considcrcd. 8clorc turn 6·, thc doctor asks to look at thc
paticnt’s tonguc. Tcn thc cxamination is complctcd, and thc diagnosis in tcrms
ol diffcrcntiation ol pattcrns is rcachcd. Vc noticc that thc paticnt is continuing
to providc inlormation on hcr illncss in turn 6, saying that shc also lccls latiguc.
Apparcntly, thc paticnt’s 6, uttcrancc about lack ol strcngth is not addrcsscd by
thc doctor in thc lollowing turn. !n lact, thc paticnt’s complaint is not addrcsscd
by thc doctor until thc paticnt’s third visit whcn thc syndromc pattcrn ol dcplc
tion (xu 虚) is diagnoscd. !t is always strcsscd in thc zhongyi clinic that among
complicatcd symptom configurations, a doctor should grasp thc main conflict
(zhuyao maodun 主要矛盾). 8y not addrcssing thc ncw inlormation, thc doc
tor also indicatcs thc cnd ol thc stagc ol bianzheng (diffcrcntiation ol pattcrn)
and thc bcginning ol lunzhi (discussing trcatmcnt).´⁴ Tc doctor’s uttcrancc 6·
bcgins with, “Ti::s uh: is likc this (.¸)” which is a prcscqucncc to thc coming
concluding rcmarks. “Lct’s do rclcasing thc stagnation and dissolving vcxa
tion” shows both a diffcrcntiation ol syndromc pattcrn and dctcrmination ol a
thcrapcutic stratcgy. Tc doctor particularly mcntions thc paticnt’s supprcsscd
(yayi 压抑) hcartcmotion as thc main problcm, with which thc paticnt agrccs
complctcly (6µ). Apparcntly, thc paticnt’s condition is diagnoscd as “stagnation
ol cmotions” (qingzhi zhi yu 情志之郁) originatcd lrom thc difficultics and
problcms in hcr social cnvironmcnt.´⁵
!n thc abovc analysis, ! havc shown how thc zhongyi diagnostic proccss ol
diffcrcntiation ol pattcrns (bianzheng) works in onc particular casc. ! havc tricd
to tracc thc origin ol thc diagnosis ol yu and dcmonstratc how this particular
pattcrn diffcrcntiation cmcrgcs as thc rcsult ol thc proccss ol intcraction and
ncgotiation bctwccn thc doctor and thc paticnt. Tc purposc is not to prcscnt
thc standard practicc ol bianzhen lunzhi (pattcrn diffcrcntiation and thcrapy
CLI NI CAL PROCESS OF TI AO 123
dctcrmination), but rathcr to show how a particular zhongyi physician, who is
known lor his cfficacy in trcating yuzheng (stagnation illncss), particularizcs this
“standardizcd” proccss through his pcrsonal cxpcricncc, pcrspcctivcs, languagc,
and stylc ol communication. His attcntivcncss to thc paticnt’s cmotional and
social problcms as shown in thc casc analyzcd hcrc may wcll show his particular
strcngth that contributcs to his rcputation with cmotionrclatcd disordcrs.
NEGOTI ATI NG A PATH TO EFFI CACY
Sincc zhongyi thcrapy is typically undcrstood as tiao, a gradual and carclully
managcd proccss ol adjustmcnt, cfficacy, or cffcctivcncss (xiao 效) can bc as
scsscd at any givcn stagc ol a trcatmcnt. Tc zhongyi wisdom “il cffcctivc, do
not changc thc lormula/mcthod” (xiao bu geng fang 效不更方) is still cvokcd by
physicians in clinical actions, not so much as a guiding principlc but rathcr as
usclul accumulatcd cxpcricncc (jingyan 经验) to indicatc that xiao is constantly
asscsscd so that thcrapcutic stratcgics can bc adjustcd accordingly.´⁶ !n this
scnsc, xiao or liaoxiao 疗效 has thc mcaning ol “proximatc cffccts that indicatc
thc hcaling/curing proccss is undcr way.” Howcvcr, xiao is also uscd to mcan
“thc ultimatc outcomc” ol a trcatmcnt.´⁷ For thc purposc ol this analysis, xiao
or liaoxiao is glosscd as both cffcctivcncss and cfficacy. ! usc thcm intcrchangc
ably with thc lormcr to indicatc morc “proximatc cffccts” and thc lattcr morc
“as thc ultimatc outcomc.”
Transcript Segment 7.4
6¸. P: háiyou:: zu :: fāgān: fāk :::
66. Ð: w kànkan shétou kànkan: (.)
tāi bóhuáng (.) shézh dan:: dan
(. . .)
6,. P: y u shíhour: ba:: juéde: ba::
cóng: jiānjiăg r:: dào liăng ge
bì ba:: juéde yì diăn::r jìnr dōu
méiy u:: méi jinr
6·. Ð: (zhège:: e: shì zhèyàng) (.)
ji yù chúfán ba::(tā zhè zh ng
shi:) xīnqíng b jiăo yāyì
6µ. P: àhn::: xīnqíng tè::: yā:: yì::
y u shíhòur xiăngq zhèixiē shìr::
yuè:: xiăng yuè:: fán: (.) y u
shíhour (.) jiù::jiu xiăng::n=
6¸. P: And also:: my mouth lccls dry: and
bittcr:::.
66. Ð: Lct mc look at your tonguc. Look at:
(.¸) Tc coating is thin and ycllow (.¸).
Tc color ol thc tonguc is palc:: palc (. . .)
6,. P: Somctimcs uh:: lccl: uh:: lrom:: thc
shouldcr bladcs:: to my two arms:: lccl
no strcngth at a::ll, no strcngth.
6·. Ð: (Ti::s uh: is likc this.) (.¸) Lct’s do
rclcasing thc stagnation: and dissolving
vcxation uh:: (Hcr casc is) hcartcmotion
lccls quitc dcprcsscd.
6µ. P: Yeh::: hcartcmotion lccls very:::
dcprcsscd. Somctimcs whcn thinking ol
thcsc thi::ngs, the more ! think, the more
! lccl vcxcd. (..¸) Somctimcs (.¸) ju:st ju:
st wa::nt-
124 TRANSFORMI NG EMOTI ONS
!n thc zhongyi clinical cncountcr, thc paticnt’s own narrativc on how cl
lcctivc or not cffcctivc a particular trcatmcnt is plays an important rolc in thc
doctor’s dccision to changc a thcrapy or to rctain a currcnt onc. Vhilc it is truc
that thc zhongyi doctor cannot rcjcct thc paticnt’s own prcscntation ol thc cl
lccts ol a trcatmcnt, thc doctor, having prolcssional training and cxpcricncc, is
ablc to put in mcdical pcrspcctivc thc signs obscrvcd and rcportcd by thc pa
ticnt and pcrsuadc thc paticnt to scc thc signs as proximatc mcdical cffccts that
indicatc that thc hcaling proccss is undcr way. Zhongyi trcatmcnt cmphasizcs
hcaling as a proccss, thus proximatc cffccts arc givcn considcrablc attcntion.
Tc conccpt “tiao” (attuning or balancing) itscll suggcsts that zhongyi thcrapy
is a longtcrm task. Sincc thc “ultimatc cfficacy” ol bcing “attuncd” or balanccd
cannot bc absolutc and timclcss, tiao might bc a lilclong cffort.
!n addition, zhongyi cfficacy is also sccn as cmcrging lrom thc cntirc clini
cal proccss ol tiao involving adjustmcnts in all aspccts ol thc paticnt’s illncss
conditions. Zhongyi doctors assumc that a pcrson’s cmotions, thoughts, and
visccral systcms arc intcrconncctcd in a lunctional way and that changcs in
onc aspcct would lcad to changcs in othcr aspccts. Tcy gcncrally lccl no nccd
to makc distinctions bctwccn cfficacy produccd by spccific hcrbal contcnts
and that lrom “nonspccific thcrapcutic sourccs.”´⁸ Ðoctors consistcntly prc
scribc hcrbal mcdicinc lor thc paticnts whosc illncss conditions arc diagnoscd
as causcd by cxccssivc cmotions or by social difficultics. Similarly, prcscribing
hcrbs docs not ncccssarily ncgatc thc nccd lor nonmcdical “talk” to pcrsuadc
thc paticnt to changc his or hcr pcrspcctivcs. Rathcr, zhongyi doctors makc usc
ol all availablc sourccs, mcdical and nonmcdical, to lacilitatc a positivc changc
in thc paticnt.
!n thc casc analyzcd in this chaptcr, a hcrbal mcdication was prcscribcd at
all thrcc ol thc paticnt’s visits. Clcarly, both doctor and paticnt cxpcctcd that
a particularly tailorcd hcrbal mcdication would work to activatc qi movcmcnt
and thus to dissolvc thc stagnation ol cmotions. !n lact, thc sharcd confidcncc
in hcrbal intcrvcntions is vcry much thc contcxt in which thc zhongyi “talk”
takcs placc. Tc choicc to locus on talk is not to dcny cffcctivcncss ol hcrbal
thcrapics but rathcr that thc thcorctical lramcwork ol microanalysis docs not
accommodatc an adcquatc asscssmcnt ol thc rolc ol hcrbs. Morc importantly,
this analysis is not mcant to asscss cfficacy ol a givcn zhongyi thcrapy but to
uncovcr thc aspcct ol thc clinical proccss ol tiao that has cscapcd most cthno
graphic scrutiny, namcly, thc discursivc attcndancc to cmotions and thoughts.
Mcdical cfficacy “might lic in thc dctcrmination ol who or what causcd thc
illncss and why that particular pcrson was affcctcd.”´⁹ !n othcr words, cfficacy
may start with diagnosis. As shown abovc, thc casc analyzcd hcrc was diffcr
cntiatcd as “livcr qi stagnation” (ganqi yujie) induccd by “cmotion not flowing
smoothly” (qingzhi bushu) and “thc livcr systcm losing its ability to strctch and
cxtcnd” (gan shi tiaoda). Tc thcrapcutic principlc that thc doctor chosc was to
“drcdgc thc livcr systcm and rcordcr thc flow ol qi” (shugan liqi) and “dissolvc
stagnation and climinatc vcxation” (jieyu chufan). Tc abovc analysis is mcant
CLI NI CAL PROCESS OF TI AO 125
to show thc intcractional history lcading to this spccific diagnosis and to tracc
how this particular diagnosis cmcrgcd lrom a dynamic intcraction bctwccn
thc doctor and paticnt. !n thc lollowing, thc locus ol my analysis will bc on
how both doctor and paticnt activcly ncgotiatc ovcr “thc conditions” in which
dcsircd changcs in thc paticnt’s cxpcricncc may takc placc.
For qingzhi disordcrs, tiao is particularly undcrstood as involving morc
than thc adjustmcnt ol physiological proccss. Adjustmcnt ol onc’s pcrccptions
and ol onc’s social rclations is also part ol thc attuning proccss and, in lact, onc
important condition lcading to cfficacy. A passagc lrom a zhongyi tcxtbook
statcs:
As pointcd out in Linzheng Zhinan Yi’an: Yuzheng, “hcaling ol yuzheng dc
pcnds vcry much on a paticnt’s ability to translorm cmotions and changc
pcrspcctivcs.”`⁰ Tat’s why doctors should show conccrn lor paticnts’ suffcr
ings, counscl thc paticnts, lully motivatc thc positivc clcmcnts in thc paticnts,
so that thcy can hclp thc paticnts rcoricnt thcmsclvcs and cncouragc thcm to
lct go ol thcir worrics and to dcvclop confidcncc in ovcrcoming illncsscs. . . .
Ðcpcnding solcly on matcrial mcdicinc, thc stagnation cannot bc dissolvcd
and cfficacy is hard to achicvc.`'
!n thc casc ol thc paticnt, thc mcaning ol hclping smooth (shu) and rcordcr
(li) thc flow ol cmotions and dissolvc (jie) and climinatc (chu) thc lccling ol
blockagc in hcr social and cmotional lilc is also cmbcddcd in thc thcrapcutic
stratcgy ol “drcdging thc livcr and rcordcring thc flow ol qi” and “dissolving
stagnation and climinating vcxation.”`´ Looking closcly at thc actual clinical
intcraction in thc contcmporary zhongyi practicc, it is clcar that doctors do
cngagc in counscling paticnts. Howcvcr, thc way zhongyi doctors work with
paticnts is diffcrcnt lrom thc psychological counscling normally lound in typi
cal Vcstcrn psychiatric clinics. Unlikc a psychothcrapist who trics to bring
thc paticnt into contact with his or hcr “truc lcclings or conflict” that arc sup
poscdly supprcsscd or dcnicd by thc paticnt, a zhongyi doctor has no intcrcst
in any unconscious “truc” lcclings. Vhat is important to zhongyi counscling,
shown in thc lollowing analysis ol thc clinical intcraction, is to hclp thc paticnt
dcvclop an adaptivc attitudc and pcrspcctivc in ordcr to bcttcr adjust to hcr
social cnvironmcnt.
A zhongyi doctor docs not posc him or hcrscll as an cxpcrt in cmotions,
but as a wisc pcrson who has accumulatcd practical wisdom through lilc and
prolcssional cxpcricnccs.`` Tc zhongyi doctor cannot assumc an “objcctivc”
point ol vicw on thc paticnt’s “cmotional problcm” as a psychothcrapist docs
in thcrapcutic intcraction. A zhongyi doctor vcry oltcn lorgcs a conncction
with thc paticnt by translorming “thc paticnt’s problcm” into sharcd human
conditions and thcrclorc makcs it lcgitimatc to offcr modcratc advicc in lorms
ol pcrsonal cxpcricncc and rcflcctions that onc may hcar lrom onc’s trustcd
lricnds or rclativcs. For cxamplc, whcn thc paticnt in this casc says that shc docs
not want to tcach P¡ and givcs “poor hcalth” as thc rcason, thc doctor says in
126 TRANSFORMI NG EMOTI ONS
rcply that “lrcqucnt cxcrcisc is hclplul,” which is ccrtainly a rcjcction ol thc rca
son that thc paticnt offcrs. Hc thcn offcrs an anccdotc about himscll that onc
wintcr his bicyclc was stolcn, so hc had to gct up carly and walk to thc hospital
cvcry morning, and as a rcsult, hc ncvcr caught a cold that wintcr. !n zhongyi
clinics, thc socallcd counscling is vcry much a ncgotiation bctwccn at lcast
two diffcrcnt points ol vicw and pcrspcctivcs inlormcd by diffcrcnt knowlcdgc,
cxpcricncc, and intcrcst. Tc succcss ol ncgotiation dcpcnds largcly on thc typc
ol conncctions lorgcd bctwccn thc doctor and paticnt through activcly man
agcd turnbyturn intcractions.
Altcr thc diffcrcntiation ol pattcrn and dctcrmination ol thcrapcutic prin
ciplc, thc convcrsation movcs on to talking about a mcdical prcscription. !n
turn ,µ (scc transcript scgmcnt ,.¸ lor ,¸–·µ), thc doctor asks il it is okay lor thc
paticnt to takc thc hcrbal mcdicinc that shc nccds to dccoct by hcrscll at homc.
Tc paticnt rcplics that it is finc with hcr bccausc shc is not working thcsc days,
mcaning shc has timc to prcparc hcrbal mcdicinc. Tc doctor rcads morc into
thc paticnt’s rcply. !n turn ·., thc doctor says, “8rcw somc hcrbal soup and just
gct wcll last.” Hc thcn lollows thc samc mcssagc in turn ·¸ “Gct wcll last, thcn
you can go back to work soon (.) Havc to makc moncy, right:” Tc turn rclcrs
to thc paticnt’s uttcrancc in turn ·c that thc paticnt is not working, at thc samc
timc “havc to makc moncy” is mcant and hcard to bc a jokc. Tc thcmc ol “not
working” (mei shangban 没上班) in thc paticnt’s uttcrancc ·c is only sccondarily
mcntioncd and is lurthcrmorc prcscntcd as a lacilitating condition. Howcvcr,
thc doctor picks up on this as a problcm or a complaint. From turns ·. to ·¸,
hc managcs to turn it into a major topic ol discussion in thc convcrsation that
lollows.
Rcsponding to thc doctor’s humorous rcmark that shc nccds to gct wcll last
so that shc can go to work and makc moncy, thc paticnt laughs and rcplics by
saying that hcr situation has almost bccomc a vicious cyclc and that thc longcr
shc is not ablc to work, thc morc hcr hcartcmotion lccls vcxcd. Tc cxprcssion
shc uscs to charactcrizc hcr situation is “unablc to go to work” (shangbuliao ban
上不了班) rathcr than “not go to work” (bu shangban).” Tc paticnt trics to say
that hcr illncss prcvcnts hcr lrom going to work. Tc illncss originatcs lrom hcr
vcxcd hcartcmotion, which rcsults lrom hcr unhappy pcrsonal lilc and thc un
rcsolvcd problcms in hcr social world. To complctc this “vicious cyclc,” inability
to work can only worscn hcr alrcady straincd rclationship at hcr workplacc.
At this point, thc doctor thcn says, “Somc amount ol work will bc hclplul.
!t is not good not to work.” Scqucntially and logically, thc doctor’s uttcrancc
is a rcsponsc to thc paticnt’s turn ·,, saying that somc amount ol work will
hclp thc paticnt lccl bcttcr. 8ut il wc look at thc cxchangcs lrom ·c through
··, turn ··, cspccially thc criticism “!t is not good not to work” can also bc rcad
as a lollowup to ·. and ·¸, as a rcsponsc to thc paticnt’s rcvclation that shc is
not working. ¡spccially, thc mcntion ol moncy in ·· makcs it rclcvant to turn
·.. !l thc uttcrancc “!t is not good not to work” was said at turn ·. instcad ol at
··, it would bc undcrstood as a dircct criticism ol thc paticnt and would posc a
CLI NI CAL PROCESS OF TI AO 127
potcntial “loss ol lacc” thrcat to thc paticnt. Vhcn thc critical commcnt in turn
·· “!t is not good not to work” is uttcrcd, it has bccn cushioncd by a jokc, and it
is scvcral turns rcmovcd lrom thc original placc whcrc thc topic is introduccd.
Tc paticnt’s rcsponsc is a rcpctition ol thc doctor’s words “somc amount ol
work” in a suspcnding tonc that convcys conlusion and scrvcs as a rcqucst lor
lurthcr cxplanation. Tc disagrccmcnt is morc subtlc and lundamcntal than
Transcript Segment 7.5
,¸. Ð: ah:: w g i n kāi: diă:
nr chōngjì zài: dài: kāi diănr
tāngyào(.) néng chéng mā::
,6. P: áh::
,,. Ð: chōngjì zhuānmén zhì n
zhège bìng de āh::
,·. P: ah:: xí::ng
,µ. Ð: zài kāi (. .) áo diănr yào
hăobuhăo::?
·c. P: k :y :: xíng(.) făn:zhèng:
xiànzài w yě méi shàngbān::
·.. Ð: áo diănr yào: ba:: gănj n: hăo:
déle
·a. P: è:ng
·¸. Ð: hăo: le gănj n gōngzuò (.)
háiděi: zhèngqián nc
·¡. P: ha::ha:: ((laugh))
·¸. P: dōu èxìng xúnhuán le:: w pà
w dōu chéng le (.) xiànzài
·6. Ð: néng hăo méi wèntí
·,. P: yuè:: shàng bù liăo bān: ba:
xīnqíng yuè//fán:: (.) juéde: e ::
··. Ð: //shìdāng gōngzuò:: bù
gōngzuò bùhăo:: bùdān qián de
wèntí
·µ. P: shidāng gōngzuò ah:
,¸. Ð: uh:: !’ll prcscribc you somc rcady
madc prcparation and also prcscribc
somc hcrbal mcdicinc to dccoct (.) !s that
ok with you:::
,6. P: Ah:::
,,. Ð: Tc rcadymadc prcparation is
cspccially dcsigncd lor trcating thc kind
ol illncss you havc. Òkay:::
,·. P: Ah:: Fi::nc .
,µ. Ð: And also prcscribc (. .) boil somc
hcrbal mcdicinc, is that oka::y:
·c. P: Tat’s finc. No problcm. ! am staying
at homc thcsc days anyway.
·.. Ð: 8rcw somc hc:rb soup and just gct
wcll last.
·a. P. u:hn:
·¸. Ð: Gct wcll last, thcn you can go back
to work soon (.) Havc to makc moncy,
right:
·¡. P: Ha::ha:: ((laugh))
·¸. P: Almost bccomc a vicious cyclc::now, !
am alraid.
·6. Ð: You’ll bc finc. No problcm.
·,. P: Tc lo::nger ! am not ablc to wo:rk
uh: thc mo:re my hcartcmotion lccls vc:
xcd (.) //! lcc:l uh::
··. Ð: ://Somc amount ol work:: is ncccssary.
!t is not good not to work. !t is not just a
mattcr ol moncy.
·µ. P: Somc amount ol work:
128 TRANSFORMI NG EMOTI ONS
it sccms. Tc paticnt prcscnts hcr situation as “not ablc to go to work,” somc
thing that is bcyond hcr pcrsonal choicc. Howcvcr, thc doctor’s way ol talking
about thc mattcr, such as “do somc amount ol work” (shidang gongzuo) and “not
work” (bu gongzuo) challcngcs thc paticnt’s scllcharactcrization and makcs it
sound as il thc paticnt is somchow rcsponsiblc lor not going to work, which,
according to thc doctor, is a mistakc. Vc scnsc thc tcnsion bctwccn thcsc two
pcrspcctivcs. Tc paticnt sccs hcr situation as things happcning to hcr bcyond
hcr own control, yct thc doctor sccs that thc kcy lactors in thc paticnt’s illncss
and cffcctivc hcaling lic within thc paticnt hcrscll. Tc tcnsion bctwccn thc
two pcrspcctivcs runs throughout thc cntirc convcrsation and shapcs thc pat
tcrns ol thc intcraction. For cxamplc, whcn thc paticnt says that shc docs not
want to tcach P¡ bccausc ol hcr poor hcalth, thc doctor rcjccts thc paticnt’s
cxplanation by rcvcrsing hcr argumcnt and claiming that physical cxcrcisc is
actually good lor thc hcalth. Tc carlicr doctor and paticnt cxchangcs about
thc symptom ol “lullncss ol thc chcst” (xiongmen) suggcst a similar pattcrn
ol intcraction: whilc thc paticnt insists on a lccling ol suffocation, “not ablc
to brcath in” (shangbulai qi), thc doctor locuscs on thc lccling ol lullncss and
prcssurc within hcr chcst.
Tc doctor’s cmphasis on thc paticnt’s rolc in thc coursc ol illncss dcvclop
mcnt is consistcnt with zhongyi’s conccptualization ol thc qingzhi disordcr and
its hcaling. Tc stagnation syndromc (yuzheng) is undcrstood particularly as
originating in human conditions: “disappointmcnt in gctting what onc sccks”
(suoqiu busui 所求不遂), “lailurc to achicvc onc’s goal” (zhiyi buda 志意不达),
and so on. !ts hcaling dcpcnds vcry much on thc paticnt’s ability to “translorm
cmotions and changcs” (yiqing yizhi 移情易志).`⁴ Tc lamous Ming dynasty
physician Zhang Jingyuc, in his writings about yuzheng, says “a pcrson who is ill
bccausc ol cmotions can only bc hcalcd by cmotions: with a woman, hcr dcsirc
has to bc lulfillcd bclorc hcr stagnation can bc rcmovcd, with a man, hc has to
lcarn to bc flcxiblc and havc broad hcartmind and supcrior wisdom, othcrwisc
his illncss can not bc translormcd.”`⁵
Vc can scc that thc doctor is trying to translorm thc paticnt’s cmotions
and changc hcr locus. Tc implicd mcaning ol bcing disablcd by hcr illncss
in thc paticnt’s uttcrancc ol ·, is not acknowlcdgcd in thc doctor’s ncxt turn.
!nstcad, thc uttcrancc in thc doctor’s turn ·· prcsupposcs just thc oppositc, that
is, thc paticnt is ablc to work. !n thc paticnt’s turn ·µ, by rcpcating thc doctor’s
words and asking lor lurthcr claboration without addrcssing thc qucstion ol
ability to work, it sccms as il thc paticnt tacitly acccpts thc doctor’s prcsupposi
tion ol uttcrancc ·· that hcr “not working” is thc rcsult ol hcr own choicc rathcr
than causcd by hcr disability. At lcast, lrom thc doctor’s rcsponsc in turn µc (scc
transcript scgmcnt ,.6 lor µc–µ¸), wc know that thc doctor hcars thc paticnt’s
turn ·µ as asking why shc should work rathcr than il shc is ablc to work. !n turn
µc, thc doctor starts to cxplain why it is important to work, thus opcning his
lcngthy spccch to pcrsuadc (kaidao 开导, litcrally “opcn” and “guidc,” mcaning
to hclp a pcrson scc his/hcr situation clcarly and scnsibly) thc paticnt.
CLI NI CAL PROCESS OF TI AO 129
Tc doctor in turn µc starts with a gcncral claim: “Human bcings arc likc
this (. .) nccd to havc a sourcc ol satislaction (. .).” Gcncrally, a zhongyi doctor
trics to avoid gctting into thc dctails ol a paticnt’s pcrsonal lilc, partly bccausc
a zhongyi doctor docs not havc thc prolcssional claim that a psychothcrapist
has lor an authoritativc voicc ovcr intcrprcting thc paticnt’s bchavior and cmo
tional cxpcricncc. Vhat thc zhongyi doctor rclics on is somc lorm ol rclatcdncss
bctwccn him and his paticnt that allows him to draw lrom his own cxpcri
cncc to bcar on thc paticnt’s cxpcricncc, that is, thc sharcd human condition.
!n addition, thc practical purposc ol this typc ol kaidao is to hclp a paticnt
tunc into a diffcrcnt pcrspcctivc so that shc can bccomc bcttcr adjustcd to hcr
cnvironmcnt.
Transcript Segment 7.6
µc. Ð: rén jiù zhèiyà::ng (. .) yào
y u ge jìtuō (. .) w xiă:ng shì
zhèyang (.) h nduō lăonián rén
tuìxiū:: (.) wèishénme tā líxiū
jiù róngyì dé bìng ah: bùdān shì
ge qián de wèntí yīnggāi háiy u
ge gōngzuò jìtuō (.) shēnghuó
jìtuō wèntí (.)//rénde
µ.. P: //k w xiànzài shēnghuó
shang gōngzuò shang yì diănr
jìtuō dōu méiy u (. .) xīnl lăo=
µa. Ð: =bù (.) rén y u yì zh ng
(. .) búshì méiy u jìtuō (.) y
y u jìtuō (. .) jiùshi zài n
zhèr mùqián bú tài l xiăng
(. . .) rúgu rén sīxiăng shang
shēnghuó shang méi:y u jìtuō
yì tiān y huó bú xiàqù (.) w
rènwéi ta yì tiān y huó bú
xiàqu (. . .) bāokuò zìshā de rén
(.) w juéde zìshā de rén y ::
h n:: ye h n: y dào yídìng de
chéngdù búshi: shuō:: hei:: h::
((laugh)) juéxīn h n dà ha::
ha:: ((laugh)) (. . .) yìbān rén
bù xíng de (.) jiù sh:: jiù:n
xiànzài búshi méi jìtuō(. .) jiù:
shr shuō bù l xiăng (. . .) jiùshr
bù hé xīn::si.
µ¸. P: duì méicuòr
µc. Ð: Human bcing is likc this (. .) nccds
to havc a sourcc ol satislaction (. .) ! thi:
nk this is truc (.) Many old pcoplc whcn
rcti::rcd (.) why is that hc tcnds to lall ill
altcr rctircmcnt ah:: !t is not just moncy:
Tcrc should also bc somcthing to do with
having a sourcc ol satislaction lrom work
(.) and lilc. (a.c)//A pcrson’s
µ.. P: //8ut now ! do not havc any sourcc ol
satislaction at all lrom both my work and
my lilc (. .) !n my hcart ! always-
µa. Ð: -No! (..) Human bcing has a ki:nd
(. .) !t is not that you do not havc a sourcc
ol satislaction (.) You too havc a sourcc
ol satislaction (. .) Just that your prcscnt
situation is not that idcal (. . .) !l a pcrson
cannot find any satislaction in his mind or
lilc, hc cannot livc on lor a singlc day (.) !
think hc is not ablc to livc on lor onc day
(. . .) including thosc who scck suicidc (.)
! think a suicidal pcrson also:: vc::ry also
vc:ry must havc comc to a ccrtain dcgrcc.
!t is not to say:: hci:: h:: ((laugh)) must bc
vcry dctcrmincd ha::ha:: ((laugh)) (. . .) An
ordinary pcrson is not ablc to do it (.¸) As
lor:: as: your prcscnt situation, it is not that
you do not havc a sourcc ol satislaction
(. .), it’s just that it is not idcal (. . .), not
what your hcartmind wants it to bc.
µ¸. P: Right. ¡xa::ctly.
130 TRANSFORMI NG EMOTI ONS
Altcr thc doctor lramcs thc subjcct as a sharcd human condition, hc gocs
on to say, “! think this is truc.” Phrascs with “! think” or “! lccl” arc lrcqucntly
uscd by thc doctor in his talk with thc paticnt. Tc usc ol such cxprcssions
makcs thc doctor’s spccch lcss inviting ol thc paticnt’s rcjcction or rcsistancc. At
lcast, thc doctor is cntitlcd to havc his own point ol vicw. Also, thc status ol lao
zhongyi (scnior, cxpcricnccd zhongyi doctor) lcnds crcdibility to his words and
cxpcricncc. Tc doctor uscs thc cxamplc ol rctircd pcoplc to support his claim
that work is ncccssary (scc turn µc). Altcr hc finishcs thc scntcncc that working
has somcthing to do with finding satislaction in lilc, thcrc is a long pausc, in
dicating that thc doctor cxpccts thc paticnt to rcspond and to acknowlcdgc thc
importancc ol work othcr than lor cconomic rcasons. Altcr about two scconds,
sccing that thc paticnt has madc no movc to rcspond, thc doctor is obligcd to
continuc. Tc paticnt’s dclaycd rcsponsc ovcrlaps with thc doctor’s cffort to
continuc his kaidao. Tc paticnt’s rcsponsc comcs as a surprisc to thc doctor.
!nstcad ol lollowing thc logic sct lorth by thc doctor to acknowlcdgc that
continuing to work is hclplul bccausc it givcs a pcrson a scnsc ol satislaction in
lilc, thc paticnt claims, “8ut now ! do not havc any sourcc ol satislaction at all
in both my work and my lilc” (µ.). Tc paticnt’s claim is quickly and lorcclully
rcjcctcd by thc doctor, who cuts thc paticnt’s uttcrancc short. !t is noticcablc
throughout thc transcript that thc doctor is particularly scnsitivc to any potcn
tial asscrtion ol ncgativc lcclings, cspccially lcclings ol hopclcssncss thc paticnt
may makc, and docs not hcsitatc to intcrvcnc whcncvcr hc sccs onc coming.
For cxamplc, in turn 6µ, thc paticnt claims that hcr “hcartcmotion” is lccling
low and hcavy (yayi), and whcn shc says, “somctimcs (.¸) ju::st ju::st want::, ”
thc doctor cuts in, and thc paticnt’s scntcncc is not finishcd. From thc contcxt,
thc doctor scnscd thc unfinishcd uttcrancc might bc ncgativc. Again in turn ·,,
thc paticnt claims that thc longcr shc is not ablc to go to work, thc morc vcxcd
shc lccls. Vhcn shc is about to continuc talking about hcr vcxcd lcclings, hcr
scntcncc “! lcc:l uh::” is intcrruptcd by thc doctor’s spccch. Similarly, in turn
µ. thc paticnt says that shc docs not havc any satislaction in work or lilc, and
hcr scntcncc “!n my hcart ! always” is intcrruptcd by thc doctor’s lorcclul “No.”
Unlikc a Vcstcrn psychothcrapist who lrcqucntly cncouragcs thc clicnt to talk
about cmotions and particularly hcr ncgativc lcclings, a zhongyi doctor discour
agcs thc paticnt lrom talking about ncgativc lcclings and thcrclorc rcluscs to
makc it a topic. !n a zhongyi contcxt it is almost sccn as thcrapcutically hcalthy
not to locus on ncgativc clcmcnts ol a pcrson’s cxpcricncc.
!n turn µa, altcr a quick rcjcction and a rclativcly long pausc, thc doctor
starts to do thc samc thing as hc did in turn µc, that is, to lormulatc thc prob
lcm as a sharcd human condition. Somchow, hc lccls compcllcd to addrcss thc
paticnt’s ncgativc cvaluation ol hcr own situation and to offsct thc ncgativc
ovcrtonc ol thc uttcrancc by stating his rcjcction again. Hc bcgins with “!t is
not that you do not havc a sourcc ol satislaction,” thcn thcrc is a short pausc,
a wouldbc transitional point, but thc paticnt docs not takc thc turn. Tcn thc
doctor continucs to contradict thc paticnt’s ncgativc opinion and says, “You
CLI NI CAL PROCESS OF TI AO 131
too havc a sourcc ol satislaction.” Tis uttcrancc is lollowcd by anothcr short
pausc that is a littlc longcr than thc prcvious onc. Tc doctor’s invitation lor
thc paticnt to rcspond lails again. Hc thcn adds a morc compromising com
mcnt, “Just that your prcscnt situation is not that idcal.” Altcr this uttcrancc,
thcrc is an cvcn longcr pausc. Howcvcr, thc doctor still lails to gct thc paticnt’s
rcsponsc. Considcring that thc doctor is talking about thc paticnt’s cxpcricncc
and contradicting thc paticnt’s statcmcnt, thc paticnt’s lack ol rcsponsc implics
that shc insists on hcr own opinion and rcjccts thc doctor’s charactcrization ol
hcr situation. Tc doctor simply cannot kccp talking about thc paticnt’s cxpcri
cncc without thc paticnt’s acknowlcdgcmcnt in somc lorm. Hc thcn rcsorts to
his old stratcgy to makc a morc gcncralizcd rcasoning that il a pcrson docs not
havc any satislaction in lilc, shc cannot livc on lor onc day. As thc rcalm has
now bccn switchcd to gcncral human bchavior, thc doctor gains lcgitimacy to
givc his opinions. Hc brings out thc topic ol suicidc to support his casc that onc
cannot livc without any sourcc ol satislaction in lilc, but hc quickly discovcrcd
that this is a mistakc. Hc is obviously uncomlortablc discussing thc topic in this
situation. Tc argumcnt about suicidc is incohcrcnt and markcd by cmbarrasscd
laughs. Howcvcr, altcr thc doctor has madc thc point about “satislaction in lilc,”
hc rcturns to thc paticnt’s spccific argumcnt and rcpcats his lormcr dcnial to thc
paticnt’s scllcharactcrization. Hc continucs, “As lor:: as: your prcscnt situation,
it is not that you do not havc a sourcc ol satislaction, it’s just that it is not idcal
(. .), not what your hcartmind wants it to bc.” To this, thc doctor finally gcts a
wholchcartcd acknowlcdgcmcnt lrom thc paticnt (turn µ¸).
Tc doctor’s concluding words in this long turn (turn µ¸) arc almost an cxact
rcpctition ol what hc says at thc bcginning ol thc turn. 8ut at thc bcginning ol
thc turn, dcspitc scvcral tacit attcmpts lrom thc doctor to gct thc paticnt’s con
firmation, thc paticnt lails to rcspond. !t is truc that in ccrtain convcrsational
contcxts, lack ol rcsponsc may imply confirmation. Howcvcr, sincc thc doctor’s
commcnt hcrc contradicts thc paticnt’s prcvious scllcvaluation (turn µ.), thc
abscncc ol confirmation suggcsts disagrccmcnt. Tcn wc may ask why latcr thc
paticnt givcs a complctcly diffcrcnt rcsponsc to similar statcmcnts. !n lact, wc
may noticc that a similar intcractivc pattcrn starts to appcar. For instancc, whcn
thc doctor finishcs his scntcncc, “it’s just that it is not idcal,” hc pauscs a littlc,
inviting thc paticnt to rcspond. Hc lails, which is what happcncd at thc bcgin
ning ol thc turn. Tcrclorc, wc may inlcr that thc paticnt’s positivc rcsponsc is
not to this particular uttcrancc, but to thc uttcrancc that lollows, “not what your
hcartmind wants it to bc.”
Tcrclorc, whcn thc paticnt says “ycs, cxactly,” shc mcans ycs, hcr lilc and
work arc not going according to hcr hcart’s dcsirc. Tc doctor’s last scntcncc
is shapcd to makc his point and at thc samc timc to clicit an agrccmcnt lrom
thc paticnt. Vith this agrccmcnt, both thc doctor’s long turn ol kaidao and thc
paticnt’s cxpcricncc arc somcwhat acknowlcdgcd. Tc lccling ol things going
against hcr hcart’s wishcs cchocs throughout thc intcraction. Tc typical char
actcrization ol this lccling has somcthing to do with xin (hcartmind) and
132 TRANSFORMI NG EMOTI ONS
manilcsts in somatic, cmotional, and social tcrms. Hcr vcry first complaint is
hcart vcxcd (xinfan). Tc paticnt rcports “unhappy things happcning in hcr
cvcryday lilc”, shc says that altcr somc timc hcr pcrsonal lilc still cannot bc sat
islactorily rcsolvcd, hcr hcartcmotion “pcrsistcntly |docs| not flow smoothly”
(laoshi bu shuchang). Latcr, shc again claims hcr hcartcmotion docs not flow
smoothly and lrccly and says that both hcr lilc and work “do not flow smoothly
with hcr hcart” (bu tai shunxin). Again, whcn thc paticnt talks about hcr lrustra
tion at work, shc says that shc lccls “vcry uncomlortablc in thc hcart” (xinli te
bu shufu) and “vcry lrustratcd” (te wonang). Tc paticnt, though coming to scck
a zhongyi mcdical trcatmcnt, undcrstands that hcr illncss originatcs socially,
rcsulting lrom thc conflicts bctwccn hcr mindlul hcart’s dcsirc and social rcal
ity. Shc honcstly bclicvcs that il hcr problcms in lilc and work can bc rcsolvcd
satislactorily, hcr illncss would bc curcd.
Howcvcr, thc idca ol “bcing not idcal” (bu lixiang 不理想) is morc lrom
thc doctor’s point ol vicw. !n a scnsc, thc doctor bclicvcs that thc paticnt locuscs
on somcthing that is “idcal” rathcr than “rcal.” Tis pcrspcctivc ol thc doctor
bccomcs obvious lrom thc convcrsation that lollows. Tc doctor also sccs that
thc paticnt’s illncss has a clcar social origin, and hc also assumcs that il thc
paticnt’s social circumstancc changcs, hcr cmotional and bodily cxpcricncc will
probably changc, too. Tis is not just common scnsc but has bccn mcticulously
thcorizcd in thc zhongyi undcrstanding ol shenti (bodypcrson), cmotion, and
illncss. Howcvcr, as a thcrapist in modcrn Chincsc socicty, thc doctor docs not
havc thc mcans to dircctly intcrvcnc into thc paticnt’s social rclations, givcn
that a pcrson’s social world involvcs practically lar morc complicatcd lactors
than a doctor is ablc to dcal with. Vhat hc is ablc to do is to hclp thc paticnt
to “translorm cmotions and changc pcrspcctivcs” (yiqing yizhi). Sivin points
out that thc zhongyi doctor still has to makc dccisions: “Vhcn conlrontcd
with a withdrawn young woman, to cncouragc hcr to changc hcr situation, or
to dcccivc hcr so that shc will acccpt it docilcly.”`⁶ !n modcrn zhongyi practicc,
it is not as much to “dcccivc” a paticnt as to pcrsuadc hcr to stcp back lrom
hcr narrow pcrsonal conccrns to cmbracc a broadcr vicw ol lilc. Tis tcndcncy
markcd thc doctor’s discoursc ol kaidao (pcrsuasions), in which wc scc thc doc
tor lrcqucntly uscs such abstract phrascs as “human lilc” and “socicty.” Tis
diffcrcncc in thc ncgotiation bctwccn two diffcrcnt pcrspcctivcs continucs to
thc cnd ol thc convcrsation.
!n turn µ¸ (scc transcript scgmcnt ,., lor µ¸–.cc), thc paticnt oncc again
insists that hcr unsolvcd social problcm is thc kcy to hcr illncss. Shc argucs
cloqucntly with thc doctor who throughout thc intcraction trics to pcrsuadc
thc paticnt to changc hcr pcrspcctivc. Tc paticnt insists that hcr problcms
rcmain unsolvcd, and cvcn though shc trics not to locus on thcm, thcy arc hcr
rcality: “Sincc thcy arc unsolvcd, you cannot stop thinking about thcm, right:”
Clcarly, thc paticnt sharcs thc zhongyi assumption that “cxccssivc thinking” (silu
guodu 思虑过度) rcsults in mcdical problcms. Shc insists that shc cannot hclp
lrom dwclling on thcsc problcms, thcy arc part ol hcr social rcality. Tc doctor
CLI NI CAL PROCESS OF TI AO 133
chooscs not to dircctly addrcss thc paticnt’s rhctorical qucstion and rcplics, “!t
is impossiblc to havc cvcrything go complctcly according to onc’s wishcs” (µ6).
8y not addrcssing thc paticnt’s qucstion, thc doctor avoids discussing hcr argu
mcnt that hcr social problcms nccd to bc solvcd bclorc shc is ablc to changc
hcr locus in lilc. Hc thcn turns to challcngc hcr basic complaint that things lail
to go according to how shc wants thcm to go. As mcntioncd abovc, thc paticnt
has cxprcsscd hcr lrustration as “not going smoothly according to hcr hcart
cmotion’s dcsirc” (bu shunxin) or “not conlorming to hcr liking” (bu he xinsi 不
合心思). Tc doctor’s challcngc is lcgitimatc and to thc point. Hc docs not
dircctly commcnt on thc paticnt’s bchavior as it is but rcsorts again to a gcn
cralizcd statcmcnt about human lilc. Hc, on thc onc hand, tacitly criticizcs thc
paticnt as scllccntcrcd, suggcsting that thc rcason that thc paticnt’s problcms
rcmain unsolvcd is bccausc shc cxpccts thc impossiblc, but on thc othcr hand,
hc avoids thc paticnt’s possiblc rcjcction.
Tc subscqucnt rcsponsc lrom thc paticnt shows that thc paticnt docs
hcar thc doctor’s commcnts as criticism, and shc trics to dclcnd hcrscll in rc
sponsc. Sincc thc criticism is only implicd by a gcncralizcd statcmcnt, a straight
lorward rcjcction docs not sccm appropriatc, particularly whcn thc statcmcnt
rings so truc in Chincsc common scnsc, which cmphasizcs rclatcdncss and
intcrdcpcndcncc ol thc mcmbcrs within a socicty. Tc paticnt dclcnds hcrscll
by saying that shc only wishcs that hcr problcms could bc solvcd pcrlcctly (yu-
anman de 圆满地). Tc hcsitations and pauscs at thc bcginning ol hcr scntcncc
indicatc that thc paticnt lccls difficulty in challcnging thc doctor’s criticism.
8clorc shc finishcs hcr scntcncc, thc doctor quickly grasps thc word thc paticnt
uscd “pcrlcctly” (yuanman de) and cuts in: “You can on::ly talk about rc:lativcly
satislactory. Complctcly satisficd (.): Tat’s not possiblc.” 8y this, thc doctor
finally gcts thc paticnt to admit: “! havc probably cxpcctcd too:: much ” (µµ).
Altcr thc paticnt finishcs hcr turn, thc doctor waits lor about onc sccond
bclorc hc rcsponds, showing littlc cagcrncss to commcnt on thc paticnt’s ncwly
acquircd insight. Vc may think that thc doctor’s pcrspcctivc is finally acccptcd
by thc paticnt and that hc probably would show his agrccmcnt with thc paticnt
in his rcsponsc. Yct, whcn hc starts to rcspond, hc says “no” (bushi), which sccm
ingly contradicts thc paticnt’s statcmcnt. Tcn, what can wc makc out ol this
particular dcnial, “bushi”: Vc havc to look at thc intcractional scqucncc that
dircctly lcads to thc paticnt’s uttcrancc in µµ. Turn µ6 can bc rcad as a criti
cism ol thc paticnt, accusing hcr ol bcing unrcalistic. Facing this criticism, thc
paticnt’s choicc is cithcr to acccpt or dcny it. Vc scc that in turn µ, thc paticnt
makcs an cffort to dcny thc criticism by qualilying hcr position. Howcvcr, thc
paticnt’s choicc ol “pcrlcctly” (yuanman de) happcns to scrvc thc doctor’s point,
and thc doctor quickly takcs thc opportunity to launch a lurthcr criticism that
thc paticnt is bcing unrcalistic. Now, wc scc that thc paticnt’s uttcrancc ol µµ is
a rcluctant acccptancc ol a criticism. Tc doctor might at this point also noticc
that hc has bccn a littlc too harsh in thc past two turns. Tcn “bushi” could
bc rcad as “no, ! am not saying this” or “no, this is not what ! mcan.” Tcn,
134 TRANSFORMI NG EMOTI ONS
lollowing this dcnial, thc doctor is obligcd to dcal with what hc rcally mcans to
offsct thc imagc ol bcing unsympathctic. Vc scc that altcr thc doctor’s “bushi,”
thcrc arc many hcsitations, rcpctitions, pauscs, and lalsc starts, indicating that
thc doctor is not comlortablc with his sccmingly irrcconcilablc positions. Hc is
trying to lormulatc a cohcrcnt uttcrancc that is both consistcnt with thc idca
that hc has bccn making throughout thc convcrsation that thc paticnt is bcing
unrcalistic and unpractical and with thc dcnial that hc is not bcing unsympa
thctic or not undcrstanding.
Tc doctor’s “no” can also bc rcad in a slightly diffcrcnt way. From thc pcr
spcctivc ol convcrsational structurc, whcn a pcrson makcs a ncgativc cvaluation
ol hcrscll, it projccts a constraint on thc ncxt turn and makcs it rclcvant to thc
cvaluation. Normally, altcr a ncgativc scllcvaluation, a dcnial is prclcrrcd. Tc
paticnt’s turn µµ is clcarly a ncgativc scllcvaluation, though it is in agrccmcnt
with thc doctor’s cvaluation. Tc doctor is obligcd to contradict at lcast in lorm.
Vc havc sccn throughout thc convcrsation, that this doctor is scnsitivc to thc
paticnt’s ncgativc scllcvaluations and tcnds to contradict thcm whcncvcr thcy
appcar. Tis happcns similarly in thc cxchangc ol turns µ. and µa, though thc
contradiction was rcally mcant by thc doctor in that cxchangc.
Again, in his turn .cc, thc doctor rcsorts to thc gcncralizcd point ol vicw
and uscs “! think” to makc his argumcnt a part ol his pcrsonal obscrvation and
cxpcricncc. Hc cmphasizcs, “Vhcrcvcr you go, thcrc will bc unhappy things. . . .
As long as thcrc arc pcoplc, thcrc arc human rclations to dcal with.” Hc thcn
comcs to a conclusion, which is thc ccntral thcmc ol his kaidao (pcrsuasion) and
thc idca hc has bccn hammcring at throughout thc coursc ol thc convcrsation
with thc paticnt. Tc doctor points out that humans arc social bcings living in
conncction with othcrs, and thcrclorc conflicts ol pcrsonal dcsircs and intcrcst
arc incvitablc, “thc qucstion is how to dcal with thcm. Tc kcy lics with thc
individual hcrscll.” Tc doctor cncouragcs thc paticnt to stcp out ol hcr small
world, to acccpt impcrlcctncss as thc way ol thc world, and to find a way to
adjust to hcr cnvironmcnt and makc thc most out ol it. Tc doctor’s cmphasis
on thc statcmcnt “Tc kcy lics with thc individual hcrscll ” carrics thc doublc
powcr ol both criticism and cncouragcmcnt by putting both thc rcsponsibility
ol bcing ill and thc rcsponsibility ol gctting wcll on thc paticnt.
!n addition to his rolc as a mcdical doctor, thc doctor positions himscll
as a mcmbcr ol socicty who takcs thc point ol vicw oppositc to thc paticnt’s
throughout thc cntirc intcraction. Tc oppositc positions ol thc doctor and
paticnt arc cvidcnt in thcir scllprcscntations. Tc paticnt’s voicc is markcd
with pcrsonal pronouns “!” and “my,” whilc thc doctor’s constant rclcrcnccs to
“human bcing” and “human socicty” lcnds him thc voicc ol socicty. Hc trics to
pcrsuadc thc paticnt to cxaminc thc appropriatcncss and practicality ol hcr own
claims on socicty. Such cxamination rcquircs thc paticnt to stcp out ol hcr “scll ”
and assumc thc pcrspcctivc ol a culturally dcfincd “wisc and maturc” pcrson,
who is ablc to asscss a “situation” lrom within and without and “attunc” hcr
bodypcrson accordingly to thc flow ol hcr social and natural world.
CLI NI CAL PROCESS OF TI AO 135
Transcript Segment 7.7
µ¸. P: y ushí xiànshí de shìr::
lăo jiějué bù li:ăo ba: (.) zìj
xiăng xiăngkāi le yě xiăng bu
kāi: (. .) mm: jiějué bù li:ăo ah:
z :ng xiă:ng zhèige wèntí ah::
µ6. Ð: bù k néng wánquán dōu
héhu zìj ah: (.) de xiăngfă ah
µ,. P: k : e: w : xi::ăng (. .) yàoshi
néng yuánmăn ji jué zhè liăng
f īāngmiàn de wèntí:=
µ·. Ð: = zh néng shuō b jiăo:
b jiăo mănyì: n yào wán:quán
mănyì (.) shì bù k néng de
µµ. P: w k néng yāoqiú tài:gāo le
ba:: (.)
.cc. Ð: búshi:: qísh: qíshí (.)
shèhuì (. .) shèhuì shíjì:
shēnghuó shíjì: w xiăng (.)
dōu zhèyàng (.) dào năr dōu
y u bù:: yúkuài de shìqing (. .)
dōuyŏu rénjì guānxì wèntí
(.) n suànsuan ba:: méiyŏu
méiy u rénjì guānxì de wèntí
zh yao y u rén shēnghuó de
dìfang(.) dōu y u rénjì guānxì
(.) jiùshi: z nme chùlĭ hăo(. .)
guānjiàn zài zìjĭ: ((Long
silcncc whilc thc doctor
is finishing writing thc
prcscription.))
.c.. Ð: băozhèng n néng hăo āh:
.ca. P: nà jiù tài hăo le ha::
h::((laugh))
.c¸. Ð:w men qiáobìng jiù y u
zhèi ge băwò (..) yào bu=
.c¡. P: =tīng nín zhème shuō::w de
bìng jiù hăo yí bànr le ha::h::
((laugh))
µ¸. P: Somctimcs, thc problcms ol rcal lilc
rcmain unsolvcd: uh: (.¸), cvcn though
you yourscll want to stop dwclling on
thcm, you just can’t hclp (. .) um: Sincc
thcy arc not solvcd uh: you just can not
stop thinking about thc problcms, right:
µ6. Ð: !t is simply impossiblc to havc
cvcrything go complctcly according to
your wish uh: (.¸)
µ,. P: 8u: u: t !: thi::nk (. .) il only !’ll
bc ablc to pcrlcctly solvc thcsc two
problcms ol my lilc:-
µ·. Ð: -You can on::ly talk about rclativcly:
rclativcly satislactory: Complctcly
satislactory: (.) Tat’s not possiblc.
µµ. P: Vcll:: ! havc probably cxpcctcd too:
much (..c)
.cc. Ð: No:: actual: actually (.¸) socicty
(. .) social rcality: lilc rcality: ! think
(.·) is all likc this (.¸) Wherever you
go, thcrc will bc un::happy things (. .)
there are problcms ol intcrpcrsonal
rclations (.) You just thi::nk about it::
no place whcrc you do not havc to dcal
with intcrpcrsonal rclationship (. .) As
long as thcrc arc pcoplc (.) thcrc arc
intcrpcrsonal rclations (¡.) Tc qucstion
is how to handle thcm (.) Tc kcy lics
with thc individual oneself. ((Long
silcncc whilc thc doctor is finishing
writing thc prcscription.))
.c.. Ð: ! guarantcc you will gct bcttcr, oka::y:
.ca. P: Tat will bc rcally good. ha::h::
((laugh))
.c¸. Ð: Vhcn wc look at thc illncss, wc havc
this assurancc (..) Òthcrwisc-
.c¡. P: - Just listcning to what you just said::
my illncss is alrcady hall curcd. Ha::h::
((laugh))
136 TRANSFORMI NG EMOTI ONS
Tc sourcc ol pcrsuasion that a zhongyi doctor rclics on is cmincntly cul
tural. Vith Vcstcrn psychothcrapy, choiccs ol conflict and conlrontation may
bc vicwcd as thc prclcrrcd mcchanism in solving problcms. “Tc paticnt is cn
couragcd to cxprcss thc lccling, to gratily thc dcsirc, and to rcmovc thc supprcs
sion.”`⁷ Howcvcr, with zhongyi, thc paticnt is cncouragcd to contain (baorong
包容), dissolvc (huajie 化解), and thcn translorm (zhuanhua 转化) thc conflicts
by cmphasizing thc conncctcdncss ol scll and othcrs, individual and socicty,
human bcing and thc myriad things ol thc world. Vhat is cmphasizcd is thc
scnsc ol unity and harmony with naturc and thc world. From this cnlightcncd
point ol vicw, thc ups and downs ol lilc arc vicwcd as “thc waxing and waning ol
thc moon,” or in Joscph Nccdham’s words, thc “ordcrly proccsscs ol changcs.”`⁸
Tc doctor calls this “thc scnsc ol ordinarincss” (pingchang xin 平常心), which
is vicwcd as important lor a hcalthy and maturc pcrson and is lrcqucntly cm
phasizcd in zhongyi counscling. Zhongyi practicc is not just a way to hcal, but
also a proccss to transmit cultural valucs and social idcology.
Arthur and Joan Klcinman arguc that cfficacy is “an altcrcd bodyscll, but
also an altcrcd flow ol rclationships, an altcrcd world.”`⁹ !n this scnsc, thc path
to ultimatc cfficacy involvcs rcdcfining rcality, rcoricntating locus, and rcor
dcring thc cxpcricncc ol local worlds. Tc paticnt in this casc prcscnts hcrscll
as a passivc victim ol hcr social cnvironmcnt lrom thc bcginning. From hcr
pcrspcctivc, hcr hcartcmotion vcxation and physical and cmotional symptoms
all rcsult lrom hcr stagnant pcrsonal lilc and hcr strcsslul and unsympathctic
working cnvironmcnt, and in turn, hcr cmotional and bodily dyslunctions im
pcdc hcr social pcrlormancc. Shc rclcrrcd to this situation as a “vicious cyclc.”
Hcr sccking zhongyi hclp is an cffort to brcak thc cyclc by dcaling with hcr
cmotional and bodily cxpcricncc. Howcvcr, shc maintains that thc unrcsolvcd
social problcms arc thc sourccs ol hcr suffcring, about which shc cannot do
anything. Although having rccognizcd thc social lactors in thc paticnt’s suffcr
ing, thc doctor insists that thc paticnt hcrscll must makc a diffcrcncc. From thc
doctor’s pcrspcctivc, his paticnt nccds to rcthink hcr own “hcartmind’s” claim
on socicty. Sccing that translormation ol thc paticnt’s cxpcricncc rclics vcry
much on hcr ability to rcasscss hcr situation and rcadjust hcr social rclations,
thc doctor makcs cvcry cffort to pcrsuadc thc paticnt to changc hcr attitudc and
scc things lrom a diffcrcnt pcrspcctivc. As shown at thc cnd ol thc convcrsation,
thc doctor and thc paticnt achicvc somc sort ol alignmcnt whcn thc paticnt
admits that shc might havc cxpcctcd too much (scc turn µµ in transcript scg
mcnt ,.,) and claims jocoscly that hcr illncss is hall curcd just by listcning to
thc doctor (turn .c¡). Tc paticnt and doctor part with a sharcd cxpcctation that
thc prcscribcd hcrbs and an “attuncd” attitudc would hclp improvc thc paticnt’s
hcalth. 8oth thc doctor and paticnt undcrstand that thc proccss ol “attuning”
has just startcd, and thc ultimatc cfficacy ol rcstoring hcalth dcmands diligcnt
and continuous cfforts lrom both thc paticnt and thc doctor.
As analyzcd abovc, lor a qingzhi (cmotionrclatcd) disordcr, dcfincd as “ill
ncss duc to disordcrcd cmotions” (yi qing bing zhe 以情病者), zhongyi doctors
CLI NI CAL PROCESS OF TI AO 137
particularly cmphasizc thc importancc ol thc paticnts’ ability to “translorm
thcir cmotions and changc thcir pcrspcctivcs” (yiqing yizhi). Tcy assumc that
changcs in onc’s attitudc and bchavior havc physiological outcomcs and vicc
vcrsa. Tcrclorc, “talking” as pcrsuasion or manipulation ol cmotions is also
an intcgratcd part ol zhongyi thcrapy, which is vcry oltcn acccptcd as mcrcly
hcrbal thcrapy. Howcvcr, zhongyi “talking” is not mcant to bc a “talk thcrapy” ol
thc Vcstcrn psychological counscling, and it should not bc judgcd as such. !t
has to bc undcrstood in thc light ol thc wholc clinical proccss ol tiao, aiming at
adjusting multiplc dimcnsions ol thc paticnt’s cxpcricncc, including prcscrib
ing mcdicinal hcrbs, and pcrsuading thc paticnt to “translorm cmotions and
changc pcrspcctivcs.” Tis analysis ol thc intcraction bctwccn thc doctor and
paticnt could bc claboratcd into a sociocultural critiquc, in which thc doctor can
bc sccn as cmbodying thc hcgcmony ol cstablishcd social ordcrs and thus in
strumcntal to social control. Such an analysis dcmands a lurthcr distancc lrom
thc nittygritty naturc ol cvcryday clinical work pcrccivcd primarily as clinical
actions against illncsscs by both doctor and paticnt and an intcrprctation at
a highcr lcvcl ol structural abstractions. Such a projcct could bc a ncxt stcp.
Additionally, thc transcribcd data ol naturally occurring clinical intcraction is
rcadily acccssiblc to othcr intcrcstcd scholars who may attcmpt to carry out a
diffcrcnt typc ol analysis.
Finally, this chaptcr has cmpirically documcntcd how thc doctor and
paticnt cngagc cach othcr in dctcrmining thc mcaning ol a particular illncss
and ncgotiating thc path to cfficacy. !t is implicd that a microanalytically ori
cntcd cthnography can providc uniquc cmpirical insights to complcmcnt thc
undcrstandings dcrivcd lrom thc morc convcntional approach ol participant
obscrvation. !n rcccnt anthropological accounts ol Chincsc mcdicinc, thc dc
tailcd dcscriptions ol obscrvcd cascs and anccdotcs and rccordcd cxpcricncc
rcportcd to thc rcscarchcrs by inlormants hclp providc sophisticatcd picturcs ol
zhongyi practicc in timc and placc. Howcvcr, givcn that a clinical cncountcr is
lundamcntally a lacctolacc intcraction, without considcring its intcractional
aspcct, our undcrstanding ol this “practiccoricntcd” hcaling systcm is incom
plctc. ¡vcn with thc dctailcd dcscription and analysis ol thc clinical proccss
ol kanbing (looking at illncss) offcrcd by Farquhar,⁴⁰ wc still would “not know
cxactly how Chincsc mcdical doctors gct lrom paticnts’ complaints to thc prc
scription ol spccific drugs.”⁴' Hcrc, microanalysis that rclics on thc actions and
intcractions ol thc participants thcmsclvcs lor analytical rcsourccs may offcr thc
promisc to tracc how a particular syndromc typc is dcfincd and a thcrapcutic
action is dctcrmincd in a rcal cpisodc ol clinical cncountcr.
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139
VI I I
Conclusion
Tis book has offcrcd an cthnographic account ol how cmotionrclatcd disor
dcrs (qingzhi bing 情志病) arc construcd, constructcd, trcatcd, and cxpcricnccd
in thc contcxt ol Chincsc mcdicinc, or zhongyi in contcmporary China. ! havc
structurcd my dcscription in a way morc or lcss matching thc Chincsc habit
ol dcfining a situation, that is, bcginning with a broadcr contcxt and gradually
narrowing down to morc spccific obscrvations. ! start with a historical pcrspcc
tivc ol translormations ol Chincsc mcdicinc, thcn movc to thc situatcd discus
sions ol Chincsc pcrccptions ol bodypcrson (shenti 身体), cmotion (qing 情),
cmotionrclatcd disordcrs (qingzhi bing), and finally to an analysis ol a spccific
zhongyi clinical momcnt ol attuning (tiao 调).
First ol all, to makc scnsc ol thc Chincsc cxpcricncc ol bcing ill and bcing
hcalcd, wc must “considcr thc prcscncc ol bodics.”' Yct “thc bodics” that thc
Chincsc mcdicinc works on and thc Chincsc paticnts cxpcricncc arc con
structcd diffcrcntly lrom thc Vcstcrn commonscnsical and bioscicntific notion
ol body. Tcy do not cntail thc distinction bctwccn mind and body or soma and
psychc. Tc mcaning and cxpcricncc ol a qingzhi disordcr and its zhongyi trcat
mcnt, thcn, must bc intcrprctcd within thc Chincsc conccptual and cxpcricntial
world ol livcd bodypcrson (shenti) which is, at thc samc timc, cmotivc, moral,
and visccral, and in rclation to thc cmbodicd cultural valucs ol cvcryday lilc.
Tc conccpt ol somatization by virtuc ol its dualistic prcsupposition has scrious
limitations in undcrstanding Chincsc cmbodicd cxpcricncc.
!n prcscnting qingzhi disordcrs as Chincsc cxpcricncc, ! cxplorcd in chap
tcr ¸ thc Chincsc conccption and cxpcricncc ol shenti (bodypcrson): how thc
Chincsc world ol shenti is pattcrncd and shapcd by cultural valucs and scnsibili
tics that arc dccply rootcd in thc bodily practicc ol cvcryday lilc. ! particularly
discusscd thc salicnt Chincsc acsthctic valucs and scnsibilitics ol flowing and
connccting (tong 通), dcgrcc and position (du 度), and harmony (he 和) in
shaping and giving mcanings to thc Chincsc cxpcricncc ol bcing ill and bcing
hcalcd. ! showcd that thc ordinary Chincsc in thcir daily practiccs arc oricntcd
140 TRANSFORMI NG EMOTI ONS
to a dccply cmbodicd acsthctic ordcr, which hclps dcfinc qingzhi disordcrs as
thosc charactcrizcd by stagnation, cxccssivcncss, and disharmony in all thc as
pccts ol thc local world. To makc scnsc ol Chincsc qingzhi disordcrs, thcn, wc
havc to attcnd to thc “lclt quality” ol this world.
Sccond, thc knowlcdgc and practicc ol zhongyi is rootcd in an cpistc
mological tradition diffcrcnt lrom that ol thc paradigm ol biomcdicinc that
privilcgcs a languagc ol anatomic structurcs and rcductivc causality that
charactcrizcs a discasc as a discrctc cntity. Zhongyi, howcvcr, privilcgcs a
languagc ol proccss and translormation that dcscribcs a “syndromc pattcrn”
(zheng 证) as a contingcnt statc ol dynamic rclations in a pathological proccss.
From lunctions ol thc visccral systcms, to manilcstcd bodily symptoms, to
cmotionalmcntal cxpcricncc, and to natural and social cnvironmcnt, zhongyi
physiology rcvcals a ccasclcss continuum ol proccss and translormation. Tc
cffcct ol a thcrapcutic intcrvcntion at any particular point ol this continuum
can bc cvcntually translcrrcd to othcr aspccts ol thc bodypcrson according to
this physiology. Tcn, zhongyi hcaling cntails a proccss ol carclully studying
and disccrning thc changcs and rclations ol illncss manilcstations in timc and
spacc and using whatcvcr tcchnology is availablc—mcdicinal, psychological,
and social—to manipulatc thc clinical dynamics and rclations in ordcr to cn
ablc a dcsirablc dcvclopmcnt. Tis thcrapcutic proccss is bcst summarizcd as
tiao (attuning).
Tird, zhongyi hcaling should also bc undcrstood and analyzcd as intcrac
tional phcnomcna in actual clinical work. Zhongyi is undcrstood by doctors as
“thc scicncc ol practicc” (shijian de kexue 实践的科学). Zhongyi thcorics and
thc accumulatcd knowlcdgc ol hcaling (shijian jingyan 实践经验) cannot bc
scparatcd lrom actual clinical judgmcnts and choiccs and ultimatcly thc cffccts
ol thc clinical work. As Farquhar points out, zhongyi knowlcdgc is “quintcsscn
tially cmbodicd and transmittcd in thc momcnt ol clinical practicc.”´ !t lollows
lrom this that a closc cxamination ol what actually gocs on and what is actually
accomplishcd within thc clinical proccss could bc particularly inlormativc to
our undcrstanding ol zhongyi clinical practicc. !n addition, thc participation
ol thc paticnt is intrinsic to cffcctivc thcrapcutic practicc. Tis is particularly
significant in thc zhongyi contcxt. Yct, as ! mcntioncd in chaptcr ,, Chincsc
mcdicinc has not bccn studicd cmpirically as actual social practicc in its intcrac
tional contcxt. Vithout considcring thc intcractional aspcct, our undcrstanding
ol this practiccoricntcd hcaling systcm is incomplctc.
As my analysis in chaptcr , dcmonstratcs, a microanalitically oricntcd
cthnography offcrs a vantagc point lrom which to look at thc zhongyi clini
cal practicc ol looking at an illncss (kanbing). !t providcs cmpirical insights
into many important thcorctical issucs ol zhongyi practicc. Zhongyi doctors and
paticnts both cmphasizc thc importancc ol accumulatcd cxpcricncc through
practicc (jingyan) lor a doctor in clinical practicc, whcrcas in biomcdicinc thc
latcst scicntific knowlcdgc and tcchniqucs arc morc rcvcrcd. Tc long ycars
CONCLUSI ON 141
ol a doctor’s cxpcricncc arc lrcqucntly in thci clinics. A lcgitimatc qucstion is
how jingyan comcs into play in an actual proccss ol “diffcrcntiating syndromcs
and dctcrmining thcrapics.” A closc look at actual clinical intcraction shows
that thc doctor’s jingyan is dcploycd in his pcrccption ol thc clinical situations
in intcractional lorms, in his ability to makc conncctions and asscssmcnt ol
symptoms, and vcry importantly, in his ways ol cngaging thc paticnt. Jingyan
is not only thc accumulatcd knowlcdgc that rclatcs thc doctor to a particular
syndromc pattcrn and an hcrbal lormula, but also thc accumulatcd lilc cxpcri
cncc that rclatcs thc doctor to thc pcrson who is suffcring.
Sincc Zhongyi clinical proccss is charactcrizcd as “looking at illncss” by
both doctor and paticnt, an cxamination ol thc actual intcraction that takcs
placc in clinical practicc offcrs a way to study how doctor and paticnt cngagc
cach othcr and bring thcir own insights to bcar on thc illncss. As my analysis in
chaptcr , shows, it is through thc intcractions bctwccn thc doctor and paticnt
that a particular zhongyi syndromc typc cmcrgcs or is dcfincd and a particular
thcrapcutic mcthod is dctcrmincd. Tc microanalysis in chaptcr , cmpirically
documcnts how thc doctor and paticnt oricnt thcmsclvcs to cach othcr and
ncgotiatc thc mcanings ol thc illncss and thc path to cfficacy.
Zhongyi practicc is also rccognizcd as having a holistic pcrspcctivc (zhengti
guan 整体观) that sccs an illncss as a disordcr ol bodypcrson in rclation to thc
social and natural cnvironmcnt. \cry oltcn thc zhongyi holistic pcrspcctivc is
discusscd in an abstract way as part ol a thcorctical discoursc on thc unity ol
human and naturc. Vc rarcly scc how this holistic pcrspcctivc is rcflcctcd in thc
clinical proccss. Vith a closcr look at thc actual clinical intcraction, wc can scc
that thc conncction ol thc paticnt’s social cnvironmcnt, cmotional cxpcricncc,
and physical suffcring is assumcd by both doctor and paticnt and is activcly
cvokcd in clinical actions and intcractions. Vc can also scc that thc holistic
principlc is actually a practical guidc in thc zhongyi clinical work ol diffcrcntiat
ing syndromcs and dctcrmining thcrapics.
Tis raiscs somc vcry important qucstions. Ðocs zhongyi addrcss cmotional
complaints: How docs zhongyi handlc thc cmotional aspccts ol thc paticnt’s
suffcring: Tc imprcssion that wc gct lrom many discussions ol zhongyi and
Chincsc mcdical culturc in gcncral is that Chincsc tcnd to cmphasizc physical
discomlort rathcr than cmotional complaints.` Zhongyi is said to conccptual
izc cmotional disordcrs as physical illncsscs and to trcat thcm as such. Yct, as
! showcd in my microanalysis ol a clinical intcraction, it is obvious that, lor
trcating qingzhi disordcrs, zhongyi docs addrcss thc paticnt’s cmotional and so
cial difficultics as wcll as hcr bodily dyslunctions. !n lact, thc microanalytically
oricntcd study can bc uscd as a tool ol discovcry. ! myscll was surpriscd, whcn
! was transcribing thc actual clinical intcractions, at how much cmphasis thc
paticnt put on hcr cmotional disturbancc and social difficultics and how much
cffort thc doctor actually madc to addrcss thc paticnt’s social and cmotional
problcms. Still, thc qucstion rcmains, why thc lact that cmotional aspccts in
142 TRANSFORMI NG EMOTI ONS
zhongyi clinical work, which sccms so obvious, has cscapcd analytical and cth
nographic attcntion.
Ònc possiblc rcason is that thc lorms, conccrns, and tcchniqucs ol zhongyi
counscling, as it is shown in chaptcr ,, arc radically diffcrcnt lrom thosc ol thc
standard Vcstcrn psychological counscling. Comparing thc lramcwork ol thc
Vcstcrn “talk thcrapy” to zhongyi clinical contcxts, thc zhongyi doctor’s ap
proach rcscmblcs morc ol an inlormal pcrsuasion by a closc lricnd or lamily
mcmbcr than a prolcssional cxploration ol thc paticnt’s inncr cmotional con
flicts. Tis approach may sccm lcss prolcssional and cffcctivc, and thcrclorc is
not rccognizcd as “rcally” dcaling with thc paticnt’s cmotional problcms. How
cvcr, as my analysis shows, thc zhongyi “talking” or “counscling” is not mcant
to bc a “talk thcrapy.” !t has to bc undcrstood in thc light ol thc wholc clinical
proccss ol “attuning” (tiao), which aims at adjusting multiplc dimcnsions ol thc
paticnt’s cxpcricncc, including pcrsuading thc paticnt to “translorm cmotions
and changc pcrspcctivcs.” Ncithcr thc doctor nor thc paticnt assumcs that a
qingzhi bing is an illncss cxclusivcly in cmotion or in mind, and “talking” will
bc thc only lcgitimatc way to hcal. Òn thc contrary, both thc doctor and thc
paticnt assumc that a qingzhi bing has social, cmotional, and physical dimcn
sions and various aspccts ol thc intcrvcntion, such as an hcrbal prcscription,
an attuncd attitudc, changc ol bchavior or thc social cnvironmcnt, all havc a
stakc in thc translormation ol cxpcricncc in thc bodypcrson. Such a proccss
ol attuning has distinctivc cultural mcanings, and zhongyi talking should not
bc analyzcd and judgcd scparatcly lrom thc cultural contcxt ol thc wholc clini
cal proccss ol attuning. ! do bclicvc that a comparativc invcstigation bctwccn
thc attuning and Vcstcrn psychothcrapy may gcncratc somc vcry intcrcsting
insights in undcrstanding how cmotionrclatcd disordcrs arc constructcd and
managcd in Chincsc socicty and in thc Vcstcrn culturcs, but that has to bc lclt
lor a luturc study.
Vhcn askcd why zhongyi still cnjoys such popularity in today’s China
whcn biomcdical tcchnology, comparcd with zhongyi practicc, is cqually avail
ablc and affordablc to thc gcncral population, onc ol thc most lrcqucntly givcn
answcrs is that zhongyi fits China’s “national conditions” (guoqing) and is thcrc
lorc likcd by thc majority ol pcoplc. My intcrprctation ol this is that zhongyi
as an indigcnous hcalth carc systcm sharcs with its paticnts a systcm ol cul
tural valucs and oricntations that rccognizc thc inccssant circulation bctwccn
thc physiological, thc psychological, and thc social. As discusscd prcviously,
zhongyi constructions such as qingzhi disordcrs offcr a culturally mcaninglul
lorm ol suffcring lor Chincsc paticnts and practical mcthods to copc with a
livcd body that lalls out ol ordcr. My study has clcarly illustratcd this aspcct
ol zhongyi.
Howcvcr, thcrc is still morc that ! would likc to claboratc about Chi
ncsc cxpcricncc ol cmotionrclatcd disordcrs and Chincsc mcdicinc. Somc
arc important issucs that ! havc touchcd upon hcrc and thcrc, but havc not
CONCLUSI ON 143
systcmatically cxplorcd, lor cxamplc thc issuc ol zhongyi cfficacy. Vc may say
that zhongyi cfficacy partially dcrivcs lrom zhongyi’s cultural lcgitimacy. Yct, thc
qucstion ol mcdical cfficacy: how it is cvaluatcd and how it plays out in zhongyi
practicc and thc zhongyi industry in today’s China is lar morc complicatcd and
ccrtainly dcscrvcs “multidimcnsional approachcs” to addrcss it.⁴
¡ffcctivcncss ol trcatmcnt (liaoxiao 疗效) is claimcd by zhongyi prolcs
sionals as thc primary lactor that zhongyi rclics on lor its succcss in thc modcrn
cra. Howcvcr, thcrc has bccn littlc cffort to addrcss thc qucstion ol how cfficacy
is constructcd in zhongyi clinical contcxts. Vhat arc zhongyi’s critcria lor dctcr
mining cfficacy: Havc thcsc critcria changcd ovcr timc: How do thc dynamics
ol intcgrating zhongyi with biomcdicinc influcncc thc way zhongyi cvaluatcs
cfficacy: Particularly, in rcccnt ycars, thc country’s commitmcnt to modcrniza
tions and ovcrall cngagcmcnt in thc markct cconomy havc translormcd Chi
ncsc social lilc in a significant way. Havc thcsc sociohistorical dcvclopmcnts
changcd thc basic tcrms on which zhongyi cvaluatcs its cfficacy or on which
zhongyi is itscll cvaluatcd lor cfficacy: Tcsc arc somc ol thc qucstions that
dcscrvc lurthcr rcscarch.
To modcrnizc zhongyi or to makc it scicntific (zhongyi kexuehua) has bccn
a qucst lor gcncrations ol zhongyi prolcssionals sincc thc .µacs, yct thcsc pro
lcssionals also rcalizc that simply applying thc bioscicntific standards and pro
ccdurcs to the practicc and its cfficacy is cxtrcmcly difficult il not complctcly
lruitlcss (Zhcn ct al. .µµc:¡¸¸–¡¸·). For cxamplc, to dctcrminc scicntific cfficacy
ol a simplc hcrbal lormula in thc contcxt ol zhongyi would bc a lormidablc task.
Tcrc arc too many variablcs that nccd to bc controllcd, considcring how it is
uscd in thc actual clinical situation. A plant in itscll docs not mcan much, and
its particular cffcct nccds to bc undcrstood as a rcsult ol intcractions with othcr
plants within thc lormula. A doctor almost always adds somc additional in
grcdicnts to, and subtracts somc lrom, thc cxisting lormula according to a par
ticular casc. Furthcrmorc, thc amount ol cach hcrbal clcmcnt, thc gcographic
origin ol thc plants, and thc mcthods ol proccssing and dccocting thc plants arc
all subjcct to manipulation. Tcrclorc, cvcn though cach clcmcnt can bc tcstcd
scparatcly lor its pharmacological quality, thc cfficacy ol a particular zhongyi
lormula is lar lrom dctcrmincd. !n addition to all ol this complcxity, zhongyi
holds that a particular paticnt’s psychophysiological disposition and his or
hcr hcalth condition at thc particular timc also influcncc thc cffcctivcncss ol a
thcrapy. !n lact, cfficacy is a much broadcr conccpt than just scicntifically as
scsscd cffcctivcncss ol a mcdicinc.
Zhongyi, bccausc it lics outsidc thc paradigm ol thc modcrn bioscicnccs,
has bccn constantly qucstioncd lor its scicntific valuc. At thc samc timc, bc
causc ol this, it is difficult lor any scicntific mcthod to simply lalsily or con
firm thc claims that zhongyi makcs, unlcss wc complctcly altcr thc basic tcrms
and clinical conditions undcr which it works. !ntcrcstingly, zhongyi is ablc to
activcly cxploit its conccptual incompatibility with scicncc and ncgotiatc its
144 TRANSFORMI NG EMOTI ONS
vcry prospcrous prcscncc in thc modcrn agc ol scicncc and tcchnology. !n this,
zhongyi dcmonstratcs its “historical toughncss.”⁵ Òn thc onc hand, it cngagcs
scicncc in producing and advcrtising a scicntifically lcgitimatc modcrn practicc
and industry, obscrvablc in zhongyi cducation, hospitals cquippcd with ncwly
dcvclopcd bioscicncc tcchnology, and a booming industry ol zhongyi patcnt
mcdicinc. Òn thc othcr hand, zhongyi continucs to cvokc a diffcrcnt cultural
modality quintcsscntially cmbodicd in thc “traditional” tcchnology ol diffcr
cntiating syndromc pattcrns and dctcrmining thcrapics (bianzheng lunzhi)
couplcd with dccocting hcrbs. Vhcn thc paradigm shilts to zhongyi clinical
practicc, what is cmphasizcd is practicc and contcxt, within which “scicncc” is
not absolutc but rathcr dcbatablc, contcstablc, and appropriablc.
145
APPENDI X
Transcription Conventions Used in the Text
!. Tc pinyin systcm is uscd in Chincsc transcription. !n CA donc on ¡ng
lish, punctuation marks arc convcntionally uscd to indicatc intonation.
Sincc Chincsc is a tonal languagc, it is not ncccssary to usc a scparatc
systcm to indicatc intonation. Punctuation is not uscd at all in thc Chi
ncsc transcription. Howcvcr, to makc thc translation casicr to undcrstand,
punctuation marks arc uscd lor grammar in thc ¡nglish translation ol thc
transcript.
!!. Tc symbols uscd in thc transcription arc ol standard notations dcvcl
opcd in convcrsation analysis and uscd in most convcrsation analytical
litcraturc.
// indicatcs thc onsct ol ovcrlapping uttcranccs.
:: indicatcs that thc sound lollowcd by colons is lcngthcncd.
- is uscd at thc cnd ol onc linc and thc bcginning ol anothcr, indi
catcs that no timc clapscd bctwccn two lincs ol uttcranccs.
(.) (cach dot in parcnthcscs) indicatcs a pausc ol about onctcnth ol
a sccond.
(c.c) indicatcs duration ol pauscs or silcncc in scconds.
(word) indicatcs that thc transcribcr is not surc that thc cxprcssion that
appcars in thc parcnthcscs is cxactly what is said.
((word)) indicatcs transcribcr’s rcmarks.
word indicatcs sound loudcr than normal spccch.
word indicatcs sound much loudcr than normal spccch.
ºwordº indicatcs sound uttcrcd at low volumc.
This page intentionally left blank.
147
Notes
CHAPTER I
.. Tc samc catcgory ol illncss is somctimcs rclcrrcd to as shenzhi bing 神志病 or
shen bing 神病 (mindrclatcd disordcrs). Qingzhi 情志, commonly translatcd as “cmo
tions,” spccifically rclcrs to thc zhongyi conccpt ol ‘qiqing’ 七情 (scvcn cmotivc or mcntal
activitics): xi 喜 (joy), nu 怒 (angcr), you 忧 (worry/anxicty), si 思 (thinking/longing),
bei 悲 (sadncss/gricl ), kong 恐 (lcar), jing 惊 (lright). A dctailcd analysis ol qingzhi is
providcd in chaptcr ¡.
a. Zhang Jicbin in his book Lei Jing 类经 (Commcnts on !ntcrnal Classics .6a¡)
listcd twcntyninc commcnts undcr thc hcading ol qingzhi bing. Scc also Sivin .µµ¸ lor
thc discussion ol a group ol disordcrs collcctcd undcr thc hcading qingzhi (cmotions) in
Vu Kun’s Yifang Kao 医方考 (Research on Medical Formulas) (.¸·¡).
¸. Jackson .µµ¡:a...
¡. Yap .µ,¡.
¸. Scc Tscng ct al. .µµ¸, Chcng .µµ¸, Yang .µµ¸.
6. Klcinman .µ·6.
,. Scc Lucas and 8arrct .µµ¸ lor a discussion ol psychiatric primitivism.
·. Schcid acca:.¸.
µ. Scc Csordas .µµ¡.
.c. Scc Ðcsjailais .µµa, lor thc critiquc ol symbolic approach to culturc in
anthropology.
... 8rowncll .µµ¸:.¸.
.a. Jcnkins and \alicnt .µµ¡.
.¸. Òts .µµc:.a.
.¡. Ðcsjarlais .µµa:,.
.¸. Scc Good and Good .µ·a.
.6. Frakc .µ6..
.,. 8rowncr ct al. .µ··.
.·. Also talkcd about as rclcrcntial mcaning. Scc also Vhitc .µµ¸.
.µ. Good and Good .µ·a:.¡¸.
ac. Good .µ,,:a,.
a.. Scc Lock and SchcpcrHughcs .µµc.
148 TRANSFORMI NG EMOTI ONS
aa. Scc Taussig .µ·c, Young .µ·a.
a¸. SchcpcrHughcs.µµa.
a¡. Klcinman and Klcinman .µµ., .µµ¸.
a¸. Scc Frankcl .µ·¸, Mishlcr .µ·¡, Vcst .µ·¡, Hcath .µ·¡.
a6. Tcrc arc many diffcrcnt approachcs to discoursc analysis. My microanalyti
cal approach draws mostly lrom convcrsation (talkinintcraction) analysis (scc Atkin
son and Hcritagc .µ·¡) and intcractional sociolinguistics (scc Goffman .µ6¡, .µ,¡, .µ·.,
Gumpcrz .µ·a). Morc discussion is givcn in chaptcr 6.
a,. Scc Ðavid L. Hall and Rogcr Amcs (.µ·,) lor dctailcd discussion ol Chincsc
cosmological assumptions that arc uncommon to thc Vcstcrn philosophic rcflcctions.
a·. Scc Farquhar .µµ¡.
aµ. Good .µµ¡.
¸c. Vu (.µ·a:a·¸) discusscs thc usc ol psychothcrapy in classical Chincsc mcdicinc
and points out that thc conccpts ol ‘hcalth’ and ‘hcalth carc’ in classic tcxts cmphasizcd
thc intcrrclations bctwccn a pcrson’s statc ol mind and that ol his/hcr hcalth. For thc
past two dccadcs, numcrous publications on zhongyi psychology (zhongyi xinlixue 中医
心理学) or hcartbody mcdicinc (xinshen yixue 心身医学) havc appcarcd, lor cxamplc,
Vang .µ·6, Ðong ct al. .µ·,, Zhang .µµ¸, Ðong acc., Ðong and Li acc¸.
¸.. Scc Chcung ct al. .µ·., Klcinman .µ·c, .µ·6, Klcinman and Mcchanic .µ·.,
T. Y., Lin .µ·¸, Tscng .µ,¸.
¸a. According to Zhcng Yanping at al. (.µ·6:a¸,), thc languagc many Chincsc dc
prcssivc paticnts usc docs not fit comlortably into thc two pattcrns ol psychologization
and somatization suggcstcd by somc rcscarchcrs in thc Vcst (c.g., Marsclla .µ·c, Good
and Klcinman .µ·¸). Chincsc paticnts may usc languagc that cvokcs bodily imagcs or
cxpcricncc, but it is ccrtainly not somatic in opposition to psychological.
¸¸. Òthcr lorms ol traditional trcatmcnt likcly to bc mcntioncd by paticnts arc
acupuncturc, massagc, and qigong (mcditativc) cxcrcisc and thcrapy. Ònc paticnt whom
! intcrvicwcd told mc that oncc hcr lamily took hcr to thc countrysidc to bc trcatcd by
a shaman doctor.
¸¡. Scc Sivin .µµ¸.
¸¸. SchcpcrHughcs and Lock .µ·,:µ.
¸6. Amcs .µµ¸:.c¸.
¸,. Commonly translatcd as “spirit” or “mcntal.”
¸·. Scc also Hall and Amcs .µ·,:ac.
¸µ. Scc Farquhar .µµ¡:.·.
¡c. Scc Lin and ¡iscnbcrg .µ·¸. From many psychiatrists working in Chincsc soci
cty, zhongyi is undcrstood as having a somatopsychic approach to trcatmcnt ol mcntal
illncss, that is, trcating mcntally ill through manipulation ol physiological lunctions.
Such an approach is oltcn citcd as an obstaclc to thc dcvclopmcnt ol psychiatry in
China.
¡.. Scc Chcung .µ·a, .µ·µ, Klcinman .µ,,, .µ·a, .µ·6, Lin .µ·¸, Tscng .µ·¸, Zhang
.µ·µ.
NOTES TO CHAPTER I 149
¡a. Scc Klcinman .µ,,, .µ·c, Lcff .µ·., Tscng .µ,¸.
¡¸. Jcnkins and \alicnt .µµ¡:.,¸. According to Klcinman (.µ·6:.¡µ), somatization
is “thc substitution ol somatic prcoccupation lor dysphoric affcct in thc lorm ol com
plaints ol physical symptoms and cvcn illncss.” Latcr, hc rcdcfincs thc conccpt as “thc
normativc cxprcssion ol pcrsonal and social distrcss in an idiom ol bodily complaints
and mcdical hclpsccking” (.µ·6:a). Òthcrs dcfinc it as “cxprcssion stylc or idiom ol
cmotion” (Zhcng at al. .µ·µ:a¡c), “illncss picturcs in which bodily symptoms arc ovcrly
dominant,” and “cmbraccs displaccd psychosocial distrcss” (Fabrcga .µµc:.). Tc conccpt
prcsupposcs an ontological distinction bctwccn thc somatic and thc psychological and
involvcs “a postulatc about thc corrcspondcncc and association bctwccn changcs in thc
body as vcrsus thc mind and bchavior” (Fabrcga .µµc: 6¸¡).
¡¡. Jcnkins and \alicnt .µµ¡.,¸
¡¸. Klcinman .µ·c:.¡6.
¡6. F. M., Chcung .µµ¸:.66.
¡,. Chcng .µµ¸.
¡·. Tscng .µ,¡.
¡µ. Scc Chcung .µµ¸, Young .µ·µ, Zhcng ct al. .µ·6.
¸c. !n rcccnt ycars, China has madc mcntal hcalth a public hcalth priority and dc
vclopcd many social and mcntal hcalth programs (Cohcn, Klcinman, Saraccno acca:.¸).
Yct, thcsc psychiatricoricntcd programs and scrviccs rarcly bring in Chincsc mcdical
cxpcrtisc in thcir dcsign. ¡vcn thc communitybascd Shanghai modcl aimcd at both
trcatmcnt and rchabilitation docs not considcr Chincsc mcdicinc as rclcvant. Yct many
psychiatric paticnts, as ! obscrvcd during my ficldwork, do scck zhongyi hclp lor trcat
mcnt ol thcir illncsscs.
¸.. !n lact, thcrapcutic manipulation ol cmotions and thoughts by zhongyi doc
tors was documcntcd in carly Chincsc mcdical classics. Scc Sivin .µµ¸, Vu .µ·a. Morc
dctailcd inlormation is providcd in chaptcrs ¸ and ¡.
¸a. Scc Hsu .µµµ, Schcid acca, Sivin .µ·,, Unschuld .µ·¸.
¸¸. Scc also Schcid acca.
¸¡. Hsu .µµµ.
¸¸. Schcid acca:a.
¸6. !bid., a6¸.
¸,. Pcoplc’s Mcdical Publishing Housc:.¸µ.
¸·. Although thc typical paticnts ol Shcnjing Kc includc thosc with ncurological
disordcrs and thosc with what Vcstcrn mcdicinc calls “psychological” or “psychiatric”
problcms, thc distinction ol diffcrcnt ke in a zhongyi hospital is not as significant as in
a biomcdical hospital. Such a distinction is significant to thc doctors mostly in tcrms ol
diffcrcnt points ol vicw or positions in approaching thc samc pathological rcality. !t is
common that a paticnt consults diffcrcnt ke in onc visit to thc hospital, and thc doctor
and paticnt do not sccm to havc problcms with diffcrcnt prcscriptions sincc idcally thcsc
prcscriptions aim at thc samc pathological conditions with a diffcrcnt cmphasis.
¸µ. ! was particularly closc to two studcnt doctors, Ðr. Huang and Ðr. Lcc. Huang
had bccn a zhongyi doctor lor fivc ycars in Hcbci provincc bclorc coming to 8cijing lor
150 TRANSFORMI NG EMOTI ONS
lurthcr training. Shc offcrcd to accompany mc on my visits to paticnts. Lcc was a gradu
atc studcnt lrom South Korca. Shc lct mc borrow hcr notcs whcncvcr ! nccdcd thcm.
Shc was also a paticnt. ! obscrvcd a couplc ol timcs whcn paticnts wcrc not prcscnt, shc
askcd thc doctor to “look at hcr illncss” and was prcscribcd hcrbal mcdicinc lor slccping
problcms and low cncrgy.
6c. Tc oppositc movcmcnt is lcss cvidcnt but dcfinitcly cxists. 8ascd on my ob
scrvation, local doctors lrom provincial arcas with spccial cfficacy in trcating ccrtain
difficult discascs arc also invitcd to trcat paticnts in largcr hospitals in 8cijing.
6.. My lricnd, an instructor in a zhongyi collcgc, insistcd on paying thc bills whcn
cvcr wc dincd out, saying that shc madc morc than ! did. Shc cxplaincd that although
hcr salary was nothing, by taking in paticnts privatcly shc could makc a couplc ol thou
sand Chincsc yuan a month.
6a. Tcsc sourccs includc Farquhar .µµ¡, Liu .µ··, Òu ct al. .µµ, .µµa, Schcid acca,
Sivin .µ·,, and Chincsc Tcrms in Traditional Chincsc Mcdicinc and Pharmacy (Zhon-
gyiyaoxue Mingci 中医药学名词) acc¡.
CHAPTER I I
.. An cxpcricnccd scnior zhongyi doctor is lrcqucntly invitcd to attcnd group con
sultations, which usually includc both zhongyi and xiyi doctors on difficult mcdical cascs.
Gcncrally, thc zhongyi doctors arc thc oncs who arc cxpcctcd to movc back and lorth
bctwccn two mcdical systcms, whilc biomcdical doctors arc not cxpcctcd to mastcr
zhongyi conccpts and languagc.
a. According to my clinical obscrvation in a zhongyi hospital, a doctor docs not
routincly ordcr laboratory tcsts or cxaminations using pcnctrativc imaging dcviccs cx
ccpt on suspicion ol scrious organic discascs. For zhongyi intcrvcntion, thc purposc ol
thcsc tcsts and cxaminations is not strictly diagnostic in naturc sincc thc tcst rcsult is
not csscntial in dctcrmining thc thcrapcutic principlc or in choosing or dcsigning thc
drug lormula. Gcncrally, thc purposc is to dctcrminc whcthcr or not thcrc cxists any
scrious organic problcm that rcquircs drastic intcrvcntion ol biomcdicinc. Somctimcs,
paticnts ask lor ccrtain tcsts and cxaminations or biomcdical drugs. Ðoctors usually go
along with thc rcqucsts in ordcr to lct thc paticnts havc pcacc ol mind (fangxin 放心).
Howcvcr, in thc hospital whcrc ! did my rcscarch thcrc is a clcar guidclinc rcgarding how
much biomcdicinc a doctor can prcscribc. Gcncrally it should not cxcccd .¸ pcrccnt ol
thc total prcscription. Òccasionally, administrativc pcrsonncl would comc down to thc
clinics to chcck thc rccords. Situations might bc diffcrcnt in a clinic or hospital ol intc
gratcd Chincsc and Vcstcrn mcdicinc (zhongxiyi jiehe 中西医结合), whcrc biomcdical
cxaminations and drugs arc uscd morc libcrally. Scc Schcid acca:µ¸.
¸. Sincc many hospitals ol Chincsc mcdicinc also run a clinic ol Vcstcrn mcdicinc,
and biomcdical hospitals normally havc a Chincsc mcdical scction, paticnts somctimcs
choosc to scc both a biomcdical doctor and a zhongyi doctor in thc samc visit to thc hos
pital. Tcrc is also a lorm ol practicc officially callcd “intcgrativc trcatmcnt ol Chincsc
and Vcstcrn mcdicinc” (zhongxiyi jiehe zhiliao 中西医结合治疗), which is rccognizcd
as a practicc scpcratc lrom cithcr Chincsc or Vcstcrn mcdicinc.
¡. Scc Farquhar .µµ¡.
NOTES TO CHAPTER I I 151
¸. According to thc carlicst oraclc bonc inscriptions in thc Shang Ðynasty (.,66–
..aa ncv), thc charactcr ol yi 医 was ctymologically composcd ol two parts, yi (illncss,
curc) and wu 巫 (divination). Latcr in thc Zhou Ðynasty (..aa–,,a ncv), thc charactcr
was translormcd into its contcmporary lorm composcd ol curc and winc (jiu 酉) (scc
Tscng .µ,¡). According to thc carlicst Chincsc dictionary Shuo Wen 说文, yi mcans a
pcrson who curcs illncss with wincs. !n thc Spring and Autumn ol thc Zhou Ðynasty
(,,c–¡,6 ncv), yi (physician, mcdicinc) and wu (shaman, divination) had bccamc scpa
ratc spccializations listcd in diffcrcnt official catcgorics. Mcdical practicc during this
pcriod “witncsscd thc bcginning ol an organization” (Hoiscy and Hoiscy .µµ¸:¸¸). Ac
cording to Te Zhouli 周礼 (Te Rite of Zhou), at thc top ol thc mcdical hicrarchy wcrc
thc yishi 医师 (mastcr physicians), undcr whom thcrc wcrc also shiyi 食医 (physicians
lor nutrition), jiyi 疾医 (physicians lor thc curc ol illncss), yangyi 疡医 (physicians lor
trcating wounds), and shouyi 兽医 (physicians lor animals) (scc Zhcn ct al. .µµ.).
6. Porkcrt (.µ,¡) rclcrs to this hcaling systcm as thc mcdicinc ol “systcmatic
corrcspondcncc.”
,. According to Sivin, “classic mcdicinc docs not rclcr to thc thcory and practicc ol
a cohcrcnt group, but to thc rccords lclt by thc most litcratc and scholarly rcprcscntativcs
ol scvcral traditions (.µ·,:aa–a¸).
·. !t may sound likc an ovcrsimplification, but lrom thc point ol vicw ol many
scnior doctors who livcd through thc ycars struggling lor survival in thc .µacs and ¸cs,
thc contrast bctwccn thc currcnt statc ol lull lcgitimacy and official support and thc
past insccurity is rcal. Tc lccling is lully illustratcd in thc pocm by Zhang Zanchcn, a
rcnowncd scnior doctor: “Zhongyi at thc prcscnt is absolutcly diffcrcnt lrom thc past,
likc an ancicnt trcc rcvivcd thriving grccn in Spring” (quotcd in Li .µ·,:¸µ).
µ. Faquhar .µµ¡:.a.
.c. According to Unschuld (.µ·¸), whcn Robcrt Morrison, thc first Protcstant mis
sionary in China, and J. Livingston, a physician ol thc ¡ast !ndia Company, opcncd a
pharmacy and startcd to trcat paticnts in Macao in .·ac, Vcstcrn mcdicinc did not yct
havc much to offcr. Tcir willingncss to lcarn nativc hcaling tcchniqucs, in a ccrtain
scnsc, shows that “thcrapcutic knowlcdgc availablc to Vcstcrn physicians at thc timc
was still not yct sufficicnt to occasion an attitudc ol supcriority” (a¸6). Unschuld also
maintains that whcn Pctcr Parkcr, thc first Protcstant missionary with complctc mcdical
training, sct up a clinic in Canton in .·¸¸, “it was primarily minor surgical proccdurcs,
such as thc rcmoval ol cxtcrnal tumors and thc trcatmcnt ol supcrficial ailmcnts, as
wcll as spcctacular cataract opcrations, that quickly madc him lamous.” Scc also Cai
.µ··:¸a¸.
... Scc Hoizcy and Hoizcy .µµ¸:.¸c, Unschuld .µ·¸:a¸µ. Altcr thc sccond Òpium
Var, thc Vcstcrn powcrs’ privilcgcs in China wcrc lurthcr confirmcd and cxtcndcd lrom
thc coastal trcaty ports to thc intcrior, whcrc in lorty ycars lrom .·6c, .cc missionary
hospitals wcrc cstablishcd (Zhcn ct al. .µµ.:¡..).
.a. Quitc a lcw influcntial rclormmindcd intcllcctuals and politicians ol thc timc
had oncc in thcir carccrs choscn to study Vcstcrn mcdicinc, including Sun Yatscn and
Lu Xun.
.¸. Quotcd lrom Unschuld .µ·¸:a¸c.
152 TRANSFORMI NG EMOTI ONS
.¡. Tc discoursc ol xin 新 (ncw) vcrsus jiu 旧 (old) bccamc a dominant rhctoric in
thc ncw culturc movcmcnt (.µ.¡–.µ) with xin associatcd with things modcrn, progrcs
sivc, and Vcstcrn, and jiu with things outdatcd, backward, and traditional Chincsc. Tc
tcrm jiu yi 旧医 (old mcdicinc) rclcrring to Chincsc mcdicinc was uscd proluscly by
thosc who argucd lor abolishing zhongyi. Yu Yunxiu in his Revolution of Medicine (.µ.¡)
invariably rclcrrcd to Chincsc mcdicinc as jiuyi that should bc complctcly oblitcratcd.
Hc argucd that “mcdicinc was not to bc dividcd into Chincsc and Vcstcrn, and thc only
mcaninglul division was ‘ncw’ lrom ‘old/backward’ (yi wu fen zhong-xi, dan you xin-jiu
eryi. 医无分于中西, 但有新旧而已).” Scc Zhcn ct al. .µµ.:¡a·–¡¸¸.
.¸. Zhcn ct al. .µµ¡:¡·,.
.6. Cai .µ··:¸a¡.
.,. Unschuld .µ·¸:a¡6–a¡,.
.·. Different Schools of Chinese Medicine (Zhongyi Gejia Xueshuo 中医各家学说) cd
itcd by Rcn ct al. (.µµ¡) idcntifics scvcn major schools (xuepai 学派) ol mcdical thoughts
in history. Tcsc arc Hcjian, Yishui, Ðanxi, Gongxic, Vcnbu, Shanghan, and Vcnbing.
.µ. Zhcn ct al. .µµ.:¡¡..
ac. !bid., ¡µc–¡µa.
a.. Tc Ccntral National !nstitutc was cstablishcd in .µ¸c (Zhcng ct al. .µµ.).
aa. Scc Zhcn ct al. .µµ.:¡µµ–¸a·.
a¸. !n lact, thc argumcnt to abandon or radically rclorm Chincsc mcdicinc was
prcscntcd cqually in patriotic tcrms il not morc.
a¡. Quotcd in Zhcn ct al. .µµ¡:¡a6.
a¸. Scc Schcid acca:66–.c6.
a6. Tc Chincsc original is “Zhongguo yiyao xuc shi yi gc wcida dc baoku, ying
dang luli lajuc, jiayi tigao 中国医药学是一个伟大的宝库, 应当努力发掘, 加以提高.”
a,. Until .µ¡µ, all kinds ol inlcctious and parasitic discascs, such as plaguc, cholcra,
smallpox, tubcrculosis, black watcr lcvcr, malaria, and bilharzias had ragcd across thc
country. According to thc statistics on twclvc inlcctious discascs ol .µ¡,, about ..¸ million
wcrc inlcctcd and morc than .cc,ccc pcoplc dicd. (Zhcn, ct al. .µµ.:¸¡c). !n old China
(bclorc thc lounding ol thc PRC in .µ¡µ), thcrc wcrc only limitcd hospitals conccn
tratcd in main citics. Most Chincsc did not havc acccss to thcsc rarc mcdical rcsourccs.
To improvc hcalth conditions lor all thc Chincsc pcoplc bccamc an urgcnt task lor thc
ncw govcrnmcnt. At thc first National Conlcrcncc on Public Hcalth hcld in .µ¸c, onc
ycar altcr thc Communists took powcr, thrcc objcctivcs wcrc sct: hcalth work should bc
aimcd at thc mass ol workcrs, pcasants, and soldicrs, prcvcntion should takc priority, and
Chincsc and Vcstcrn mcdicincs should bc unitcd. Scc Hoizcy and Hoizcy .µµ¸:.,6.
a·. Scc Zhcn ct al. .µµ.:¸¸¸–¸¸6, and Li .µ·,: ¸6–¸,. Vhcn thc first hospital, thc
Rcd Hospital, was sct up in .µa, in thc Jingang Mountain Rcvolutionary 8asc, two ol
thc thrcc doctors wcrc doctors ol Chincsc mcdicinc. Tc division ol practicc was that
zhongyi trcatcd ordinary discascs with hcrbal mcdicinc and thc xiyi handlcd thc cxtcrnal
injurics. Tc Rcd Army also sct up mcdical schools to tcach basic biomcdical knowlcdgc
and Chincsc mcdicinc. Tc usc ol both Vcstcrn and Chincsc mcdicinc has bccn in
practicc sincc thc Jingang Mountains pcriod.
NOTES TO CHAPTER I I 153
aµ. 8ao Jinghcng .µ¸c “Vhy Chincsc mcdical doctors nccd lurthcr training,” in
Jian Kang \ol. .¸¸, quotcd in Zhcn ct al. (.µµ.).
¸c. Unschult .µ·¸:a¸..
¸.. Scc Zhcn ct al..µµ.:¡·,–¸a·. Tc Guideline for Academic Standardization of Na-
tional Medicine (Zhengli Guoyiyao Xueshu Biaozhun Dagang 整理国医药学术标准大纲)
was compilcd and publishcd by thc Ccntral Acadcmy ol National Mcdicinc (Zhong
yang Guoyi Guan 中央国医馆) in .µ¸¸. Latcr bascd on this guidclinc, thc acadcmy
issucd a documcnt suggcsting unilying zhongyi illncss namcs with thc Vcstcrn illncss
namcs. !n thc .µ¸cs, Vcstcrn mcdicinc was incorporatcd in thc curriculum ol many
zhongyi shools. For cxamplc, courscs such as anatomy, physiology, public hygicnc, bactc
riology, and pathology wcrc taught in thc North China !nstitutc ol National Mcdicinc,
cstablishcd by rcnowncd zhongyi physician, Shi Jinmo 施今墨, in .µ¸a.
¸a. Schcid acca:66.
¸¸. Òltcn simply rclcrrcd to as Neijing (thc !nncr Classics).
¸¡. Hanshu: Yiwenzhi 汉书:艺文志 (Records of Han Dynasty: Bibliography of Art
and Literature ac6 ncv–aac c~:) lists ·6· volumcs ol mcdical trcatiscs in ¸6 catcgorics.
¡xccpt lor thc Huangdi Neijing, all thc othcrs arc lost. Scvcral volumcs ol ancicnt mcdi
cal works wcrc cxcavatcd in thc third Han tomb (datcd .6· ncv) in Mawangdui in thc
.µ,cs. Tcsc works wcrc not cvcn listcd in Hanshu and possibly antcdatcd Neijing. Nei-
jing, composcd ol two books, Suwen 素问 (Basic Questions) and Lingshu 灵枢 (Ðivinc
Pivot), covcrs various topics ranging lrom thc rclationship ol a human bcing to his or
hcr natural cnvironmcnt and discussion ol human psychology, physiology, pathology, ill
ncss diagnosis, trcatmcnt, and prcvcntion. Many important thcorctical basics ol today’s
zhongyi can bc traccd to this book. !t is bclicvcd to bc thc product ol a group ol diffcrcnt
authors at diffcrcnt timcs. !ts compilation may havc lastcd lor ccnturics, starting dur
ing thc Varring Statc pcriod (around ¸cc ncv). !t did not takc on its final lorm until
Qin (aa.–ac, ncv) and Han (ac6 ncv–a¸ c~). Tc book probably startcd as scattcrcd
tcxts, which wcrc latcr addcd to, rcviscd, and rcarrangcd. Tc hctcrogcncsis ol thc book
is markcd by rcpctitions and inconsistcncy in contcnt and stylc. Scc Zhcn ct al. .µµ.,
Hoizcy and Hoizcy .µµ¸.
¸¸. Scc Jiqun, Xu & Qingzhi, Vang .µ·¸:.. Zhang Zhongjing (.¸c–a.µ ~b) is said
“to crcativcly intcgratc thc mcdical thcorics (li), mcthods (la), lormulas (lang), and drugs
(yao)” in his book Shanghai zabing Lun (Ðiscussion ol Cold Ðamagc and various dis
ordcrs), and was thcrclorc rclcrrcd to as “fangshu zhi zu” 方书之祖 (thc anccstor ol
lormulas).
¸6. Scc Unschult .µ·¸:a¸c–a¸., .µµa:¸¡.
¸,. Schcid acca:µ.
¸·. Zhcn .µµ.:.cc–..c. Scc also Fcng and Zhang acc¡.
¸µ. Scc Tian acc¸ lor inlormation on Yijing and Chincsc philosophic thought ol
tongbian (通变).
¡c. For cxamplc, Neijing’s statcmcnts about mingmen 命门 (gatc ol lilc) and san-
jiao 三焦 (thrcc burncrs) contradict complctcly thc statcmcnts givcn in Nanjing 难经
(Òn Ðifficult Mcdical !ssucs), anothcr canonical mcdical tcxt publishcd in Han pcriod
bclorc Zhang Zhongjing’s Shanghan Lun.
154 TRANSFORMI NG EMOTI ONS
¡.. Scc also Schcid acca:acµ–a...
¡a. Amcs .µµa.
¡¸. Farqhuar .µµ¡: a·.
¡¡. Vang Qi (acc¸) cxamincs thc prolcssional accomplishmcnts ol ..a rcnowncd
contcmporary zhongyi doctors and thcir ways to bccomc da yi 大医 (cxcmplary physi
cians). Shc notcd that all ol thcm cmphasizc thc importancc ol mcmorizing zhongyi
classic tcxts.
¡¸. Sivin .µ·,:a,.
¡6. Vhilc it is truc that contcmporary zhongyi cducation incrcasingly dcpcnds on
thc latcst tcxtbooks, thc latcst tcxtbooks in Chincsc mcdicinc probably do not diffcr as
much as in modcrn mcdicinc lrom prcvious tcxtbooks. Tc diffcrcncc among various
tcxtbooks dcpcnds morc on thc purposc ol thc books, such that thc tcxtbooks writtcn
lor studcnts spccializing in zhongyi arc diffcrcnt lrom thc tcxtbooks that arc writtcn lor
studcnts ol biomcdicinc, in stylc, dcpth, dctail, and languagc. Classic mcdical sourccs
actually lcaturc promincntly in rcccnt tcxtbooks, whcrc at thc cnd ol cach chaptcr, rcl
cvant sclcctcd rcadings ol classics (wenxian xuandu 文献选读 or wenxian zhailu 文献
摘录) arc providcd in thcir original lorms. Total translation ol classic mcdical tcxts into
modcrn Chincsc has ncvcr bccn wholchcartcdly carricd out. Tc common practicc is to
publish thc yuanwen 原文 (thc original tcxt) along with historical and linguistic notcs
and modcrn paraphrascs. Scc also Farquhar .µµ¡:a·.
¡,. Farquhar .µµ¡:aµ.
¡·. Sivin .µ·,:a¸.
¡µ. Hall and Amcs .µ·,:¡¡.
¸c. !n rcading biographics ol rcnowncd zhongyi physicians, ! noticc that almost all
ol thcm havc thcir lavoritc zhongyi classics that thcy claim hclp shapc thcir own clinical
work and that thcy tcnd to go back to lrcqucntly.
¸.. A discussion ol this worldvicw can bc lound in chaptcr ¸. For morc inlormation,
scc Hall and Amcs .µ·,.
¸a. Scc Unshult, .µµa¸·. Hc suggcsts thc possiblc cxistcncc ol a lundamcntal di
viding linc bctwccn Chincsc cognitivc dynamics markcd by “an cxpansion ol knowlcdgc,
adding ncw to thc old.” And Vcstcrn cognitivc dynamics “charactcrizcd by a rcplacing
ol thc old with thc ncw.”
¸¸. Scc Farquhar’s analysis ol thc rclationship bctwccn past cxpcricncc and prcscnt
clinical actions in Chincsc mcdicinc. Shc argucs, by cvoking past cxpcricncc, a doctor is
drawing on thc scholarly and clinical cxpcricncc ol his lorbcarcrs. Hc puts thcir insights
into play whcn hc dccidcs thcy arc appropriatc to thc spccific casc ol thc prcscnt, hc
modifics thcir lormulac according to thc prcscnt situation. “!n doing so hc both rcani
matcs thc cxpcricncc ol his lorcbcars and makcs his own contribution to a continuing
proccss ol accumulation” (.µµa:,a–,¸).
¸¡. Unshult (.µ·¸, .µµa), Farquhar (.µµ¡), and Schcid (acca) all mcntioncd thc
influcncc ol “dialcctics” in shaping zhongyi knowlcdgc in thc .µ¸cs and .µ6cs.
¸¸. Scc Zhongguo Keji Daobao 中国科技导报 (Chincsc Scicncc and Tcchnology)
.µµµ,\,.
NOTES TO CHAPTER I I I 155
¸6. Scc “Tc spccch givcn by scnior zhongyi physicians Jiao Shudc & Ðcng Tiatao”
in Xiandai Jiaoyubao 现代教育报 (Modcrn ¡ducation) August .c, acc.. As was also
rcportcd rcccntly on CCT\ ncws (Scptcmbcr µ, acc¡), many zhongyi graduatc studcnts
havc a good knowlcdgc ol thc ¡nglish languagc and computcr scicncc but havc littlc
timc lor studying Chincsc mcdicinc. Somc ol thcm can hardly undcrstand thc introduc
tion ol Bencao Gangmu 本草纲目 (Òutlincs ol Matcrial Mcdica).
¸,. Scc a scrics ol articlcs by Mao Jialing publishcd in Zhongguo Zhongyiyao Bao
中国中医药报 (Chincsc Mcdicinc and Pharmacy Vcckly) bctwccn January and May
acc¡.
¸·. Zhongguo Zhongyiyao Bao rcccntly invitcd spccialists lrom various ficlds to par
ticipatc in “Zhongyi and Scicncc Forum acc¡.”
¸µ. Scc thc rcccntly publishcd “Òutlinc lor thc dcvclopmcnt ol zhongyi clinical
rcscarch” (zhongyyi linchuang yanjiu fazhan gangyao 中医临床研究发展纲要 .µµµ–ac.¸)
draltcd by thc Ðivision ol ¡ducation ol thc Statc Zhongyiyao Administrativc 8urcau.
6c. For cxamplc, thc lormula ol xiao chaihu tang (dccoction ol blupcuri) is originally
rccordcd in Shanghan Lun (Ðiscussions ol Cold Ðamagc) and uscd lor trcating shaoyang
(lcsscr yang) disordcr. Tis spccific lormula has bccn uscd lor thousands ol ycars by Chi
ncsc physicians lor its cffcctivcncss in rcmoving thc hcat, activating qi movcmcnt, and
nourishing thc stomach yin. !n thc .µ,cs, a Japancsc pharmaccutical company startcd
to manulacturc thc mcdicinc bascd on this lormula which was latcr clinically tcstcd as
having cfficacy in trcating chronic hcpatitis. !t was thcn uscd libcrally to trcat hcpatitis
in Japan. !n thc .µµcs, rcports camc out that thc manulacturcd 8uplcuri could causc
intcrstitial pncumonia that could rcsult in dcath. Scc Fcng ct al. acc¡: ¸a–¸¡.
6.. Scc thc ncwspapcr articlc by Vang, “Suping in Jiankang Bao” 健康报 (Hcalth
Vcckly) Ðcccmbcr .c, acc¸.
6a. Translations arc my own unlcss othcrwisc notcd.
6¸. Farquhar .µµ¡:ac. Scc also Fauquhar acca:¡.–,, on mcdicinal mcals in con
tcmporary China.
6¡. According to Vci, Yu, and Minghui Rcn (.µµ,:.¸a), thc major profit lor hos
pitals comcs lrom sclling drugs. Hospitals arc allowcd to add .¸ pcrccnt to thc cost ol
purchascd drugs. Hospitals tcnd to makc morc profit on scllproduccd drugs.
CHAPTER I I I
.. Scc Csordas .µµc, .µµ¡.
a. Rogcr Amcs suggcsts that Chincsc tradition is “cvcntlul” rathcr than “csscntial,”
so gcrunds arc bcttcr than nouns lor translating Chincsc conccpts. Hcncc shenti might
bc bcttcr rcndcrcd “bodying” (Pcrsonal communication .µµ,).
¸. Ðcsjarlais .µµ¸.
¡. Lutz .µ··:¸¡.
¸. Lcc .µµ6:¡¸,. Scc also Klcinman .µ·c, .µ·6, F. Chcung .µ·., Òts .µµc. Klcinman
sccs somatization as a basic lcaturc ol illncss construction in Chincsc culturc. Susan
8rowncll .µµ¡, lollowing Klcinman’s conccpt ol somatization, claims “somatization has
charactcrizcd Chincsc culturc sincc ancicnt timcs” (a¸·).
156 TRANSFORMI NG EMOTI ONS
6. Scc Klcinman .µ·c, .µ·6, Òts .µµc, .µµ¡.
,. Òts .µµc:a¸.
·. Scc Zhang .µ·µ. Many Vcstcrn and Vcstcrntraincd psychiatrists bclicvc that
Chincsc mcdicinc has ncvcr sccn cmotion or cmotional disordcrs as “thc lcgitimatc do
main ol mcdicinc,” and thus doctors ol Chincsc mcdicinc do not takc trcating cmotional
disordcrs as thcir rcsponsibility.
µ. !t is vcry common that a paticnt prcscnts a banncr to thc clinic or doctor who
has succcsslully trcatcd him or hcr. ! saw banncrs prcscntcd to thc doctors who wcrc
spccialists on mcntal disordcrs, but in thc lcrtility clinics, onc scldom sccs any such
banncrs. Paticnts lccl cmbarrasscd to lct cvcn thcir lamily mcmbcrs and rclativcs know
about lcrtility problcms.
.c. According to a .µµ¡ survcy in 8cijing donc by ¡dward Malinovski (pcrsonal
communication), hall ol thc rcspondcnts indicatcd that zhongyi should bc consultcd
whcn a pcrson suffcrs dcprcssion.
... Scc Xu .µµ¡, Young .µ·µ.
.a. My own obscrvation in hospitals ol Chincsc mcdicinc in 8cijing docs not sup
port such a clcarcut distinction bctwccn paticnts lrom rural arcas and citics. Paticnts
lrom thc rural arcas and citics both prcscnt cmotional symptoms. Tcrc may bc somc
diffcrcncc in vcrbal stylc. Tc wcllcducatcd paticnts may rcadily usc morc tcchnical
words such as yayi 压抑 (dcprcsscd) or jiaolu 焦虑 (anxious), whilc thc lcss cducatcd
paticnts may simply usc cvcryday cxprcssions such as xinqing buhao 心情不好 (hcart
cmotion not lccling good), xinli nanshou 心里难受 (uncomlortablc insidc thc hcart), faji
发急 (worricd and anxious), or fahuo 发火 (gctting angry).
.¸. Lcc .µµ6: ¡¸·.
.¡. Yamamoto ct al. .µ·¸
.¸. Zhcng ct al. .µ·6.
.6. Scc Fabrcga .µµc.
.,. Pollock .µµ6:¸a..
.·. Jackson .µµ¡:a.a.
.µ. Fabrcga .µµc:66a.
ac. Lcc and Vang .µµ¸:.c¡.
a.. Tc Chincsc translation lor CFS is pilao zonghezheng 疲劳综合症. Zhongyi
doctors tcnd to rclatc thc syndromc to such pathological conditions as “wcarincss”
(juan),” “sluggishncss,” (xieduo 解堕), “slccplcssncss and lack ol cncrgy” (kunbo 困薄),
and “tircd lour limbs” (sizhi buju 四肢不举) dcscribcd in zhongyi classics. According
to zhongyi diagnosis, thc conditions havc somcthing to do with an imbalancc in lunc
tions ol visccral systcms causcd by stagnant cmotions (qingzhi buchang 情志不畅) ovcr
physical/mcntal cxcrtions (laoyi guodu 劳役过度) and cxtcrnal pathogcnic attacks (gan-
shou waixie 感受外邪).
aa. Scc Hall and Amcs (.µ·,) lor comparison ol Vcstcrn transccndcntal ontology
and a Conlucius immancntal cosmos.
a¸. Scc Lcdcr .µµ¸.
a¡. Zito .µµ,:¸a.
NOTES TO CHAPTER I I I 157
a¸. SchcpcrHughcs and Lock .µ·6:.c.
a6. Scc Hall and Amcs .µ·,.
a,. Good .µ,,:¸µ.
a·. Amcs .µµ,:.¸c.
aµ. Tung .µµ¡:¡·,.
¸c. ¡lvin .µµ¸:a.µ.
¸.. Òts .µµ¡:..,.
¸a. For lack ol a bcttcr word to convcy thc scnsc ol prcscncc ol thc wholc pcrson
including body, cmotion, intcllcct, and spirit, ! translatc ‘ti’ as “body pcrsonally” though
it sounds awkward.
¸¸. 8rowncll .µµ¡:.6.
¸¡. !bid.,.,.
¸¸. 8rowncll .µµ¡ points out that “with thc introduction ol Vcstcrn scicncc and
physical cducation, thc linguistic usagcs ol ‘ti’ bccamc much morc dctachcd, objcctivc,
and instrumcntal than was lormcrly thc casc” (.,). To somc cxtcnt, this may bc truc,
cspccially in prolcssional sports. Howcvcr, to claim that in today’s China, “thc instru
mcntal, gcndcrncutral body is unqucstionably thc locus ol thc culturc ol thc body” is
an ovcrgcncralization.
¸6. Tc Chincsc words lor bodypcrson (shen 身), spiritvitality (shen 神), and thc
kidncy (shen 肾) arc homonyms. Vhcn thcy appcar not in combination with othcr
Chincsc words, ! add toncs to distinguish thcm. Tus, shen as bodypcrson will not bc
markcd, but as spiritvitality will bc shén with a sccond tonc and as kidncy will bc shèn.
with a lourth tonc.
¸,. According to thc dictionary ol Shouwen Jiezi 说文解字, thc original mcaning
ol jing was “sclcctcd ricc” (ze mi ye 择米也), and latcr thc mcaning was cxtcndcd to
anything that is thc bcst ol its kind (fan qu hao zhi cheng 凡取好之称).
¸·. Porkcrt (.µ,¡) translatcs jing as “structivc potcntial.”
¸µ. Shén is oltcn translatcd as “spirit”. Porkcrt .µ,¡ translatcs it as configurativc
lorcc.
¡c. Scc Lin .µ·.
¡.. Neijing: Suwen (¸:·). Scc Shangdong Yixucyuan .µ·a:.a¡.
¡a. Li and Liu .µ·µ:ac¡.
¡¸. Tung .µµ¡:¡·6.
¡¡. Scc Òts .µµ¡.
¡¸. Zhong .µ··:a·¸.
¡6. Shandong Zhongyi Xucyuan .µ·a:µ.¸.
¡,. Farquhar .µµ¡:a6.
¡·. !bid.
¡µ. Li Y. .µµ¸:ac.
¸c. Ðcsjarlais .µµ¡:6¸.
158 TRANSFORMI NG EMOTI ONS
¸.. !bid., 6·.
¸a. Nccdham .µ¸6.
¸¸. Sivin .µ·,:6,.
¸¡. !bid., 6¸.
¸¸. Shandong Zhongyi Xuyuan .µ·a:¸.
¸6. Martin Schocnhals (.µµ¸:.6¸), in his cthnographic studics ol a Chincsc
middlc school, noticcs that Chincsc placc positivc valuc on bcing huoyue (activc and
cncrgctic).
¸,. Scc Yan .µµ6, Yang .µµ¡.
¸·. Li Y. .µµ¸: ¸a.
¸µ. Yan .µµ6:.c¸.
6c. Yijing Suhui ji: Wuyu Lun 医经溯洄集: 五郁论 (commcnts on mcdical classics:
fivc typcs ol yu) by Vang Andao (.¸¸a–.¸µ.) statcs: “Most disordcrs ol qi comc lrom
yu. Yu by mcaning is obstruction ol thc passagc.” Scc chaptcrs ¡ and ¸ lor morc dctailcd
discussions ol yu.
6.. !n his Danxi Xinfa: Liu Yu 丹溪心法: 六郁 (mcthods ol danxi: six typcs ol
yu), Zhu Ðanxi (.a·.–.¸¸·) claims, “Vhcn thc blood and qi arc circulating in harmony,
onc will not lall ill, oncc thc circulation is stagnant, various illncsscs may appcar. Many
illncsscs rcsult lrom stagnation.”
6a. Shwcdcr .µ·¸:.µ¸.
6¸. Klcinman .µ·6 maintains that “in modcrn timcs thc indigcnous Chincsc cat
cgory, yu, has not bccn widcly uscd, in cithcr traditional Chincsc mcdicinc or thc popular
culturc (¡a).” Howcvcr, my obscrvation shows thc oppositc. Yu is a vcry common conccpt
in modcrn zhongyi practicc. Yuzheng (syndromc ol stagnation), a typc ol qingzhi (cmo
tionmind) disordcr, is a common zhongyi disordcr.
6¡. Farquhar .µµ¡:¸a.
6¸. Scc Lcc and Vang .µµ¸.
66. Scc Fabrcga .µµc.
6,. Scc Lcc .µµ6.
6·. Scc Klcinman .µ·c, .µ·6, Òts .µµc, .µµ¡.
6µ. Òts .µµ¡:..µ.
,c. ¡vcn Conlucius allowcd lor “cxccss” ol cmotion and justificd it within ccrtain
social rclations and circumstanccs. An instancc in Lunyu 论语 (Te Analects ..:.c) is
an intcrcsting illustration. Vhcn his lavoritc studcnt, Yan Yuan, dicd, Conlucius was
ovcrcomc with gricl and cricd cxccssivcly. Ònc ol his lollowcrs rcmindcd Conlucius that
hc wcnt too lar in his gricl and that hc sccmcd to violatc what hc had bccn tcaching,
namcly, “modcration.” Conlucius rcplicd: “! gricvc with abandon |you tong hu 有恸乎|:,
il ! don’t gricvc with abandon lor him, thcn lor whom:” (fei fu ren zhi wei tong er shei
wei 非夫人之恸而谁为).
,.. Scc Pottcr .µ··.
,a. Scc Li Y .µµ¸.
NOTES TO CHAPTER I V 159
,¸. Scc Zhuang Chu “Hongyang Zhonghua ‘hehe wenhua’ chuyi 弘扬中华 ‘和合文
化’ 刍议 (Commcnts on Promoting Chincsc Culturc ol Harmony) in People’s Daily
April a¸, .µµ·.
,¡. Li Y .µµ¸:.µ.
,¸. Scc Li .µµ¸:a¸.
,6. For dctailcd analysis on Chincsc social cxchangcs, scc Yan .µµ¸, Yang .µµ¸.
,,. Li Y .µµ¸:a¡.
,·. Tc Chincsc original is “yi ta ping ta wei zhi he, gu neng feng er wu gui zhi, ruo
yi tong bi tong, jin nai qi yi 以他平他谓之和, 故能丰而物归之。若以同裨同, 尽乃
弃已.”
,µ. Amcs and Hall .µ·,:.66.
CHAPTER I V
.. Scc AbuLughod .µ··, Lutz .µ·,, .µ··, and Vhitc, .µµ¸.
a. Scc Cosdas .µµc, .µµ¸, .µµ¡, Ðcsjalcis .µµa, Lock and ShcpcrHughcs .µ·,, and
Òts .µµc, .µµ¡.
¸. Scc Klcinman .µ·c, .µ·6.
¡. Scc Òts .µµc, .µµ¡.
¸. Pottcr and Pottcr .µµc:.·c–.µ¸.
6. Scc Kipnis .µµ,.
,. Scc Schocnhals .µµ¸, Yan .µµ6.
·. Schocnhals .µµ¸:.66
µ. !bid.
.c. Vhilc involvcd in cditing a Chincsc¡nglish dictionary, ! noticcd that thc
Chincsc languagc docs not linguistically mark thc distinction bctwccn what is causal
and what is causcd. Tc cxact rclationship has to bc dctcrmincd in thc contcxt. Tc samc
word out ol contcxt can mcan both causal and causcd. !t sccms thc agcnt, thc action, and
thc cvcnt mutually cntail cach othcr.
... Vhitc .µµ¸.
.a. Solomon .µµ¸:a6¸.
.¸. Amcs .µµa:.cc.
.¡. According to Lau and Amcs (.µµ6), onc is undcrstood “in thc scnsc that it is a
continuous plcnum, so that cvcrything is rclatcd and dcpcndcnt upon cvcrything clsc.”
.¸. Scc Xunzi: Zhcngming (ca. a¡c ncv). Tc Chincsc original is “xing zhi haowu,
xi, nu, ai, le wei zhi qing 性之好恶, 喜怒哀乐谓之情.”
.6. Quotcd in Hanyu Dacidian 汉语大词典 ,:¸,6.
.,. Chad Hanscn .µµ¸.
.·. Solomon .µµ¸:a6¡.
.µ. Scc Hu .µ¡¡, Hwang .µµ¡, King .µ··, Schocnhals .µµ¸, and Yan .µµ6.
160 TRANSFORMI NG EMOTI ONS
ac. Scc Hu .µ¡¡, King .µ··.
a.. 8ond and Hwang .µ·6: a¡,.
aa. King .µ··.
a¸. 8ond and Hwang .µ·6 classily thc Chincsc lacc bchavior into six catcgorics.
Tcsc arc cnhancing onc’s own lacc, cnhancing anothcr’s lacc, losing onc’s own lacc,
hurting othcr’s lacc, saving onc’s own lacc, and saving anothcr’s lacc.
a¡. Schocnhals .µµ¸:,c.
a¸. Scc Schocnhals .µµ¸.
a6. Hwang .µ·,.
a,. Klcinman and Klcinman .µµ.:a·,.
a·. Yan .µµ6.
aµ. Pottcrs and Pottcr .µµc:.·µ.
¸c. Yan .µµ6:.¸µ.
¸.. Schocnhals .µµ¸:.¸..
¸a. Lutz .µ·¸:,a.
¸¸. Lunyu 论语 (Te Analects). Tc Chincsc original is “吾日三省吾身: 为人谋而
不忠乎: 与朋友交而不信乎: 传不习乎:
¸¡. People’s Daily, Junc 6, .µµ·.
¸¸. Yan .µµ6:.aa.
¸6. Zhongyi doctors usually do not makc distinctions bctwccn qing 情 and zhi 志
whcn both rclcr to cmotions. Howcvcr, somc zhongyi scholars arguc that though both
qing and zhi sharc thc samc mcanings, thcy arc diffcrcnt in cmphasis. Qing is obscrv
ablc lrom outsidc, and zhi is hiddcn insidc. Scc Li and Liu .µ·µ:a.¸. !n othcr words, zhi
arc cmotions in latcncy (weifa 未发), and qing arc activatcd or dcmonstratcd cmotions.
Qiqing (scvcn qing cmotions) arc rcgroupcd in wuzhi (fivc zhi cmotions) in ordcr to
corrcspond with thc fivc visccral systcms.
¸,. Klcinman and Klcinman .µµ..
¸·. Sivin .µµ¸:!!–a.
¸µ. Òts .µµc:a,.
¡c. !n .µµa, Ðcng Xiaopin on his trip in south China publishcd his spccch, which
callcd lor lundamcntal cconomic rclorm. Following thc spccch, thc wholc nation
plungcd wholchcartcdly into thc occan ol thc markct cconomy.
¡.. Li and Liu .µ·µ:a.¸–a.¡.
¡a. Neijing: Suwen a:¸. Tc Chincsc original is “人有五脏化五气, 以生喜怒悲忧
恐惊.”
¡¸. Tc tcrm sanjiao is somctimcs translatcd as “thrcc burncrs,” but thc actual phys
iological lunctions ol sanjiao havc nothing to do with burning. As Farhquar .µµ¡ points
out, thc conccpt is almost impossiblc to translatc sincc it is not an objcct and its charac
tcristics havc varicd ovcr thc ccnturics. 8ascd on my own obscrvation, thc conccpt was
lrcqucntly uscd to rclcr to thc thrcc vagucly dcsignatcd locations that scparatc intcrnal
organ systcms into uppcr, middlc, and lowcr ficlds.
NOTES TO CHAPTER V 161
¡¡. Farquhar .µµ¡:µ..
¡¸. Yin ct al .µ·¸:aµ.
¡6. Farqhuar .µµ¡:µ¡.
¡,. Scc Kuriyama .µµµ:a¸. A Chincsc doctor, placing his fingcrs at thrcc diffcrcnt
positions ol both wrists, rcads at lcast .a diffcrcnt pulscs, which rcgistcr inlormation
rclating to diffcrcnt visccral systcms.
¡·. Zhongyi tcachcs that clcar and flucnt spccch dcpcnds on hcalthy hcart lunc
tions, bccausc xin-thc hcart govcrns shen (vitality, consciousncss, spirit).
¡µ. For morc systcmatic inlormation on thc fivc translormativc phascs and thc
traditional Chincsc mcdicinc, scc Porkcrt .µ,¡ and Sivin .µ··.
¸c. Sivin .µ··:,¸.
¸.. Farquhar .µµ¡:µ6.
¸a. Tc phasc that produccs thc othcr phasc is figurativcly callcd “mothcr,” and thc
phasc that is produccd is callcd “son.” Tcrclorc bctwccn thc pair ol thc livcr and thc
hcart, thc livcr systcm is “thc mothcr” and thc hcart is “thc son.”
¸¸. Tc kidncy is thc watcr phasc and is supposcd to producc thc wood phasc ol
thc livcr.
¸¡. Neijing: Suwen a:¸.
¸¸. Tcsc cmotion tcrms do not find cxact corrcsponding mcanings in ¡nglish.
Si, lor cxamplc, has thc mcanings ol “thinking,” “worry,” and “longing”. You and bei
arc intcrchangcablc hcrc, mcaning both “sorrow” and “conccrns.” Kong (lcar) hcrc also
incorporatcs thc mcaning ol jing (lright).
¸6. Vang and Li .µ··:¡¡.
¸,. Scc Yin ct al. .µ·¸:¸¡–¸6.
¸·. !bid.
CHAPTER V
.. Zhao ct al. .µ·,. Today, zhenghou classification and dcfinition rcmain a much
dcbatcd issuc, and it looks likc this situation will rcmain lor a long timc to comc.
a. Farquhar (.µµ¡) translatcs zheng 证 as “syndromc” lor thc sakc ol convcnicncc.
Zheng 证 is not an atcmporal group ol symptoms that collcctivcly charactcrizc an illncss
or disordcr as ‘syndromc’ in ¡nglish suggcsts, but a rccurrcnt typc or pattcrn ol symptom
configuration ovcr a pcriod ol timc. Any slight changc in thc symptom pattcrn may
rcsult in a rcconfiguration and thus a diffcrcnt zheng. !n this book, ! usc to translatc
zheng as a “pattcrn.”.
¸. Schcid acca:acc–a¸,.
¡. Zhao ct al. .µ·,:,–µ.
¸. Zhao ct al. .µ·,:·.
6. Farquhar .µµ¡: ¡6.
,. Farquhar .µµ¡:¸¸–¸µ.
162 TRANSFORMI NG EMOTI ONS
·. !bid., ¸·.
µ. Somc zhongyi scholars arguc that liujing bianzheng is csscntially thc samc as
bagang bianzheng. Scc Fcng ct al. acc¡:.c–.6.
.c. Tc clcar articulation ol bagang bianzheng is traccd to thc Ming scholar–
physician Zhang Jicbin (.¸6a–.6¸µ). His “liang gang” 两纲 (two rubrics: yin and yang)
and “liu bian” 六变 (six variations): biao-li 表里 (cxtcrior and intcrior), han-re 寒热
(cold and hot), xu-shi 虚实 (dcplctc and rcplctc)” includc all thc contcnt ol today’s cight
rubrics. Howcvcr, to clcvatc banggang bianzheng to thc position ol thc most important
systcm ol pattcrn diffcrcntiation was a morc rcccnt dcvclopmcnt in thc .µ¸cs and 6cs.
Scc Schcid acca:acc–a¸,.
... Tc illncss location hcrc should not bc undcrstood as thc pathological sitc in
an “anatomoclinical pcrspcctivc,” but rathcr rclcrs to “thc location whcrc bingxie” 病邪
(pathogcnic lactors) manilcst. Scc Fcng ct al. acc¡:.a.
.a. Liu .µ··:a¸..
.¸. Zhao ct al. .µ·,:¡.
.¡. !bid.
.¸. Tc charactcr yu 郁 itscll also suggcsts qi stagnation rathcr than blood stagna
tion, which is usually rclcrrcd to by a diffcrcnt charactcr, yu 瘀.
.6. Farquhar .µµ¡.
.,. !bid., ¸·.
.·. Scc Farquhar .µµ¡: chaptcr ¡, lor a dctailcd analysis ol zhongyi classification.
.µ. Zhao ct al. .µ·,:,.
ac. !n spring .µ·¡, thc first conlcrcncc on zhongyi zhenghou guifan 中医证候规范
(standardization ol zhongyi syndromc pattcrns) was hcld in 8cijing. Tc spccialists dis
cusscd thc namcs, conccpts, classification, and diagnostic standards ol zhenghou (syn
dromc pattcrns). Subscqucntly, scvcral influcntial tcxts on zhenghou standardization and
diagnosis wcrc publishcd, such as Zhongyi Zhenghou Zhenduan Xue 中医证候诊断学
(Tc Ðiagnostics ol zhongyi Syndromc Pattcrns) .µ·, by Zhao Jinduo ct al., Zhongyi
Zhenghou Bianzhi Guifan 中医证候辨治轨范 (Standards ol Ðiffcrcntiation and Trcat
mcnt ol Zhongyi Syndromc Pattcrns) .µ·µ by Lcng Fangnan ct al., and Zhongyi Zheng-
hou Guifan 中医证候规范 (Standardization ol Zhongyi Syndromc Pattcrns) .µµc by
Ðcng Tictao ct al.
a.. Scc Farquhar .µµ¡: introduction.
aa. ! translatc bing as “illncss” or “disordcr” to mark a distinction lrom thc bio
mcdical conccpt ol “discasc,” which arc undcrstood as discrctc biological and psycho
physiological cntitics, rcsulting lrom lcsions or abnormal lunctions ol any structurc, part,
or systcm ol an organism. Tc dichotomy bctwccn discasc and illncss has bccn a kcy
conccpt in mcdical anthropology. Ðiscasc is a primary mallunction ol psychobiologi
cal proccsscs, whilc an illncss is a sccondary psychosocial cxpcricncc and mcaning ol
thc primary discasc. Scc Klcinman .µ·c:,a. Howcvcr, bing docs not conlorm to such a
dichotomy. !t is a disordcr that rccognizcs both psychophysiological and psychosocial
dimcnsions.
a¸. Zhao ct al. .µ·,:·.
NOTES TO CHAPTER V 163
a¡. Zhang ct al. .µ·¸.
a¸. Scc Fcng, ct al. acc¡:.¡. Rcn Yingqiu also points out that taiyang 太阳 (thc
grcat yang illncss, onc ol thc six cold damagc illncsscs) is not an indcpcndcnt illncss but
onc zhenghou (pattcrn) ol thc cold damagc illncsscs. Scc Chcn, acc¸.
a6. Scc Chcn, .µµ,.
a,. !bid.
a·. !bid. Chcn rclcrs to this proccss as “bian benzhi lunzhi” 辨本质论治 (diffcrcn
tiation ol roots/csscncc and dctcrmining thcrapics).
aµ. Scc Zhao, ct al. .µ·,:a–¸.
¸c. Scc Chcn .µµ,. Scc also Liangchun Zhu, acc¸. According to Zhu, cxccpt lor
vcry lcw cascs, such as malaria (nueji 疟疾) and jaundicc (huandan 黄疸), lor most
zhongyi illncsscs, diffcrcntiation ol pattcrns is lundamcntal, whilc thc illncss namcs arc
only significant as sccondary rclcrcnccs.
¸.. Scc Chcng, acc¸. Zhenghou Guifan Yanjiu de Si Da Jiaodian Wenti 证候规范的
四大焦点问题 (Four Fundamcntal !ssucs Rcgarding Zhcnghou Standardization). Tc
anccdotc ol Prolcssor Lu Guangshcn trcating A!ÐS in Tanzania is also an intcrcsting
illustration. !n .µ·,, Prolcssor Lu wcnt to Tanzania with a tcam ol mcdical spccialists to
hclp in trcating thc A!ÐS cndcmic in thc country. Hc causcd a considcrablc stir by stat
ing that although hc had ncvcr cncountcrcd a casc ol A!ÐS in China, hc was confidcnt
that thc discasc could bc trcatcd with zhongyi. Again, thc idca is that as long as a pat
tcrn ol manilcstations could bc diffcrcntiatcd, thc discasc is thcn trcatablc with Chincsc
mcdicinc. Scc Jingjing Hu, acc¡ Zhongguo Yaoshi Zhoukan 中国药师周刊 (Chincsc
Pharmacists Vcckly), \L. aac¡.
¸a. Tc six principal pattcrns arc taiyang 太阳, yangming 阳明, shaoyang 少阳,
taiyin 太阴, shaoyin 少阴, and jueyin 厥阴.
¸¸. Scc Fcng and Zhang acc¡:¸–a¡. Scc also Schcid acc¡:ac¸–ac¡.
¸¡. Rcn Yinqiu ct al., .µ·6:.a6–.¸..
¸¸. !bid., .¸µ–.6¡. Although thc conccpt and mcthod ol bianzheng can bc lound
as carly as in Neijing 内经 (Tc !nncr Classics), thc actual tcrm “bianzhcng lunzhi” or
‘bianzhcng shizhi’ did not appcar in rccords until thc Ming and Qing pcriod. “Bian-
zheng shizhi” first appcarcd in Shenzhai Yi Shu 慎斋遗书 (8ook by Shcnzhai) by thc
Ming physician Zhou Shcnzhai (.¸c·–.¸·6). ‘Bianzheng lunzhi’ first appcarcd in Yimcn
8anghc 医门棒喝 (.·aµ) by thc Qing physician Zhang Nan.
¸6. Scc Zhcn ct al. (.µµ.:¡a¸–¡¸·). Yang Zcmin (.·µ¸–.µ¡·), anothcr scholarphysi
cian ol thc timc, argucd that Chincsc mcdicinc cmphasizcs diffcrcntiation ol pattcrns
lor thc purposc ol using drugs and Vcstcrn mcdicinc cmphasizcs knowing discascs lor
thc purposc ol discriminating thc location ol a discasc. Scc Schcid acca:a.6.
¸,. Scvcral scholars ol Chincsc mcdicinc mcntioncd an obvious rclationship bc
twccn thc zhongyi diagnostics “bianzheng lunzhi” and thc modcrn Chincsc tcrm lor “dia
lcctics”—bianzhengfa (辩证法). Scc Unschult .µµa:¸a–6., Farquhar .µµ¡, and Schcid
acca:acµ–a.¡. Tian (acc¸) argucs that “dialcctics” lound in thc Vcst philosophic tradi
tion is not thc samc as thc Chincsc vcrsion ol bianzhengfa, which draws hcavily on
thc traditional Chincsc stylc ol thought tongbian (continuity through changcs). !n this
scnsc, thc zhongyi scholarphysicians’ cnthusiasm about bianzhengfa in thc .µ¸cs and
164 TRANSFORMI NG EMOTI ONS
6cs should bc undcrstood much morc than just lollowing “an idcologically corrcct” linc.
Rathcr, bianzhengfa offcrs a sct ol casily acccssiblc vocabulary lor scholars to articulatc
thc zhongyi way ol doing mcdicinc that sharcs thc samc intcllcctual roots in ancicnt
Chincsc philosophical thought.
¸·. Schcid acca:acµ–a.¡.
¸µ. Zhao, ct al., .µ·,:·.
¡c. Scc also Shcid acca:aac–aaa.
¡.. Vrittcn by thc Han scholarphysician Zhang Zhongjing.
¡a. !n contcmporary zhongyi clinics, biomcdical discasc namcs arc lrcqucntly uscd.
!n lact, paticnts arc morc lamiliar with many common biomcdical discasc namcs than
with zhongyi illncss namcs. Adopting thc morc scicntific biomcdical discasc classifica
tions has bccn promotcd by quitc a lcw zhongyi physicians, including Shi Jinmo and
Zhang Cigong, and othcr influcntial scholarphysicians. Scc Schcid acca:aa.. !l a patho
logical condition is not idcntificd as bentun (running pig illncss) but with a biomcdical
discasc tcrm, such as hystcria, thc physician is dircctcd to a diffcrcnt coursc ol rcsourccs
and thc conncction is madc bctwccn thc particular casc and thc biomcdical sourccs. !n
any casc, thc biomcdical discasc namc uscd in a zhongyi contcxt docs not lunction thc
samc way as it docs in a biomcdical clinic. !t docs not lcad to systcmatic matching with
thcrapics. Scc Zhu acc¸.
¡¸. Qingzhi bing (cmotionrclatcd disordcrs) is also rclcrrcd to as “shenzhibing”
(mindrclatcd disordcrs). 8oth arc sccn as attributablc to intcrnal injurics duc to cxccss
ol thc scvcn cmotions and manilcstcd with bodily, cmotionalmcntal symptoms. Tcy
arc intcrchangcablc in usc, though thc lattcr is uscd lcss lrcqucntly. Li ct al. (.µµ¸:¸µ)
rclcrs to baihe bing 百合病 (an illncss commonly listcd as qingzhi bing) as “shenzhi
zhi bing” 神志之病 (mindrclatcd disordcrs). !n thc samc book, thc authors also statc
cxplicitly that “mind disordcrs arc also callcd qingzhi bing” (a6c). Although thc tcrm
qingzhi appcars as illncss lactors in thc carlicst mcdical classics and thc various qingzhi
rclatcd disordcrs arc rccordcd and dcscribcd as carly as in Neijing, thc actual combina
tion ol qingzhi and bing (illncss, disordcr) might bc a morc rcccnt dcvclopmcnt.
¡¡. Sincc symptoms ol dian 癫 and kuang 狂 cannot bc complctcly scparatc, and
thcy oltcn appcar altcrnatcly, dian and kuang arc oltcn listcd undcr thc onc disordcr ol
duankuang 癫狂 (apathy and madncss). Scc Li ct al. .µµ¸:a6c. Tc authors writc “shenzhi
bing (mindrclatcd disordcrs), also callcd qingzhi bing (cmotionrclatcd disordcrs), in
cludc such illncss as diankuang, yuzheng 郁证 (stagnation illncss), and bentunqi 奔豚气
(running pig syndromc).”
¡¸. !n Li and Liu .µ·µ, dian and kuang arc listcd scparatcly lrom thc catcgory ol
qingzhi disordcrs, which includc yuzheng (stagnation illncss), zangzao (visccral vcxa
tion), meiheqi (plumc pit syndromc), baihuobing (hundrcd conlusions syndromc), and
so on.
¡6. Zhang ct al. cds. .µ·¸.
CHAPTER VI
.. Li and Liu .µ·µ:¸.¡.
a. Scc Jingyue Quanshu 景岳全书 (Te complete works of zhang jingyue).
NOTES TO CHAPTER VI 165
¸. Scc notc 6 in chaptcr a lor inlormation on Huangdi Neijing 黄帝内经 (Te Yel-
low Emperor’s Internal Medicine).
¡. Zhubing Yuanhou Lun 诸病源候论 (On the Origins of Various Illnesses) was writ
tcn in 6.c cv by thc Sui physician Chao Yuanlang and his associatcs.
¸. Gujin Yitong Daquan 古今医统大全 (Complete Collection of Principal Medi-
cal Works from Ancient Time to the Present) was writtcn by Ming physician Xu Chunlu
(.¸ac–.¸µ6) and publishcd in .¸¸6.
6. !n contcmporary usagc, jic 结 rclcrs morc to thc congcstion that has bccn
lormcd into tangiblc lumps, whcrcas yu 郁 is morc about obstruction ol flow ol qi that
is lormlcss and intangiblc.
,. Scc notc ¡.
·. Scc Danxi Xinfa: Liu Yu 丹溪心法:六郁 (Danxi’s Healing Methods : Te Six
Stagnations).
µ. !bid.
.c. Scc Yijing Suhui Ji 医经溯洄集 (Collected Reflections on the Medical Classics)
(.¸6·).
... Scc Tuiqiu Shi Yi: Yubing 推求师意: 郁病 (Undcrstanding thc Mastcr’s Tcach
ings: Stagnation !llncss) by Ðai Sigong. Tis could bc thc carlicst appcarancc ol thc tcrm
combining ‘yu’ and ‘bing’ in zhongyi tcxts. Scc Rcn ct al. .µ·¡:µ6–.ca. Tc combination
ol ‘yu’ and ‘zhcng’ did not appcar until thc Ming dynasty whcn thc scholarphysician Yu
Tuan first uscd thc tcrm in his book, Yixue Zhengzhuan 医学正传 (Te Orthodox History
of Medicine) (.¸.¸). Scc Li and Liu .µ·µ: .c¸.
.a. Scc Rcn ct al. .µ·¡:..·–.ac.
.¸. Scc Jingyue Quanshu 景岳全书 (Te Complete Works of Zhang Jingyue), chaptcr
.µ.
.¡. Quotcd in Rcn at al. .µ·¡:a.a–a.·.
.¸. Scc Yc Tianshi Lin Zheng Zhinan Yi’an: Yuzheng 临证指南医案: 郁证 (Guidc
to Clinical Practicc with Mcdical Cascs).
.6. Scc Li and Liu .µ·µ, Zhang ct al. .µ·¸:.a.–.a¡.
.,. !n biomcdicinc, a spccialist is morc dcfincd by training, howcvcr, in Chincsc
mcdicinc, a zhuanjia (spccialist) is dcfincd mainly by his or hcr clinical cxpcricncc and
cfficacy in trcating ccrtain problcms.
.·. Scc Li and Liu .µ·µ:¸.,.
.µ. Chao Yuanlang, a wcllknown doctor ol thc Yuan dynasty, uscs thc tcrms jieqi
bing or qi bing (illncss ol congcalcd qi) to rclcr to thc samc illncss manilcstation typc
as thc plum pit qi or qi stagnation illncss. !n lact, qi bing uscd hcrc by thc doctor has a
doublc mcaning, onc is thc disordcrcd qi circulation in thc body, and thc sccond is thc
disordcr causcd by qi (angcr). Tc paticnt immcdiatcly rcad it as thc sccond mcaning.
ac. Scc Zhang ct al. .µ·¸:.a¸.
a.. Scc Li and Liu .µ·µ.
aa. Scc chaptcr ¸ ol this book lor a discussion ol du 度 (dcgrcc).
a¸. Tc paticnt’s mothcr did not rcvcal any dctails rcgarding thc naturc ol thc
trauma (ciji), and thc doctor did not ask about it.
166 TRANSFORMI NG EMOTI ONS
a¡. Zhcn ct al. .µµ.:.c¡.
a¸. Scc Li .µµ¸:,¸,.
a6. Citcd in Li and Liu .µ·µ:..a.
a,. Scc Jingyue Quanshu 景岳全书 (Tc Complctc Vorks ol Zhang Jingyuc).
CHAPTER VI I
.. Portions ol this chaptcr appcar in my articlc “Ncgotiating a path to cfficacy in
a clinic ol traditional Chincsc mcdicinc.” Forthcoming in Culturc, Mcdicinc and Psy
chiatry. Springcr Ncthcrlands.
a. Convcrsation analysis (CA), dcvclopcd within thc paradigm ol cthnomcthod
ology, cmcrgcd in thc .µ6cs as a rcsult ol thc pionccring works by Harvcy Sacks, Gail
Jcffcrson, ¡manual Schcgloff, and othcrs. CA providcs analytical rcsourccs and mcthod
ological proccdurcs lor analyzing naturally occurring human intcractions. Scc C. Good
win and J. Hcritagc .µµc. Rclcr to appcndix . lor thc transcription convcntions.
¸. Scc Atkinson and Hcath .µ·., Fishcr and Todd .µ·¸, Labov and Fanshcl .µ,,,
Hcath .µ·¡, Mishlcr .µ·¡, Pcndlcton and Haslcr .µ·¸, and Tanncr .µ,6, Vcst .µ·¡.
¡. Labov and Fanshcl .µ,,.
¸. Hutchby & Vooffitt .µµ·:.¡.
6. Goodwin and Hcritagc .µµc:a··. Scc also Hutchby and Vooffitt .µµ·:.¸–.,.
,. Scc Frankcl .µ·¸, Hcath .µ·6.
·. Scc Frankcl .µ·¸, Hcath .µ·6, Mishlcr .µ·¡.
µ. Vcst .µ·¡:¸¡.
.c. Mishlcr .µ·¡:¸¸.
... Goodwin and Hcritagc .µµc:a·¸.
.a. 8ilmcs .µµa:¸,..
.¸. Mishlcr .µ·¡:¸¸.
.¡. For dctailcd analysis ol kanbing in zhongyi clinics, scc Judith Farquhar’s book
Knowing Practice .µµ¡.
.¸. Sivin .µµ¸:¸.
.6. 8cijing Mcdical School .µ,¸:¡¡.
.,. Scc Li and Liu .µ·µ:ac¸.
.·. Scc Farquhar .µµ¡.
.µ. !n thc transcript, Ð stands lor doctor and P lor paticnt.
ac. Jiaolu is an introduccd biomcdical conccpt. Vhcn uscd in zhongyi contcxt, it
rclcrs morc to a vaguc lccling ol uncasincss or rcstlcssncss, than to a psychiatric conccpt
ol “anxicty”. A zhongyi tcrm lor thc symptom might bc zuowo bu’an 坐卧不安 (rcstlcss)
or jizao 急躁 (anxious), or jingzhang 紧张 (ncrvous).
a.. “Uhn” in this casc is uttcrcd with a short first tonc. !l it is uttcrcd with a long,
strong lourth tonc, it can bc undcrstood as a confirmation.
NOTES TO CHAPTER VI I 167
aa. 8ian Quc, a lcgcndary physician lrom morc than two thousands ycars ago, is
wcll known lor his cxaminations by looking at thc paticnt and taking his or hcr pulsc.
a¸. 8ilmcs .µ··:.6¸.
a¡. Normally, bianzheng (diffcrcntiatc syndromcs) and lunzhi (dctcrminc trcat
mcnt) lorm a continuous proccss. Tcrc is no clcar distinction bctwccn thcsc two parts.
Howcvcr, it is always clcar that bianzheng comcs bclorc lunzhi, and it is thc basis lor
dctcrmining a thcrapy.
a¸. Also known as livcr qi stagnation (ganqi yujie 肝气郁结) causcd by blockcd
flow ol cmotions (qingzhi bushu 情志不舒).
a6. Somctimcs it gocs “xiaojigcnglang 效即更方” (il thc cffcct has bccn achicvcd,
changc thc lormula).
a,. ¡tkin .µ··:¸ca. ¡tkin argucs that hcaling should bc undcrstood as a proccss. ¡l
ficacy might mcan cithcr an “ultimatc outcomc” ol lull symptom rcmission or a “proxi
matc cffcct” ol partial rcmission or somc physical signs that indicatc thc hcaling is undcr
way.
a·. Klcinman .µµ¸:¸¸.
aµ. ¡tkin .µ··:aµµ.
¸c. Guide to Clinical Practice with a Collection of the Cases by lamous Qing doctor Yc
Tianshi, which was compilcd by his studcnt Hua Youyun in .,¡6.
¸.. Zhang at al. .µ·¸:.a¸.
¸a. !n his articlc “Tc Angry Livcr, thc Anxious Hcart, and thc Mclancholy
Splccn,” Òts (.µµc) shows that in Chincsc mcdicinc lunctions ol thc visccral systcms
arc undcrstood as isomorphic with thc corrcsponding cmotions.
¸¸. As Labov and Fanshcl (.µ,,) show in thcir analysis ol thcrapcutic discoursc,
“thc thcrapist is an cxpcrt at intcrprcting thc cmotions ol othcrs.” Tc thcrapist has thc
authority to judgc not only thc paticnt’s intcrprctation ol othcrs’ cmotions but also hcr
claim about hcr own lcclings. A zhongyi doctor docs not havc that kind ol authority
ovcr thc paticnt’s cmotional cxpcricncc. Òn thc contrary, zhongyi tcnds to hold that onc
can ncvcr know cxactly what anothcr pcrson actually cxpcricnccs outsidc ol what thc
othcr pcrson tclls you about how hc or shc lccls. !n zhongyi contcxt, paticnts rcmain thc
authoritativc voicc ol thcir own cxpcricncc. A doctor’s claim about a paticnt’s cxpcricncc
is subjcct to thc paticnt’s confirmation.
¸¡. Quotcd in Zhang ct al. .µ·¸:.a¸.
¸¸. Scc Jingyue Quanshu:Yuzheng Mo 《景岳全书:郁证谟》(Te Complete Works
of Zhang Jingyue: Stagnation illncss) by Zhang Jicbin during thc .6¸cs. Tc patronizing
tonc toward lcmalc paticnts is common in thc mcdical classics. Vomcn arc prcscntcd as
il thcy wcrc childrcn whosc dcsircs can bc satisficd, but thcy arc not capablc ol bcing cn
lightcncd. Howcvcr, although not many contcmporary zhongyi physicians disagrcc with
Zhang about hcaling cmotions with cmotions, thcy do not assumc his outright gcndcrcd
approach to stagnant cmotions. Vomcn, activc in thc public sphcrc in contcmporary
China, arc also counsclcd to bc broadmindcd and flcxiblc, as shown in this casc.
¸6. Sivin .µµ¸:!!:.6.
¸,. Tscng ct al. .µµ¸:aµa.
168 TRANSFORMI NG EMOTI ONS
¸·. Scc Nccdham .µ¸6.
¸µ. Arthur and Joan Klcinman .µµ¸:.¸¸–.¸¡.
¡c. Farquhar .µµ¡.
¡.. Hsu .µµµ:6.
CHAPTER VI I I
.. Ðcsjarlais .µµa:a¡µ.
a. Farquhar .µµa:,a.
¸. Klcinman .µ·6:¡¸.
¡. ¡tkin .µ··:aµµ.
¸. Scc Farquhar .µµ¡.
169
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BI BLI OGRAPHY 175
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BI BLI OGRAPHY 177
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Li, Mucai
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Li, Qinglu, and Liu Ðuzhou
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Li, Vcnrui, with Li Chi and Li Yuc
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Liao, Yuqun
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184 TRANSFORMI NG EMOTI ONS
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186 TRANSFORMI NG EMOTI ONS
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187
Index
adjustmcnt, proccss ol, .a¸, .a¡. See also
attuning (tiao)
acsthctics, cultural, .¡, ¸c–¸., ¸c
acsthctic valucs, ¸c, ¡a, ¡¡, ¸., ¸·, .¸µ
agitation, ¡c, ·¸, µ¸, .c¸–.c¡, visccral, µ.,
.cc, .c., ..,. Scc also zangzao
Amcs, Rogcr, a6, ¸., .¡·na,, .¸¡n¸., .¸¸na,
.¸6 naa
angcr (nu), a, ¸a, ¡c, ¸c, ¸¡–¸¸, ¸µ, 6¸–6¡,
66–6,, ,a–,¡, ·,, µa, µ¸–µ·, .c¸.
Scc also qiqing
anxicty, .a, ¸·, 66, 6·, ,¸, .c., ..6, .¡,n., as
jiaolu, ..¡, ..6–..,, .66nac, as
you, 66, 6·
attuning (tiao), 6, .¡, ¸., 6¸, .c¡–.c¸,
.c·, ..c, ..a, .a¸–.a¸, .¸6–.¸,,
.¸µ–.¡c, .¡a
bei (gricl/sadncss), ¡c, 6¡, 66, 6·, ,¸, .¡,n.,
.6.n¸¸. Scc also qiqing
bentunqi (running pig illncss/syndromc),
·¡–·¸, .6¡n¡¡
bianzheng (diffcrcntiation ol pattcrns/
syndromcs), ,6, ,·, ·c–·., µc,
.6¸n¸¸, .6,n.a¡, bagang (cight
rubrics), ,·, ·a,.6annµ–.c,
bingyin (illncss lactor), ,·, ,µ,
liujing (six pattcrns), a¡, ,·, ·a.
.6anµ, zangfu (visccral systcms),
,·, ·a. Scc also bianzheng lunzhi
bianzheng lunzhi (diffcrcntiating pat
tcrns/syndromcs and dctcrmin
ing trcatmcnt/thcrapics ), .¡,
a·, ,¡, ,·, ·.–·¸, .c,, .cµ, .¡¡,
.6¸n¸¸, .6¸n¸,
bianzheng shizhi. Scc bianzheng lunzhi
8ilmcs, Jack, .c,, ..6
bing, ,6, ·c–·¸. See also illncss
biomcdicinc, 6, µ, .., .¸, .µ, a¸, ¸¸, 6,, ·.,
·¸, .c·, ..c, .¡c, .¸cna, .¸¡n¡6,
.6¸n.,, as Vcstcrn mcdicinc
(xiyi), 6, .¸, .¸, .,, .·, .µ–aa, aµ,
,¸, ·a–·¸, ..c, .¡µn¸·, .¸cnna–¸,
.¸.n.c, .¸¸ n.¸., .6¸ n.¸6
bittcr mouth, µ., µ¸, µ6, .ca, ...
blockagc (du or butong), as Chincsc
mcdical symptoms, ¸a, ¡¡–¡6,
6¡, ,¡, ··–µc, µ¸–µ¡, µ,, ..c, ..·,
..µ, .aa, .a¸
blood (xue), ¸µ, ¡µ, 6,, 6·, ,c, ,., ,µ, µ., µ¸,
.cc–.c¸, ..a
body: as cmbodimcnt, a–¸, ¸., ¸6, dis
coursc or languagc ol , ¸, .¡, ¸¸–
¸6, mindbody dichotomy, 6, ·,
¸., ¸¸–¸¡. See also somatization
bodypcrson or bodyscll (shenti), ¸, ·, .¡,
¸., ¸¸–¸6, ¡,, ¡µ–¸., ¸¸, 6¸, 6,, .c¸,
.¸a, .¸¡, .¸µ–.¡a, .¸,n¸6
boncs (gu), ¸,, 6·, ,c
boundarics, bctwccn Chincsc and Vcst
crn mcdicincs, .,
8rowncll, Susan, a, ¸6, .¸¸n¸, .¸,n¸¸
CA. See convcrsation analysis
188 TRANSFORMI NG EMOTI ONS
CCP. See Chincsc Communist Party
Chcn Xiaoyc, ·., .6¸na·
Chincsc Communist Party, aa
Chincsc cosmological assumptions, ¸,
.¡·na,
Chincsc languagc, ¸¸, ¸¸, 6a, .aa, .¸µn.c
Chincsc mcdicinc: classification, ,6–·¡
(scc also bianzheng lunzhi),
contcmporary dcbatc, a,–a·,
continuity, a¸–a6, cmotion
rclatcd, ¸–·, ¸¸, 6¡, 66, ,a–,¡,
·¸, cthnographics ol, µ–.c, .¸,,
modcrn translormation, .·–a¸,
physiology ol , 66–,¡, ··, plu
rality ol, µ–.c
Chincsc paticnts, ¡–¸, ·, .¡, ¸a–¸¸, ¡¸, .ca,
.¸µ, .¡a
Chincsc social lilc, ¸6, ¡¡, ¸c, ¸,–¸·
clinical actions, a¸–a6, ,., ,µ, .c¸, .c,, .a¸,
.¸,, .¡.
clinical cncountcr, ¡, µ, .,, .c,–..., .a¡, .¸,
clinical intcractions, ¡, .a, .¡, ¸¡, .c¸–.c·,
..a, ..¡, ..6, .a¸, .¸,, .¡.
clinical obscrvation, .c–.a, ,¸, ·,, µa–µ¸,
µ,–µ·, .¸cna
clinical proccss, ¡, µ–.c, .a, ,¡–,·, µ6, .c¸–
.c,, .cµ, ..a, .a¡, .¸,, .¡c–.¡a
clinical work, µ, .¡, .,, a¡, ¸¸, ,¸–,6, ,µ–·c,
µc, .c¸, .c·, .¸,, .¡c–.¡a
closc analysis .c6–.c,. See also convcrsa
tion analysis, microanalysis
Conlucius, 6a, .¸6naa, .¸·n,c, doctrinc/
thinking, a6, ¡,, ,a
congcstion, ,¡, ,µ, ··, µ.–µ¸, µ,, µµ, ...
convcrsation analysis, .c¸–.c,, ..6, .¡¸,
.66na
crossculturc psychiatry, ,–·
culturc, anthropological notion ol, .–¡
dao, ¡.–¡¸
dcplction, ¸a, ,µ, ·a, ·¡, µc–µa, µ,, .cc–
.c¡, ..a, ..,, .aa
dcprcssion, a, ·, ¸¸, ¡¸–¡,, ¸¸, µc
Ðcsjarlais, Robcrt, ¸, ¸., ¡a
dian, ·¸, µ., µ·–µµ, .6¡nn¡¡–¡¸
diffcrcntiation ol syndromcs. Scc
bianzheng
discasc, as biomcdical conccpt, a, 6, ·, ¸¸,
,6–,,, ·c–·¸, µc, .¡c, .6anaa,
.6¸n¸6, .6¡n¡a. Scc also bing,
illncss
divcrsity, µ–.c, a¸–a¡
dizzincss, µ., µ¸, µµ, .ca, .c¸
du (dcgrcc/position), ¡6–¡·, ¸., ¸¸, 66, ,c,
µ·, .¸µ
cfficacy, 6, .a, .·, a·–aµ, 6¡, .c¸, .a¸–.a¸,
.¸6–.¸,, .¡., .¡¸, as cffcctivcncss,
a,–aµ, ..6, .a¸–.a¡, .¡¸
cmotion: as scvcn cmotions, ¡c, 6¡, 66,
,µ, ·¸, ··, ··–·µ, .c., .6¡n¡¸,
Chincsc, ¸¡–¸¸, countcr ¸¡,
disordcrcd, ., ¸, ·, .¡, ¡¸, ·¸, .¸6,
cxccssivc, ., ¡,, ,¡, ·µ, .a¡, .ca,
stagnation ol, ··–µc, .c6, ..c,
..a, .aa, .a¡, supprcssion ol, ¡·,
¸c. Scc also qingzhi
cmotional disordcr, ., ¡, ¸a, ¡6–¡,, ,a, .¡.
cmotional distrcss, ¸, ,, ¸a
cmotional disturbancc, ¡¡, µ·, .cc, .¡.
cmotional cxpcricncc, .¡, ¸¸, µ¡, .ac, .aµ,
.¡., .6,n¸¸
cmotional cxprcssion, ¡,, ¸¡
cmotional symptoms, ·, ¸¸, .aa, .¸6,
.¸6n.a
cmptincss, ¡¸–¡6
cpistcmology, biomcdical, .,, ¸¸–¸¸
cthnography, a, ¸, µ, .c, .c6–.c,, .¸,, .¡c,
as ficldwork .c–.a, ,¸, .c·
¡tkin, Nina, .6,na,
cxpcricncc, accumulatcd. Scc jingyan
Fabrcga, Horacio, Jr., ¸¸, .¡µn¡¸
lacc (lian or mianzi), ¸¡–¸µ, 6., .a,,
.6cna¸
lacctolacc intcraction, µ, .c6–.c·, .¸,
Fanshcl, Ðavid, .c¸
Farquhar, Judith, ·, µ, .·, a¸, ,,, ,µ, .cµ,
.¸,, .¡c, .¸¡n¸¡, .6.na, .6¸n¸,
lcclings, ¸, 6, ,, ¸a, ¸µ, ¡c, ¡¸–¡6, ¸¸–¸·,
6c–6a, 6¸, ·,, .a¸, .¸c, .¸6. See
also cmotion, ganqing; qingzhi
fivc translormativc phascs, ¡, .·, a¡, 6µ,
·c, ·µ, .c¸, .6.n¡µ
I NDEX 189
lormula, hcrbal or zhongyi, a¸, ,µ, ·¸,
µ¡, µ,, .c., ..., ..¸, .a¸, .¡., .¡¸,
.¸cna, .¸¸n6c
ganqi yujie (livcr qi stagnation), ¸a, ·¡, ·,,
µa–µ¸, ..¸, .a¡, .6,na¸
ganqing, ¸¸, 6c–6¸. See also cmotions,
lcclings
ganyu, ¡¡, ,., ,µ, ·., ·,, µ¸, µ6, µ,. Scc also
ganqi yujie
Good, 8yron, ¸, ¸¸, ¸¸
Goodwin, Charlcs, .66na
Hall, Ðavid, a6, ¸., .¡·na,, .¸6naa
harmony, ¸c, ¡¸, ¡,, ¡µ–¸¸, ¸·, 6., 6,, ,c,
.¸6, .¸µ
hcartcmotion, ¸, ¡c, ¡¸, µ¡, ..a–..¡,
..·–..µ, .aa, .a6, .¸c, .¸a, .¸6
hcartmind, ¸¸, ¸·–¡., ¡6–¡·, ·¸, ·µ, µ¸,
µ·–.c., .c¡, .a·, .¸.
hcartyin, ¡·
hcat, as a Chincsc mcdical conccpt, ¡¸,
,·, ,µ, ·µ, µ¸, µ¡, µµ, .c¡, ..a, ..¸,
.¸¸n6c
hcrbal mcdicinc, aµ, 6¸, ,a, µ¸, µ¡, .ca, .c·,
..., ..a, .a¡, .a6
Hoizcy, Ðominiquc, and MaricJoscph,
.¸.n.., .¸ana,, .¸¸n¸¡
Hsu, ¡lisabcth, µ
Huangdi Neijing (the Yellow Emperor’s
inner classics or Inner classics), µ,
a¸–a¸, ¸,–¸·, ¡., ¡¸, ¡µ, 66, ,a, ·¸,
··, ·µ, µ6, .¸¸nn¸¸–¸¡, .6cn¡a,
.6¸n¸¸, .6¡n¡¸
illncss: affcctivc, ,, bchavior, a, ,, condi
tions, ,., ,µ, ·c, ·¸, .c¡, ..a,
..,, .a¡, constructions, ¸, ¸a, ¸¸,
.¸¸n¸, dcvclopmcnt, ,µ, ·¡, ...,
.a·, cmotionrclatcd, µa, cx
pcricncc, .a, ¸¸, ¸¡, ..c, ..¸, ..µ,
lactors (bingyin), ac, ,¡, ,·, ,µ,
·¸, ·,, ·µ, µc, .6¡n¡¸, location
(bingwei), ,µ, .6a n..., mani
lcstation, µ¸, ..a, .¡c, .6¸nµ,
namcs, ·c, ·., ·¸, ·¸, µc, .¸¸n¸.,
.6¸n¸c, .6¡n¡a, proccss, ¸¸, ,µ,
µc, stagnation, ·¡–·¸, ·,, µa, .c¡,
..¸, .ac, .a¸, .6¡nn¡¡–¡¸, .6¸n..,
.6¸n.µ, .6,n¸¸ (scc also yuzheng)
Inner Classics. Scc Huangdi Neijing
insomnia, ¡·, 6¸, 6¸, ,., ,¸, ·¡, µ., µ¸–µ6,
µ·, .cc, .ca–.c¸, ..,
intcractions, doctorpaticnt, .c6–.c,, so
cial, ¸, ¡, ¸c, ¸¸, ¡a, 6., .c6, .c,
Jcnkins, Janis, a, .¡µn¡¸
Jiao Shudc, .¸¸n¸6
jing (conccntratcd basis lor vitality or
vitality csscncc), 6, ¸,–¸·, ··,
.c¸–.c¡, .¸,nn¸,–¸·, as kidncy
csscncc (shenjing), ¸,, µ., .c¡
jingshen (mind or spirit), 6, .., .¸, ¸,–¸·,
¡¸, µµ, .ca
jingshen bing (mcntal disordcr), .., ¸·,
¡6, µ·
jingyan (accumulatcd cxpcricncc), a6, ,.,
·¡, µ·, ..¡, .a¸, .¡c–.¡..
Jingyue Quanshu (Tc complctc collcction
ol Zhang Jingyuc), ,a, .6¡na,
.6¸n.¸, .66na,, .6,n¸¸. See also
Zhang Jicbin
kaidao (pcrsuasion), .a·–.¸a, .¸¡
kanbing (looking at illncss), ¡, µ, ,6–,,,
·¡, .c·–.cµ, ..c, ..¸, .¸,, .¡c, .¡.,
.66n.¡
Klcinman, Arthur, ¡, ¸¸, 6c, .¸6, .¡µn¡¸,
.¸¸n¸, .¸·n6¸, .6anaa
kong (lcar), ¡c, 6¡, 66, 6·, ,¸, .¡,n., .6.n¸¸.
Scc also qiqing
Labov, Villiam, .c¸, .6,n¸¸
Lcc, Sing, ¡6, ¡,, .¸¸n¸
Li Yiyuan, ¡a, ¡µ, ¸c
lian. See lacc.
lilun, zhongyi, ,, a¡–a6. See also thcory, in
Chincsc mcdicinc
Lin, Kchmin, ¸·, .¸,n¡c
Lin, Tsungyi, .¡·n¸., .¡·nn¡c–¡.
Linshu (Spiritual Pivot), ¸·, ¡., ··, .¸¸n¸¡.
Scc also Huangdi Neijing
Liu Shaoqi, a.
Liu Yanchi, ,·, .¸cn6a
190 TRANSFORMI NG EMOTI ONS
livcr stagnation. Scc ganyu
Lock, Margarct, ¸¡, ¸¸
looking at illncss. Scc kanbing
Lunyu (thc Analects), ¡µ, .¸·n,c, .6cn¸¸
lunzhi (dctcrmination ol thcrapics/trcat
mcnt), ,6, ,·, ·., ·¸, .aa, .6,na¡.
Scc also bianzheng lunzhi
Lutz, Cathcrinc, ¸¸
Mao Zcdong, a.
mcdical anthropology, a, ¡, ,, ¸., .6anaa
meiheqi (plum pit illncss/syndromc), ·¸,
··, µ,, .6¡n¡¸
mianzi. See lacc
microanalysis, .c¸–.c·, ..c, .a¡, .¸,, .¡..
See also convcrsation analysis
Neijing. Scc Huangdi Neijing (thc Yellow
Emperior’s inner classics)
ncurasthcnia (shenjing suairuo), a, ¡6
Òts, Tomas, a, ¡., ¡,, ¸¸, 6¸, .¡,
pain (tong), ¡¡–¡¸
pathological condition, ,6, ·¡, .¡µn¸·,
.¸6na.
pathological proccss, ·a, ·¡, ·¸, µ,, .cc,
.c¡, .¡c
pattcrn. Scc zheng (pattcrn or
syndromc)
pcrsuasion. Scc kaidao
phlcgm (tan), ·¸, ··, µc, µ., µa, µ¸, µ,–.cc,
...
plum pit qi illncss/syndromc. Scc
meiheqi
plurality, µ–.c, a·, ·¸
Porkcrt, Manlrcd, .¸.n6, .¸,nn¸·–¸µ
Pottcr, Sulamith, and Jack, ¡·, ¸¸, ¸¡, 6c
psychologization, ¸a–¸¸, .¡·n¸a
pulsc (mai), .a, ¸µ, ¡¸, 6,, µ¸, µ6, .cc, .cµ,
..6, ..,, .6.n¡,
qi, stagnant, ·¸, ·µ, µa, µ¸, µ¸, µ6, .a., .aa
qingzhi (cmotion), ., ¸–6. .¡–.¸. ¸.–¸a. ¸·.
¡.. ¸¸. ¸¸. 6¡. 66. ,¡, ,6, ·¸, µc.
See also cmotion, qiqing (scvcn
cmotions)
qingzhi bing, ., ,¡–,¸, ·¸, µa, .¸µ, .¡a. See
also cmotional disordcr, qingzhi
disordcr/illncss
qingzhi disordcr/illncss, ., ¸, 6–.a, .¡, ¸c,
¸a, ¡c, ¡6, 6¡, 66–6,, ,¸, ·¸, ·¸,
·,, µc, µ¸–µ¡, µ·, .ca, .c¡–.c,,
.cµ, ..c, ..¸, .a¸, .a·, .¡c–.¡a
qiqing (scvcn cmotions), 6¡, 66, ,µ, ·µ,
.¡,n., .6cn¸6. See also cmotion
renqing (human cmotions), ¸c, ¸¸, 6c–6a
running pig illncss/syndromc. Scc
bengtunqi
sadncss. Scc bei (sadncss/gricl )
Schcid, \olkcr, .c, a¸, ·¸, .¸cna, .¸¡n¸¡,
.6¸nn¸6–¸,, .6¡n¡a
SchcpcrHughcs, Nancy, ¡
Schocnhals, Martin, ¸¡, ¸,, ¸·, 6., .¸·n¸6
scmantic nctwork analysis, ¸¸, ¸¸
scqucntial organization, .c6, ..¡
Shanghan Lun or Shanghan Zabing Lun,
µ, a¸–a¸, ·., .cc, .¸¸n¡c, .¸¸n6c.
See also Zhang Zhongjing
shenzhi bing, ·¸, .¡,n., .6¡n¡¡. Scc also
qingzhi bing
shenti, ¸, 6, ·, .¡, ¸., ¸¸–¸·, ¡a–¡¸, ¡¸, ¡µ, 6¸,
6,, .c¡, .¸a, .¸µ, .¸¸na. See also
bodypcrson
Sivin, Nathcn, ¡¸, 6¡, 6µ, .¸a, .¡,na,
.¡µn¸., .¸.n,, .6.n¡µ
Solomon, Robcrt, ¸¸
somatization, ,, ¸a–¸¸, .¸µ, .¡·n¸a, .¡µn¡¸,
.¸¸n¸
stagnation: ol cmotions, ··–µc, .c6, ..c,
..a, .a¡, ol qi,¡¸, ·¸, µ., µ¸, .cc,
.c¡
Suwen (Plain Qucstions), ¸,, ¡., ¡¸, 66, ,a,
··, µ6, .¸¸n¸¡, .¸,n¡., .6cn¡a.
Scc also Huangdi Neijing
symptom. Scc zheng (symptoms)
syndromc. Scc zheng (pattcrn or
syndromc)
talkinintcraction, .c6, .¡·na6
thcory, in Chincsc mcdicinc, ,, .¡, a¸–a6,
6,, 6µ, ,., ·a, ·¸, ··
I NDEX 191
thcrapcutic proccss, .¡, .¡c
thcrapcutic principlc, ¡¡, ,µ, ·., µa, µ¸, µ6,
..., ..¸, .a¡, .a6, .¸c
tiao. See attuning
Tscng, VcnShing, ,, .¸.n¸
Tung, May, ¸¸
Unschuld, Paul, .¸.nn.c–..
vcxation, ol hcart, ¡·, .c¡, .cµ
visccral systcms (zangfu), 6, ·, ¸µ, ¡µ, 6.,
66–6µ, ,., ,¡, ·a, µ.–µa, .c¸, ..a,
.a¡, .¡c, .¸6na., .6cn¸6, .6.n¡,,
.6,n¸a
wood. See fivc translormativc phascs
wuxing. See fivc translormativc phascs
xinfan, See vcxation, ol hcart
xiyi. See biomcdicinc
xu. See dcplction
Yan, Yunxiang, 6c
yang. Scc yin-yang
Yc Tianshi, ·a, µc, .6¸n.¸, .6,n¸c
yi (mcdicinc), .¡, .·–.µ. Scc also zhongyi
yin. Scc yin-yang
yin-yang, ¡–6, .¸, .·, ¡a–¡¸, 6µ, ,., ·.–·a
yu (stagnation), ¡¸–¡6, ·¸, ·,–µc, ..a,
.aa, .¸·nn6c–6¸, .6an.¸, .6¸n6,
as disordcr or illncss, ¡¸, ,a,
·µ, µa, µ,. Scc also yubing;
yuzheng
yubing, ·¡, ·µ, .6¸ n.... Scc also yuzheng
yuzheng, .., ¸c, ¡6, ,a, ·¡–·¸, ·,, ·µ–µ¸, .c¡,
..., ..¸, .ac, .a¸, .a¸, .a·, .¸·n6¸,
.6¡n¡¡, .6¸n.¸, .6,n¸¸
zangfu. See visccral systcms
zangxiang (visccral systcm imagcry), 6,, µ6
zangzao (visccral agitation syndromc), µ.,
.cc–.c., ..,, .6¡n¡¸
Zhang Congzhcng, ,a–,¸
Zhang Jicbin, ,a, ·a, ·,, ·µ, .a·, .¡,na,
.6an.c, .6,n¸¸. Scc also Jingyue
Quanshu
Zhang Jingyuc. Scc Jingyue Quanshu
Zhang Zhongjing, a¸, ·., ··, µ,, .cc,
.¸¸n¸¸, .¸¸n¡c, .6¡n¡.. Scc also
Shanghan Lun
zheng (pattcrn or syndromc), ,6, ,·, ·c–
·a, ·¡, µ.–µa, .c¸, .¡c, .6.na
zheng (symptom), ,6–,·, ·c
zhenghou, Scc zheng (pattcrn or
syndromc)
zhongchengyao (Chincsc patcnt mcdicinc
or rcadymadc mcdicinc),
aµ–¸c, ...
zhongyi. See Chincsc mcdicinc.
zhongyi counscling, .a¸, .¸6, .¡a
zhongyi diagnostics, ·., .6¸n¸,
zhongyi cducation, a., a¸, a,, ·¸, .¡¡, .¸¡n¡6
zhongyi modcrnization (xiandaihua), ., a,
zhongyi psychology (xinlixue), .¡·n¸c
zhongyi standardization (guifanhua), µ, aa,
·c, .¸¸n¸., .6anac, .6¸n¸.
Zhou ¡nlai, a.
Zhu Ðanxi, ,a, ··, ·µ, .¸·n6.
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Chinese medicine approaches emotions and emotional disorders differ- Chinese medicine approaches emotions and emotional disorders differ-
ently than the Western biomedical model. ently than the Western biomedical model. Transforming Emotions with Chinese Transforming Emotions with Chinese
Medicine Medicine offers an ethnographic account of emotion-related disorders as they are offers an ethnographic account of emotion-related disorders as they are ee
conceived, talked about, experienced, and treated in clinics of Chinese medicine conceived, talked about, experienced, and treated in clinics of Chinese medicine
in contemporary China. While Chinese medicine in contemporary China. While Chinese medicine (zhongyi) (zhongyi) has been predomi- has been predomi- ))
nantly categorized as herbal therapy that treats physical disorders, it is also well nantly categorized as herbal therapy that treats physical disorders, it is also well
known that Chinese patients routinely go to known that Chinese patients routinely go to zhongyi zhongyi clinics for treatment of illness clinics for treatment of illness ii
that might be diagnosed as psychological or emotional in the West. Through that might be diagnosed as psychological or emotional in the West. Through
participant observation, interviews, case studies, and participant observation, interviews, case studies, and zhongyi zhongyi publications, both publications, both ii
classic and modern, the author explores the Chinese notion of “body-person,” classic and modern, the author explores the Chinese notion of “body-person,”
unravels cultural constructions of emotion, and examines the way Chinese medi- unravels cultural constructions of emotion, and examines the way Chinese medi-
cine manipulates body-mind connections. cine manipulates body-mind connections.
“The author has covered an amazing range of complex ideas in a reader- “The author has covered an amazing range of complex ideas in a reader-
friendly format, increasing our understanding of both Chinese and conventional friendly format, increasing our understanding of both Chinese and conventional
Western models. I know of no other book within the English language literature Western models. I know of no other book within the English language literature
that accurately and comprehensively addresses traditional Chinese ideas of that accurately and comprehensively addresses traditional Chinese ideas of
health psychology.” health psychology.”
— Paul Pedersen, University of Hawaii — Paul Pedersen, University of Hawaii
YANHUA ZHANG YANHUA ZHANG is Assistant Professor of Chinese at Clemson University. is Assistant Professor of Chinese at Clemson University.
A volume in the SUNY series in A volume in the SUNY series in
Chinese Philosophy and Culture Chinese Philosophy and Culture
Roger T. Ames, editor Roger T. Ames, editor
State University of New York Press State University of New York Press
www.sunypress.edu www.sunypress.edu
with Chinese Medicine with Chinese Medicine
Transforming Transforming
EMOTIONS EMOTIONS
YANHUA ZHANG YANHUA ZHANG
OO
ASIAN STUDIES / ANTHROPOLOGY ASIAN STUDIES / ANTHROPOLOGY

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