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New Geographies of Chinese Medicine
Author(s): T. J. Hinrichs
Source: Osiris , 1998, Vol. 13, Beyond Joseph Needham: Science, Technology, and
Medicine in East and Southeast Asia (1998), pp. 287-325
Published by: The University of Chicago Press on behalf of The History of Science
Society
Stable URL: https://www.jstor.org/stable/301886
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New Geographies of Chinese Medicine
By TJ Hinrichs*
C HINESE GAZETTEERS OF THE IMPERIAL PERIOD contain maps quite

1 unlike those in modem atlases. Modem atlases display maps of dis
political, topographic, economic, and demographic, for example. Maps of China,
regardless of type, feature a line around the national or dynastic borders. In many
maps, provinces and other internal divisions are demarcated, the locations of rivers
indicated to scale, population densities or elevation above sea level clearly differen-
tiated by color or pattern codes overlain on the outline of China.
Imperial period gazetteers also include a set of maps, or tu (depictions, illustra-
tions), usually after the table of contents. There is a general map of the administrative
unit in question, as well as depictions of local administrative offices, local schools,
and important mountain and river systems. Like landscape paintings, these maps are
not drawn from a single fixed perspective. They tend not to depict boundaries around
or between administrative units such as provinces or prefectures, indicating these
instead by their administrative centers. The focus is on human constructions-
temples, villages, schools. Distances and directions are not ignored, but they are not
primary in organizing the arrangement of the maps, usually described in accompa-
nying text. Scale maps using grids were known, but these never became a domi-
nant standard.
Like gazetteer illustrations of local terrain, "new geographies" of scholarship on
Chinese medicine shift attention away from the clear demarcation of outer bound-
aries and inner divisions-for example, around Chinese medicine and between the
sacred and the secular. Instead, they organize information around key nexuses of
activity such as experiences of illness and healing or processes of change in medical
praxis. They tend to employ multiple disciplinary perspectives and privilege indige-
nous categories. Biomedical projections of the "terrain" of the human body are still
often drawn on as a source of knowledge, but not the dominant one. The use of
measurement and attempts at sociometric analysis have declined, though considera-
tions of "scale" and concern for disciplinary rigor have not been abandoned. Recent
scholarship is not careless of important distinctions. It is concerned with boundaries,
but more in the ways in which they are constructed and fixed than in constructing
and fixing them.
* HEAL, Harvard University, Coolidge Hall, 1737 Cambridge Street, Cambridge, Massachusetts
02138.
I would like to thank Bridie J. Andrews, Peter K. Bol, Chen Hsi-yuan, Arthur Kleinman, Joan
Kleinman, G. E. R. Lloyd, John Moffett, Jeanne Shea, and an anonymous referee for their thoughtful
comments on drafts of this essay.
(? 1999 by The History of Science Society. All rights reserved. 0369-7827/98/1301-0012$02.00
Osiris, 1998, 13:287-325 287

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288 TJ HINRICHS
One of the thickest lines on our maps of Chinese medical history is between the
traditional or premodern and the modem. This is also true of our maps of Chinese
medical historiography. The history of Chinese medicine, as practiced in premodern
China and Japan, has been characterized, in contrast to modem history of medicine,
as consisting largely of bibliographical, philological, and biographical studies; as
lacking the status of an independent field; and as motivated by the interests of clini-
cal practice rather than the concerns of history.1 These genres and links to the clinic
did not disappear with the twentieth century, and they remain prominent and vital
in scholarship on Chinese medicine around the world today.
Although not all "traditional" historians of Chinese medicine, including those of
earlier centuries and those of the twentieth century who continue to work in these
scholarly traditions, are practitioner-scholars, the clear separation of scholarship
from practice is a historical key to the model of modem medical history, first taken
from the West. While there are still medically trained historians of Western medi-
cine, medical history became divorced from medical practice in the course of the
nineteenth century. Prior to that time, Western practitioners read the texts of earlier
masters for insight into their own practice, as practitioners of Chinese medicine
continue to do today. Practitioner-scholars and medically trained historians affili-
ated with schools of Chinese medicine still play a vital role in the field in Europe,
Asia, and North America.3
Some of these practitioner-scholars have been among the most vigorous in devel-
oping the new approaches to understanding Chinese medicine that I will examine
here.4 Historically, however, practitioner interests have contributed to the sharpening
of the very boundaries that newer scholars are now smudging and erasing. For pur-
poses of their own identity or promotion, practitioners have emphasized the continu-
ity of Chinese medicine or of their particular tradition. For purposes of their own
practice, they have approached earlier texts seeking coherence and unity. These vi-
sions of essential continuity have been reinforced by parallel tendencies growing
out of the opposition of West and China, shared in Chinese nationalist constructions
of Self and orientalist constructions of Other.
The modem field of the history of Chinese medicine emerged early in this century,
when Chinese medicine was under threat of restriction by licensing or outright ban.
Chinese medicine was defined, out of emerging professional and national interests,
I Chen Bangxian, "Preface," in Zhongguo vixue shi (The history of Chinese medicine), rev. ed.
(Shanghai: Shangwu yinshuguan, 1936), p. 9; Chen Yuanpeng, Liang Song de "Shangyi shiren"
yu "ruyi"-jianlun qi zai Jin-Yuan de liubian ("Gentlemen aficionados of medicine" and "scholar
physicians" in the Northern and Southern Song: With a discussion of changes in the Jin and Yuan)
(Taibei: Guoli Taiwan daxue, 1997), p. 1; and Ishida Hidemi, Chi-goku igaku shisoshi (A history of
Chinese medical thought) (Tokyo: Tokyo daigaku shuppankai, 1992), p. 311.
2 On the separation of scholarship from practice in China see Chen Bangxian, Zhongguo yixue shi,
p. 9. For the Western use of earlier texts for practical insights see Charles Rosenberg, Explaining
Epidemics and Other Studies in the History of Medicine (Cambridge: Cambridge Univ. Press, 1992),
p. 1.
I For example, the main journal of Chinese medical history in China, Zhonghua yishi zashi (Journal
of Chinese Medical History) is associated with the Academy of Traditional Chinese Medicine in
Beijing, and nearly all mainland scholars of Chinese medicine are affiliated with similar academies
rather than with history or anthropology departments at research institutes or universities. Interna-
tional symposia on the history of Chinese medicine commonly include practitioner-scholars along
with professional historians and anthropologists.
I Those discussed here include Vivienne Lo, Zhao Hongjun, and Volker Scheid.

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NEW GEOGRAPHIES OF CHINESE MEDICINE 289
in contradistinction to and according to contemporary models of Western medicine.5

The practice of the history of Chinese medicine was part of this project of self-
definition. Chen Bangxian, in reference to the purposes of both the Medical History
Research Society (1914) and his groundbreaking institutional and intellectual his-
tory of Chinese medicine (1919), identified the need, in a civilized country, for a
modern history of medicine like that pursued in the West. Western models of history,
scientific progress, and civilization informed his approach, and Western-modeled
medical policies informed his agenda. While Chen was writing for a domestic audi-
ence, the English-language History of Chinese Medicine of K. Chimin Wong and
Wu Lien-teh, both of whom were trained in Western medicine, was conceived in
Wong's shock at discovering how little information-or even misinformation-was
available to Western audiences.6
These early historians were concerned with the international view of China as
backward and accepted the Western standards according to which China was seen
to lag. They made it their goal to demonstrate progress in Chinese medicine from
religious and superstitious origins to rational and scientific foundations.7 Such pro-
gressivist or positivist approaches have persisted in the history of Chinese medicine
both within and outside China.
This perspective informs Joseph Needham's Science and Civilisation in China
project. Needham countered the view that the origins of science and technology
were uniquely European by documenting Chinese preeminence in earlier periods,
Chinese priority in various discoveries, and Chinese contributions to a world sci-
ence. He looked forward to a continuing evolution that would culminate in an ecu-
menical science. Basic questions for Needham and those who follow his approach
have been, What were the cultural bases of China's early successes, and how did
China get derailed from the tracks of progress?8 For Chinese medicine, as for sci-
ence, "ethnic" culture might be productive at some stages but is ultimately to be tran-
scended.
One may immediately say [of Chinese medicine] that its attachment to its own culture
is so strong that it has not yet entirely come out of it. All the sciences of ancient times
5 See Bridie Andrews, "The Making of Modern Chinese Medicine, 1895-1937" (Ph.D. diss., Univ.
Cambridge, 1996), esp. Ch. 5; Zhao Hongjun, "Chinese versus Western Medicine: A History of
Their Relations in the Twentieth Century," Chinese Science, 1991, no. 10, pp. 21-37; Zhao, Jindai
Zhongxiyi lunzheng shi (History of modern controversies in Chinese and Western medicine) (Anfei:
Anhui keji chubanshe, 1989); and Ralph Croizier, Traditional Medicine in Modern China (Cam-
bridge, Mass.: Harvard Univ. Press, 1964).
6 K. Chimin Wong and Wu Lien-teh, History of Chinese Medicine: Being a Chronicle of Medical
Happenings in China from Ancient Times to the Present Period (Tientsin: Tientsin Press, 1932). See
the account in Chen Yuanpeng, Liang Song de "Shangyi shiren" yu "ruyi" (cit. n. 1), p. 2.
7 Not all historians of Chinese medicine in this period were interested in saving it from the en-
croachment of Western medicine. The "scientific foundations" explored by Wong and Wu had rather
more to do with the introduction of Western practices (three quarters of the book) than did those of
Chen, who found much of worth in imperial China. See Chen Bangxian, Zhongguo yixue shi, cit n.
1, pp. 1-3; and Wong and Wu, History of Chinese Medicine, pp. i-ii.
8 See Joseph Needham et al., Science and Civilisation in China (Cambridge: Cambridge Univ.
Press, 1954-); and Needham, with Wang Ling, Lu Gwei-Djen, and Ho Ping-yii, Clerks and Crafts-
men in China and the West: Lectures andAddresses on the History of Science and Technology (Cam-
bridge: Cambridge Univ. Press, 1970). For a critique of this type of question see Nathan Sivin,
"Why the Scientific Revolution Did Not Take Place in China-Or Didn't It?" Chin. Sci., 1982, no.
5, pp. 45-66.

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290 TJ HINRICHS
and the Middle Ages had their very distinct ethnic characteristics, whether European,
Arabic, Indian or Chinese, and it is only modem science which has subsumed these
ethnic entities into a universal mathematised culture. But while all the physical and
some of the simpler biological sciences in China and Europe have long ago fused into
one, this has not yet happened with the medical systems of the two civilisations.9
Needham and Lu Gwei-Djen, with whom he collaborated on Chinese medical

history, evaluated Chinese medicine in relation to modem models of scientific and
medical knowledge-that is, in terms of its theoretical advancement, its rationality,
and the efficacy of its particular "discoveries," generally ascertained by laboratory
analysis. Others who have taken modem science as their standard for evaluation
have treated Chinese medicine as a "quasi-science"; they described reluctance to
choose Western over Chinese medicine as irrational or as explicable only by re-
course to social and cultural factors. They do not see these factors as similarly appli-
cable to the choice of Western over Chinese medicine.10
Growing popular acceptance of Chinese medicine in the West has drawn scholars
to its study, encouraged more positive views of Chinese medicine, and motivated
the development of alternatives to narratives of biomedical triumph over other forms
of healing. Interest in acupuncture in the West grew with the popularity of Maoism
in counterculture movements in Europe and North America in the late 1960s, growing
criticism of "establishment" biomedicine, and the opening of the People's Republic of
China in the 1970s. Certain applications of acupuncture, especially in analgesia, were
being promoted in the People's Republic of China at the time, and it was appealingly
9Joseph Needham and Lu Gwei-Djen, "Medicine and Chinese Culture," in Clerks and Craftsmen,
pp. 263-293, on p. 263. As another example, note: "How to develop a public health service in keep-
ing with the modem age is . . . complicated for states within the Chinese and Indian cultural sphere
by the fact that they have ancient healing systems which are still part of their cultures." Paul Un-
schuld, "The Social Organization and Ecology of Medical Practice in Taiwan," in Asian Medical
Systems: A Comparative Study, ed. Charles Leslie (Berkeley: Univ. California Press, 1976), pp. 300-
316, on p. 300 (emphasis added).
'? For evaluations of Chinese medicine in relation to modem models see the following works by
Lu Gwei-Djen and Joseph Needham: "A History of Forensic Medicine in China," Medical History,
1988, 32:357-400; Celestial Lancets: A History and Rationale of Acupuncture and Moxa (1980; rpt.,
Taipei: Caves, 1986); "Medicine and Chinese Culture"; "Proto-Endocrinology in Medieval China,"
in Clerks and Craftsmen, pp. 294-315; "Hygiene and Preventive Medicine in Ancient China," ibid.,
pp. 340-378; and "China and the Origin of Qualifying Examinations in Medicine," ibid., pp. 379-
395; and also William C. Cooper and Nathan Sivin, "Man as Medicine: Pharmacological and Ritual
Aspects of Traditional Therapy Using Drugs Derived from the Human Body," in Chinese Science:
Explorations of an Ancient Tradition, ed. Shigeru Nakayama and Sivin (MIT East Asian Science
Series, 2) (Cambridge, Mass.: MIT Press, 1973), pp. 203-272. For examples of work treating Chi-
nese medicine as a quasi-science see Croizier, Traditional Medicine in Modern China (cit. n. 5);
Ralph C. Croizier, "The Ideology of Medical Revivalism in Modem China" in Asian Medical Sys-
tems, ed. Leslie, pp. 311-355; and Marjorie Topley, "Chinese Traditional Etiology and Methods of
Cure in Hong Kong," ibid., pp. 243-265. This pattern of explanation is also apparent in earlier
periods in China, although with different paradigms of valid knowledge. Preference for nonmedical
healing-for example, by people in areas of the south-was explained by a prevailing "respect
for spirit-mediums and belief in demons," ignorance, questionable morality, or lack of access to
proper medicines. See Xiao Fan, "Han-Song jian wenxian suojian gudai zhongguo nanfang de dili
huanjing yu difangbing ji qi yingxiang" (The physical environment and endemic diseases in ancient
south China and their impact on human activities as viewed from documents of Han through Song
times), Zhongyang yanjiuyuan Lishi yuyan yanjiusuo jikan (Bulletin of the Institute of History and
Philology, Academia Sinica), 1993, 63(1):67-17 l; and TJ Hinrichs, "The Medical Transforming of
Governance and Southern Customs in Song China (960-1279 A.D.) (Ph.D. diss., Harvard Univ., forth-
coming).

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exotic to Western audiences. This popular interest motiva

the poor quality of the bulk of these inspired several scholarly correctives.11
Much Western scholarship was driven simply to sort out the conceptual founda-
tions of what appears alien. In the 1970s and 1980s several scholars took their cue
from Lu and Needham, paying respect to the theoretical sophistication of Chinese
medicine and attempting to grapple with it on its own terms. As many noted, various
innovations or discoveries were meaningless when treated in isolation from the
broader system-which these scholars understood as a coherent unity. While provid-
ing a useful basis for approaching Chinese medicine, many of these works were ahis-
torical and acontextual, constructing Chinese medicine as a single bounded rational
system, focusing on essential conceptual contrasts between Chinese and Western
medicine, and neglecting internal tensions, contradictions, and nonrational aspects.12
In the meantime, anthropologists studying healing in Chinese and Asian cultures
were introducing the perspective of medicine as a culture system, looking at the
social production of knowledge, taking "rationality" itself as socially constructed,
focusing increasingly on patient strategies rather than treating medicine as an iso-
lated conceptual system, and examining varieties of patient choices across the spec-
trum of sacred and secular. Anthropological perspectives and social approaches
began to appear in historical scholarship, which gave increasing attention to the
plurality of healing systems in China and their social contexts."3
Disciplinary cross-fertilization has intensified in recent years. An increasing num-
ber of scholars do both historical documentary research and ethnographic field re-
search; and historians and anthropologists more and more draw on and integrate the
work of each other's fields into their own.14 Besides seeking to provide historical
11 Explicitly citing this poor quality as a motivation for publication were Lu and Needham, Celes-
tial Lancets, p. xix; and Nathan Sivin, Traditional Medicine in Contemporary China (Science, Medi-
cine, and Technology in East Asia, 2) (Ann Arbor: Center for Chinese Studies, Univ. Michigan,
1987), p. xx. These texts aimed at popular, practitioner, and scholarly audiences. For an analysis of
the nationalistic and modernizing resonances of innovations in Chinese medicine that were actively
promoted during the Great Leap Forward and the Cultural Revolution see Elisabeth Hsu, "Innova-
tions in Acumoxa: Acupuncture Analgesia, Scalp and Ear Acupuncture in the People's Republic of
China," Social Science and Medicine, 1996, 42:421-430.
12 E.g., Ted J. Kaptchuk, The Web That Has No Weaver: Understanding Chinese Medicine (New
York: Congdon & Weed, 1983); and Manfred Porkert, The Theoretical Foundations of Chinese Medi-
cine: Systems of Correspondence (Cambridge, Mass.: MIT Press, 1982).
13 For work by anthropologists see, e.g., Arthur Kleinman et al., eds., Culture and Healing in Asian
Societies (Cambridge, Mass.: Schenkman, 1978); Kleinman, Patients and Healers in the Context of
Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry (Com-
parative Studies of Health Systems and Medical Care, 3) (Berkeley: Univ. California Press, 1980);
and Leslie, ed., Asian Medical Systems (cit. n. 9). For historical work that is informed by anthropolog-
ical perspectives see Nathan Sivin, "Social Relations of Curing in Traditional China: Preliminary
Considerations," Nihon ishigaku zasshi, 1977, 23(4):505-532; Sivin, "Ailment and Cure in Tradi-
tional China: An Anthropological Study of Classical and Popular Medicine before Modern Times,
with Implications for the Present," unpublished MS; and Paul Unschuld, Medicine in China: A His-
tory of Ideas (Comparative Studies of Health Systems and Medical Care, 13) (Berkeley: Univ. Cali-
fornia Press, 1985).
14 E.g., Kenneth Dean, Elisabeth Hsu, Paul Katz, Lin Fu-shih, and Tanaka Issei have all published
substantial works both on earlier periods of history, based on extensive documentary research, and
on the contemporary period, based on extensive fieldwork. Besides the many who are integrating the
perspectives of the other field into their own work, many scholars of the contemporary period are
integrating extensive original research of both types in their work rather than relying only on second-
ary sources for background. Several years ago, Sivin proposed slightly different disciplinary borders
for the history of science, including medicine. These are technical history as usually practiced by
scientists, the philosophy of science, and anthropology and sociology. Sivin called for scholars in the

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292 TJ HINRICHS
background for their studie

cesses of change. Anthropolo
in everyday life and local k
Historians are going beyond
literature. The old division b
pology and religion on one si
separating studies of "apotr
and tending to reduce elemen
rapidly eroded.
In anthropology and the history of science, the universality of biomedical para-
digms has long been under challenge. Anthropologists no longer restrict their re-
search to exotic Others, and medical anthropologists have turned their gaze to bio-
medicine. Historians of science, medicine, and culture have been looking for some
time now at the processes by which scientific knowledge is socially produced and
by which the biomedical body is socially constructed. Anthropological studies have
exposed the complexities of efficacy as it is variously constructed and contested,
not to mention assessed, by patients and healers.15 In challenging biomedical con-
structions of the body, disease, and efficacy, these works have problematized their
analytic utility and relevance to explaining change, thus radically undermining posi-
tivist accounts of history.
Abandonment of the basic positivist assumption that change stems from the dis-
covery of more efficient technologies and theories with greater explanatory power
opens up the question of how it does in fact take place. Newer work looks beyond
those developments that can be classed as "discoveries"-innovations that accord
with current standards of rationality or technological development. It does not seek
to reduce change to a single mechanism but, rather, to interrogate multiple processes
of change.
In place of reductionist models and medical systems, we see increasing attention
to the local production, adaptation, and reproduction of knowledge. This shift has
been reinforced by trends in China studies in the United States away from such
master narratives as the "Western impact-Chinese response" approach, the treat-
ment of China as a monolithic entity, and the related division between tradition and
modernity. 16 The growth of local studies in the West has been paralleled in China and
history of Chinese science to work across these borders. See Nathan Sivin, "Over the Borders: Tech-
nical History, Philosophy, and the Social Sciences," Chin. Sci., 1991, no. 10, pp. 69-80.
'5 Prominent among anthropologists' works that consider biomedicine are Allan Young, The Har-
mony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton, N.J.: Princeton Univ. Press,
1995); Byron Good, Medicine, Rationality, and Experience: An Anthropological Perspective (Cam-
bridge: Cambridge Univ. Press, 1994); and Margaret Lock and Deborah Gordon, Biomedicine Exam-
ined (Culture, Illness, and Healing, 13) (Dordrecht: Kluwer, 1988). For investigations of the com-
plexities of efficacy see Elisabeth Hsu, "The Polyglot Practitioner: Towards Acceptance of Different
Approaches in Treatment Evaluation," in Studies in Alternative Therapy, Vol. 3: Communication in and
about Alternative Therapies, ed. Soren Gosvig Oleson and Erling Hog (Odense: Odense Univ. Press,
1996); Arthur Kleinman, Writing at the Margin: Discourse between Anthropology and Medicine
(Berkeley: Univ. California Press, 1995), p. 10; Kleinman and James L. Gale, "Patients Treated by Phy-
sicians and Folk Healers: A Comparative Outcome Study in Taiwan," Culture, Medicine, and Psychia-
try, 1982, 6(4):405-423; and Kleinman, Patients and Healers in the Context of Culture (cit. n. 13).
16 For an influential critique of older approaches in the field see Paul A. Cohen, Discovering His-
tory in China: American Historical Writing on the Recent Chinese Past (New York: Columbia Univ.
Press, 1984). For a more recent perspective, focusing on methodological implications of conceptual-

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Taiwan. The devolution of political control in mainland China and the unleashing of
Taiwanese-nationalist sentiments in Taiwan since the 1980s have brought a surge of
interest in regional distinctiveness and local identity, providing both inspiration and
funding for locally focused scholarly studies.
From the 1950s, under the People's Republic of China, both biomedical and Chi-
nese medical education were centralized. Chinese medical history became even
more closely tied to the latter: research in the field was restricted to the history
departments of academies of Chinese medicine and had an explicit mandate to serve
medical practice. The history of Chinese medicine remained a project whose point
was to demonstrate national progress and raise cultural standards, although this was
tied to the different and shifting agendas of the Communist regime and the perspec-
tive was Maoist-Marxist. Contextual historical work, as opposed to biographies and
text studies, tended, for example, toward themes such as the medical achievements
of the (proto-Maoist peasant revolutionary) Taiping rebellion and of the Communist
Worker-Peasant Red Army Sanitation Work of the Civil War period.'7
The loosening of ideological strictures since the 1980s has encouraged new ap-
proaches and more varied themes. There has been a turning away from rigid Marxist
frameworks, and from the narrow focus on medical theory and physician hagiogra-
phy, toward more broadly conceived social and cultural histories and studies of a
wider range of healing practices.'8 Practices previously considered "feudal supersti-
tion" -and their study-have gained some respectability. The popularity of qigong,
its political acceptance, and its nationalistic glamor have encouraged scholarly work
on related subjects such as longevity techniques. With greater tolerance toward reli-
gious practices, which from the Yan'an period (1935-1949) and the 1950s had been
vigorously suppressed and "exposed" as charlatanry, religious healing is now treated
more seriously. Under reexamination, it appears essential to a historical project that
attempts to go beyond the "intellectual" writings of elites to recapture the daily lives
of the people.19 The depoliticization of sexual expression, its burgeoning as a focus
izations of culture, see Judith B. Farquhar and James L. Hevia, "Culture and Postwar American
Historiography of China," Positions, 1993, ](2):486-525.
17 Lu Zhaoji, "Cong Zhonghua yishi zazhi kan woguo de yishi yanjiu" (Looking at China's medical
history studies through the Journal of Chinese Medical History), Zhonghua yishi zazhi, 1987,
]7(l):1-7.
18 E.g., Ma Boying, Zhongguo yixue wenhua shi (A history of medicine in Chinese culture) (Sh
hai: Shanghai renmin chubanshe, 1994); Li Jingwei, Yan Liang, and Zhu Jianping, Zhongguo gu
wenhua yu yixue (China's ancient culture and medicine) (Wuhan: Hubei keji chubanshe, 1990); a
Zhao Hongjun, Jindai Zhongxiyi lunzheng shi (cit. n. 5). For reviews of recent mainland schola
see Lu Zhaoji, "Cong Zhonghua yishi zazhi kan woguo de yishi yanjiu"; and Li Jingwei and Zhu
Jianping, "Jin wunian lai Zhongguo yixueshi yanjiu de jinzhan" (Progress in Chinese medical history
research in the last five years), Zhonghua yishi zazhi, 1994, 24(3):133-137.
19 Qigong practices generally involve the direction of qi flow into and in the body through regulated
breathing and movement. By cultivating qi, practitioners seek to acquire health, well-being, and
longer life. "Qi" (pronounced "chee") has been variously translated as "psycho-physical stuff,"
"pneuma and "vital energy." With the spread of qigong, Chinese medicine, and Chinese martial
arts, the term has increasingly entered common parlance in Western countries. For arguments for
taking shamanic practices and popular beliefs more seriously as objects of historical research see
Song Zhaolin, Wu yu minjian xinyang (Spirit-mediums and popular beliefs) (Zhonghua bentu wen-
hua congshu [Indigenous culture of China series]) (Beijing: Zhongguo huaqiao chuban gongsi,
1990), pp. 1-5; and Song, Wu yu wushu (Shamans and shamanic techniques) (Chengdu: Sichuan
minzu chubanshe, 1989), pp. 1-11. Song ranges widely, drawing on archaeological, historical, and
ethnographic materials for both Han and non-Han cultures in China. Another example of scholarship

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294 TJ HINRICHS
of therapeutic intervention, and its prevalence as a topic in the popular press have
helped make it an acceptable object of scholarly interest.20
There has also been a heightened interest in social approaches to medical history
in Taiwan, especially since 1992, when historians at Academia Sinica formed a
group to share work in progress on "Disease, Medicine, and Culture." Tu Cheng-
sheng has described them as practitioners of an "alternative" history. This "medical
history as social history" is "alternative" relative to the medical history done by
scholars trained in Chinese or Western medicine, such as Chen Bangxian and
K. Chimin Wong, that focuses more on medical thought per se and on institutional
structures. It is also "alternative" in that it considers topics marginal to Taiwan's
mainstream historical scholarship.2' This new scholarship has been especially pro-
ductive in areas such as the social contexts of diverse healing practices, those of
daily life, women's health, and infant care.22
on shamanic customs-Wu Duanshu, Lin He, and Long Haiqing, eds., Wufeng yu shenhua (Sha-
manic mores and myth) (Changsha: Hunan wenyi chubanshe, 1988)-focuses especially on "Chu
(Hunan) culture," taking literary and historical associations of Chu culture with shamans and danger-
ous demons as a point of regional interest and cultural richness. While still often referred to as
"superstition," these have clearly developed a cachet.
20 For example, Pan Suiming, assistant professor in sociology at China People's University, has
been conducting research and lecturing on the sociology of sexuality since 1985. Pan translated the
two "Kinsey Reports" into Chinese. Their influence is apparent in his sociological approach in
Zhongguo xing xianzhuang (The present status of sex in China) (Beijing: Guangming ribao chuban-
she, 1995). Liu Dalin has published an extensive study of "sexual culture" in ancient China, Zhong-
guo gudai xing wenhua (Sexual culture in ancient China) (Ningxia: Renmin Chubanshe, 1993), and
conducted the first nationwide study of sex in China, Zhongguo dangdai xing wenhua: Zhongguo
liangwan lie xing wenhua diaocha baogao (Sexual culture in contemporary China: Report on a sur-
vey of sexual culture in China) (Shanghai: Sanlian Shudian Shanghai Fendian, 1992). This has been
published in English as Sexual Behaviour in Modern China: Report on the Nation-wide Survey of
Twenty Thousand Men and Women, ed. and trans. Man Lun Ng and Erwin J. Haberle (New York:
Continuum, 1997). More explicit treatments of sexuality and reproduction are also notable in other
recent works on subjects related to medicine and healing, such as Ma Boying, Zhongguo yixue wen-
hua shi (cit. n. 18), pp. 618-781; Song Zhaolin, Wu yu minjian xinyang; and Song Shugong, Zhong-
guo gudai fangshi yangsheng jiyao (Collected essentials of [arts of] the bedchamber and nourishing
life in ancient China) (Beijing: Xinhua shudian, 1991).
21 At the group's monthly meetings, scholars present reports on work in progress. In 1997 the
group organized a larger symposium on medicine and Chinese society ("Yiliao yu Zhongguo shehui"
xueshu yantaohui [Medicine and Chinese Society: A Symposium]), inviting scholars from around
the world. "Medicine" here is not yixue ("medical studies"), but yiliao ("medical healing"). For
reports on this group and its work see Tu Cheng-sheng, "Zuowei shehuishi de yiliaoshi-bing jie-
shao 'Jibing, yiliao yu wenhua' yantao xiaozu de chengguo" (Medical history serving as social his-
tory, with an introduction to the achievements of the "Disease, Medicine, and Culture" discussion
group), Xinshixue, 1995, 6(1):113-154; and Tu, "Yiliao, shehui yu wenhua-linglei yiliaoshi de
sikao" (Medicine, society, and culture: Thoughts on an alternative medical history), presented at
"Yiliao yu Zhongguo shehui" xueshu yantaohui, Institute of History and Philology, Academia Sinica,
Taipei, 26 June 1997.
22 Another area of interest in scholarship, especially that coming out of Taiwan and mainland
China, is the history of disease and the impact of disease on history. Interest in this area in the West
grew with the Annales school and with the publication of William H. McNeill's Plagues and Peoples
(Garden City, N.Y.: Anchor, 1976), which presents theories concerning the role of epidemics in Chi-
nese history. Recent scholarship on disease history includes Cao Shuji, "Shuyi hluxing yu Huabei
shehui de bianqian" (The spread of bubonic plague in and social change in northern China), Lishi
yanjiu (Historical research), 1997, no. 1, pp. 17-32; Cao, "Dili huanjing yu Song-Yuan shidai de
chuanranbing" (Geographical environment and contagious disease in the Song-Yuan period), Lishi
dili (Historical geography), 1995, no. 12, pp. 183-192; Carol Benedict, Bubonic Plague in
Nineteenth-Century China (Stanford, Calif.: Stanford Univ. Press, 1996); Chia-Feng Chang, 'As-
pects of Smallpox and Its Significance in Chinese History" (Ph.D. diss., Univ. London, 1996)
(Chang's work is also notable for its attention to alternatives to elite medical approaches); Lin Fu-

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These breakdowns in disciplinary boundaries are reconfiguring "Cninese medi-

cine" as a disciplinary object. The changes include a shift away from theoretical
structures of medicine, which lend themselves to essentialist interpretations, toward
a consideration of diverse healing practices and experiences; further, a focus on the
practices and experiences involved in illness and healing has displaced medical prac-
titioners and medical theory from the center of inquiry. This reconfiguring has been
influenced, especially in Western scholarship, by postmodern sensibilities that privi-
lege contradictions, ambiguities, resistance, and the marginal spaces of life over sys-
tem, coherence, and elite versions of culture. One area of postmodern interest has been
the body as a locus for the expression and experience of power relations and culture.
As an object of inquiry, as Chinese medicine has overgrown its boundaries to
include lived bodily experience, so has lived bodily experience gone beyond the
modern Western models of the bounded individual body and the dichotomies of self
and other, mind and body, and emotion and cognition. Such dichotomies have be-
come the object of critique in many fields in the Western academic establishment,
including philosophy and psychology. In the social sciences and humanities, this
critique has been informed by challenges to the dominance of Western models. In
Asia, increasing numbers of scholars are adding their voices to the debate and are
attempting to develop indigenous approaches.23 These critiques may have sensitized
Western scholars seeking serious engagement with non-Western cultures, promoting
the development of alternative models informed by other cultures.24
In this essay I will deal with two features of recent scholarship: the retreat from
essentialist approaches that treat Chinese medicine as static and the development of
approaches that take account of change without reducing it to a positivist narrative;
shih, "Dong-Han wanqi de jiyi yu zongjiao" (Epidemics and religion in the late Eastern Han), Zhong-
yang yanjiu yuan Lishi yuyan yanjiu suo jikan (Bulletin of the Institute of History and Philology,
Academia Sinica), 1995, 66(3):695-745; Fan Jiawei, "Dongjin zhi Songdai jiaoqibing zhi tantao"
(On beriberi from the Eastern Jin to the Song period), Xinshixue, 1995, 6(1):155-178; Xiao Fan,
"Guanyu lishi shang de yizhong renti jisheng chongbing-Manshi lietou youbing" (On a human
parasitic disease: Sparganosis mansoni in Chinese history), ibid., 1995, 6(2):45-66; Xiao, "Han-
Song jian wenxian" (cit. n. 10); Fan Xingzhun, Zhongguo bingshi xinyi (New ideas on the history
of disease in China) (Beijing: Zhongyi guji chubanshe, 1989); Chen Shengkun, Chibi zhi zhan yu
chuanran bing-lun Zhongguo lishi shang dejibing (The Red Cliff Battle and contagious disease: A
discussion of disease in Chinese history) (Taipei: Mingwen shuju, 1983); Helen Dunstan, "The Late
Ming Epidemics: A Preliminary Survey," Ch 'ing Shih Wen T'i, 1975, 3(3): 1-59; and Denis Twitchett,
"Population and Pestilence in T'ang China," in Studia Mongolica (Munschener Ostasiatische Stu-
dien, 25) (Wiesbaden: Steiner, 1979), pp. 35-68.
23 Ishida Hidemi critiques the applicability to Chinese medical history of models that privilege
biomedicine, progressive history, a static view of Chinese medicine, the objectifying of the body, and
splitting spirit and flesh in Chagoku igaku shisoshi (cit. n. 1), pp. i-iii, 311-313. Tu Cheng-sheng,
while noting the influence of the Annales school, advocates the development of indigenous ap-
proaches to social history in "Shenmo shi xin shehui shi" (What is "new social history"?), Xinshixue,
1992, 3(4):95-116. Ambrose Yeo-chi King attempts to develop a model more suitable for studying
Chinese societies in "Kuan-hsi and Network Building: A Sociological Interpretation," Daedalus,
1991, 120(2):63-84.
24 Perhaps because the self-reflexive dimension is considered a standard part of ethnogra
proaches, the connection between cross-cultural engagement and scholarly method is made
in some anthropological accounts. See, e.g., Judith Farquhar, Knowing Practice: The Clin
counter of Chinese Medicine (Studies in the Ethnographic Imagination) (Boulder, Colo.: W
1994), p. 2; Kleinman, Writing at the Margin (cit. n. 15), pp. 17-18; and Arthur Kleinman an
Kleinman, "How Bodies Remember: Social Memory and Bodily Experience of Criticism,
tance, and Delegitimation Following China's Cultural Revolution," New Literary History
25:707-723, on pp. 712-713, 720-721.

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296 TJ HINRICHS
and the retreat from the tr

the development of approac
FROM ESSENCES TO PROCESSES
A common goal of scholarship on China and Chinese medicine has been to explore
and describe their essential nature. These analyses adopt an implicitly or explicitly
comparative strategy, posing an opposition between Western essence and Chinese
essence or Western medicine and Chinese medicine. Accompanying the search for
essences is the search for the characteristic structures and principles that underlie
those essences and give them unity as a coherent system. Besides pointing to the
larger dichotomies of West and China, the approach in many of these analyses is to
demarcate discrete cultural or social analytic categories-a procedure held to be a
sign of rigor. These categories are often based on polar dyads, frequently distinctly
Western ones such as mind/body, culture/nature, sacred/secular, elite/popular,
theory/practice, premodern/modern, stagnation/progress, and state/society. Thus we
get mental versus physical illnesses, symbolic or ritual versus medical healing, elite
"Confucian" doctors versus folk healers, traditional diversity versus modern conver-
gence and synthesis, stagnant Chinese medicine versus progressive Western medi-
cine, and hegemonic state medicine acting on either a passive or a recalcitrant society.
These categorizations have had points of utility, and one's own language and cate-
gories are necessary starting points for analysis. Nevertheless, the rigid application
of such categories, whether Chinese or foreign, has tended to produce anomalies.
Thus, mental and physical sensations and disorders tend to be apprehended more
indivisibly in Chinese than in Western cultures. People strive for spiritual salvation
by cultivating their bodies. Chinese culture tends not to divide theory from prac-
tice, a separation increasingly under attack in Western epistemology as well.25 His-
torically, elite medical healers have included "symbolic" techniques in their reper-
toires-exorcising demons, for example-and folk healers have included herbal
prescriptions.26 Where scholars have acknowledged these commonalities, they have
tended to treat the former practices as remnants of earlier times and the latter as the
influence of elite culture, failing to examine the processes by which those various
practices are transmitted. But modernity does not mark a rupture with the past, as
part of which biomedicine replaces or subsumes diverse "ethnic" healing practices,
and conflict between new and old practices is not a simple matter of enlightenment
battling the forces of disorder and ignorance. Policies and institutions are not simply
imposed on society. There are processes of negotiation among diverse actors-irre-
25 Arthur Kleinman, Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain
in Modern China (New Haven, Conn.: Yale Univ. Press, 1986); Martha Chiu, "Mind, Body, and
Illness in a Chinese Medical Tradition" (Ph.D. diss., Harvard Univ., 1986); Nathan Sivin, "Emotional
Counter-therapy," in Medicine, Philosophy, and Religion in Ancient China. Researches and Reflec-
tions (Variorum Collected Studies Series, CS512) (Hampshire: Variorum, 1995), pp. 11.1-19; and
Farquhar, Knowing Practice, p. 2.
26 Zheng Jinsheng, "Zaoqi Zhongyao fazhan zhong de wu wenhua jinran" (The permeation of
early Chinese pharmaceutical development with shamanic culture), presented at "Yiliao yu Zhong-
guo shehui" xueshu yantaohui (Medicine and Chinese Society: A Symposium), Institute of History
and Philology, Academia Sinica, Taipei, 26 June 1997; Kenneth Dean, Taoist Ritual and Popular
Cults of South-East China (Princeton, N.J.: Princeton Univ. Press, 1993), pp. 90-91, 128; and Song
Zhaolin, Wu yu wushu (cit. n. 19), pp. 250-274.

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ducible to state, society, or public sphere-in the ongoing shaping of policies and
their implementation.27
A focus on processes can be an antidote to the problems of essentialist ap-
proaches. One of the pillars of such approaches is the treatment of China and West
as monolithic, polar extremes. Nathan Sivin and G. E. R. Lloyd are attempting to
develop a comparative approach that goes beyond such simplistic assumptions by
not comparing things or concepts, but processes, the evolving activity of natural philos-
ophy and science in China on the one hand and in the Hellenic and Hellenistic world
on the other. Like most historians of science today, we have no use for the idea that
science is one thing and its context is another. We are looking at ideas, their use, and the
social process of their creation as a single phenomenon. How physicians or astronomers
earned a living, how thinkers grouped themselves, in what ways they publicly disagreed,
and what political significance they claimed for cosmology are just as revealing as con-
cepts, forms of proof, and patterns of thought.
From this point of view it does not make sense to ask whether social change was the
cause of scientific change, or whether philosophy changed politics. We see these as part
of a single manifold of history.28
We can see in these works that, besides making comparison both possible and
more fruitful, the central focus on processes of practice and experience helps to over-
come standard assumptions that do much violence to their object. Shigehisa Kuri-
yama, rather than comparing ancient Chinese and Greek medicine as abstracted
conceptual systems, examines what can be better described as ways of observing
and constituting the patient through, for example, sight and touch. Judith Farquhar,
in her anthropological inquiry into "culture-specific (Chinese) ways of knowing" in
medicine, found the epistemological paradigm that treats theory in isolation from
the processes of clinical encounters unwieldy: "Statements in discourse . .. had to
be seen as weapons against illness, resources for action, rather than as claims about
nature or representations of truth."29
Arthur Kleinman has moved away from such features of his earlier work as dichot-
omies between the sacred and the secular and distinct
27 Benedict, Bubonic Plague in Nineteenth-Century China (cit. n. 22); Caroline B. Reeves, "The
Power of Mercy: The Early History of the Chinese Red Cross Society, 1904-1927" (Ph.D. diss.,
Harvard Univ., 1998); Andrews, "Making of Modem Chinese Medicine" (cit. n. 5); and Ruth Ro-
gaski, "From Protecting Life to Defending the Nation: The Emergence of Public Health in Tianjin,
1859-1953" (Ph.D. diss., Yale Univ., 1996).
28 Nathan Sivin, "Comparing Greek and Chinese Philosophy and Science," in Medicine, Philoso-
phy, and Religion in Ancient China (cit. n. 25), pp. 1.4-5. A slightly different version appears in
Sivin, "Comparing Greek and Chinese Science," in East Asian Science: Tradition and Beyond, ed.
Hashimoto KeizW, Catherine Jami, and Lowell Skar (Papers from the Seventh International Confer-
ence on the History of Science in East Asia, Kyoto, 2 Aug. 1993) (Osaka: Kansai Univ. Press, 1995),
pp. 23-31, on p. 26. See also G. E. R. Lloyd, Demystifying Mentalities (Cambridge: Cambridge Univ.
Press, 1990), for a critique of the essentialist notion of distinct mentalities, including as a test case a
comparative study of early Greek and Chinese styles of scientific and philosophical reasoning (Ch.
4). Lloyd develops this comparison further in Adversaries and Authorities: Investigations into An-
cient Greek and Chinese Science (Cambridge: Cambridge Univ. Press, 1996).
29 Shigehisa Kuriyama, "Varieties of Haptic Experience: A Comparative Study of Greek and Chi-
nese Pulse Diagnosis" (Ph.D. diss., Harvard Univ., 1986); Kuriyama, 'Interpreting the History of
Bloodletting," Journal of the History of Medicine and Allied Sciences, 1995, 50:11-46; Kuriyama,
"Visual Knowledge in Classical Chinese Medicine," in Knowledge and the Scholarly Medical Tradi-
tions, ed. Don Bates (Cambridge: Cambridge Univ. Press, 1995), pp. 205-234; and Farquhar, Know-
ing Practice (cit. n. 24), p. 2.

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298 TJ HINRICHS
medical systems-the very idea, w

visions, now makes me uncomfo
medical practice as a historicized
a preoccupation with symbolic f
then on to the intersubjectivity
and new images to evoke the sam
and the body.30
The greatest challenge to approaches based on essential oppositions such as those

between East and West or between medicine and symbolic healing is the observation
that these oppositions are not natural but are themselves constructed. Studies of
Chinese medicine have generally taken the parameters of medicine as a given and
have defined doctors as practitioners of this medicine. While, again, there is some
utility to this definition, it also has its limitations. The delimiting of this particular
historiographic object has been related to the project of practitioner-scholars who
seek to identify themselves in continuous relation to a medical tradition. The appear-
ance of continuity and linear progress in a medical tradition is undermined, however,
by scholarship that looks more closely at the manifold processes of historical change
in medical practices. At the same time that this scholarship challenges traditionally
constructed continuity and discreteness, it offers hope of providing a stronger basis
for identifying continuities and the processes of transmission that sustain them.
A substantial body of scholarship in recent years has focused on the construction
of Chinese medicine. The construction of medicine as a distinct domain and doctors
as a distinct social group is bound up with matters of praxis and transmission. I treat
it separately here, however, because of its particular relevance for historiography.
Constructing Medicine
The reorientation in question here is the shift from the project of reconstructing the
fundamental, unified essence of Chinese medicine to that of reconstructing the ways
in which Chinese medicine has been variously constructed and reconstructed over
the centuries as a distinct field of endeavor. Essential to constructing internal unity
is clarifying outer boundaries between medicine and quackery, orthodoxy and het-
erodoxy, indigenous and foreign.
While this is an ongoing process, like other historical processes it is not linear.
The establishment of an indigenous orthodox medical self both emerges out of and
creates new forms of medical practice. Sometimes a departure from the past is made
explicit, although often it is constructed as a rupture with the recent past and a recov-
ery of antiquity. Internal unity may be constructed through synthesis or eclecticism.
The ways in which the lines are drawn-and not just their locations-are always
changing.
I have argued elsewhere that Northern Song (960-1126) policies aimed at the
"transformation of southern customs" entailed a redrawing of boundaries around
what properly does and does not constitute orthodox medicine. The customs at stake
were based on shunning the sick for fear of demonic contagion; they led to the
evacuation of villages, abandonment of the sick, quarantining of homes and sick-
rooms except for the passage of shamanic healers; and, critically, noninterest in
30 Kleinman, Writing at the Margin (cit. n. 15), p. 6.

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government-distributed medicines. Officials reacted by producing and distributing

medical texts and suppressing or re-educating shamanic healers. In the course of
commissioning and re-editing texts for distribution, officials narrowed the scope of
their definitions of orthodox medicine, especially in relation to theories of contagion
and demonic medicine. These activities did not suffice to narrow the scope of all
official publications and activities in comparable fashion, but they did arise out of
and contribute to contemporary developments in the treatment of epidemics and
discussions concerning the nature of proper medical practice.'
Entering these discussions was the elusive figure of the scholar-physician or
"Confucian" physician (ruyi). Needham and Lu noted the appearance of the term in
Song writings and linked it to the emergence of "a new race of men ... who were
very well educated but lacked perhaps practical experience which some of the
rougher leeches of the past had had." Later scholars have attempted to determine to
what extent elites were engaging in medical practice or, alternatively, physicians
were acquiring elite status. Chen Yuanpeng has found that changing norms in the
Song period did result in higher prestige for doctors and for scholarly medical pur-
suits. He finds evidence for a small number of elite practitioners and identifies as
counterparts of the ruyi ideal both those rare elite doctors and the more substantial
number of elite scholars who pursued textual studies of medicine in addition to the
usual studies of cultivated gentlemen and officials. The latter sometimes advised
friends and family as knowledgeable amateurs or published collections of recipes
for the greater good, but they did not make medicine their primary occupation. Rob-
ert Hymes, in a locally focused analysis of Fuzhou, found that the medical career
emerged as an option for members of the elite during the Yuan (1279-1368); it was
an alternative for those who failed to establish a civil service career, the option next
in preference behind teaching the Confucian or examination curriculum.32
Christine Bodenschatz, in a study of the Yishui school of northern Hebei in the
Jin (1 115-1234) and Yuan periods, has examined the processes by which the rhetoric
surrounding ruyi contributed to a reconstitution of medical praxis as well as an
expansion of elite status to accommodate those who, their access to more traditional
careers blocked, turned to medicine. She bridges sociohistorical approaches that set
aside issues of the content of medical theory or practice and standard internalist
approaches that ignore social context. The distinctiveness and the processes of emer-
gence of this new style of practice have been obscured in modem histories written
by practitioner-scholars who themselves are in a continuous line of descent from
and define the parameters of Chinese medicine by this very ruyi tradition.33
Bodenschatz sees these ruyi as developing new forms of medical practice and
distancing themselves from the socially dubious traditional doctor. Where the latter
reportedly matched recipes typologically with ailments, ruyi doctors insisted on tai-
loring recipes to patients' individual circumstances. These new medical practices
31 Hinrichs, "Medical Transforming of Governance and Southern Customs" (cit. n. 10).

32 Needham and Lu, "China and the Origin of Qualifying Examinations in Medicine" (cit. n. 10),
p. 391; Chen Yuanpeng, Liang Song de "Shangyi shiren" yu "ruyi" (cit. n. 1); and Robert P. Hymes,
"Not Quite Gentlemen? Doctors in Sung and Yuan," Chin. Sci., Jan. 1987, no. 8, pp. 9-76. Hymes is
writing about a prefecture in present-day Jiangxi Province, not to be confused with the homophonous
Fuzhou in Fujian.
33 Christine Bodenschatz, "Medizin als neokonfuzianische Praxis" (Ph.D. diss., Munich Inst. His-
tory of Medicine, forthcoming), pp. 9-11.

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300 TJ HINRICHS
were informed by the values of a social class now common to doctor and client-
and by the particular neo-Confucian discourse that prevailed in their milieu. Moral
concerns with moderating emotion and behavior were carried into ruyi doctors' fo-
cus on "inner causes." Ruyi doctors thus inquired into and advised clients concerning
their inner lives and behavior as well as their bodily ills. The doctors' conformity to
social standards, moral stature, learning, and emotional control became issues rele-
vant to their access to patients on such an intimate level and to their moral authority
to prescribe alterations in inner orientation and outer behavior. Ruyi sought to base
treatments on the li, a neo-Confucian concept meaning innate patterns or principles,
of drugs, matching these to the particular 1i of the patient and his circumstances.
Recipes were constituted according to the principles and language of a harmoni-
ously and hierarchically constructed society.34
Angela Leung has examined the ways in which scholarly medicine was defined
between the Song and Ming (1368-1644), in contrast to various specialties, popular
practitioners, and Song emphases on prescription medicine and Cold Damage disor-
ders. She traces this splitting off primarily to new developments in the transmission
of medical learning-for example, the establishment and valorizing of more formal
and exclusive relationships between master and disciple, analogous to that of neo-
Confucian lineages. Yuan-ling Chao has shown that dense networks of relationships
with publishers and literati fostered a strong sense of identity among Suzhou physi-
cians in the Ming and Qing (1644-1911). She finds that increasing numbers of elite
practitioners and increasing specialization led to renegotiations of the boundaries
around medical orthodoxy and physician identity.35
Geography and related cultural differences, especially those pertaining to "north"
and "south" and "Chinese" and "non-Chinese," have been recurring themes in con-
structions of the medical, cultural, and ethnic Other and Self. We can see this in
Xiao Fan's study of views from the Han (206 B.C.-220 A.D.) to the Song periods
of certain diseases as specific to the south and of southern lands as seasonally or
cosmologically out of kilter. This gives rise to bodies unbalanced with regard to yin
and yang, heterodox cultures, and noxious miasmas, flora, and fauna. Edward Schaf-
fer also dealt with some of these issues in his study of Tang images of southern
lands and peoples. My work on Northern Song policies has shown how orthodoxy
in medicine could be constructed in relation to regional, ethnic, and cultural dif-
ference.36
Marta Hanson also unpacks concepts of geography in relation to local identity
and disease in her studies of smallpox among the Manchus, fears of gu poisoning
by the Miao people, miasmatic diseases as barriers to colonizing the south, and the
nineteenth-century invention of a southern medical tradition based on Warm Factor
disorders. Warm Factor disorders were reworked from a seasonally specific subclass
34 Ibid.
35 Angela Ki-che Leung, "Transmission of Medical Knowledge from the Sung to the Ming," paper
presented at a symposium entitled "The Sung-Yuan-Ming Transition: A Turning Point in Chinese
History," Lake Arrowhead, Calif., June 1997; and Yuan-ling Chao, "Medicine and Society in Late
Imperial China: A Study of Physicians in Suzhou" (Ph.D. diss., Univ. California, Los Angeles, 1995).
I capitalize Cold Damage, also commonly translated "Cold Injury," here to indicate its technical use
in Chinese medicine. Cold Damage disorders are a class of febrile disorders.
36 Xiao Fan, "Han-Song jian wenxian" (cit. n. 10); Edward H. Schaffer, The Vermillion Bird: T'ang
Images of the South (Berkeley/Los Angeles: Univ. California Press, 1967), esp. pp. 130-134; and
Hinrichs, "Medical Transforming of Governance and Southern Customs" (cit. n. 10).

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of Cold Damage disorders to a distinct class of year-round disorders prevailing in

Jiangnan. Hanson finds in the Warm Factor school a construction of robust northern
bodies versus delicate southern ones; regional cultural differences are explicitly ar-
ticulated as physiological. This bodily difference is the basis for legitimating local
knowledge and innovation vis-A-vis the claims to universality and the authority of
ancient texts made by the orthodox Cold Damage medicine sanctioned by the state.
The construction of a regionally distinct medicine is founded on venerable notions
of locally specific qi, from which were elaborated theories of northern and southern
bodies. Hanson places these developments in the context of the rise of regionalism
and assertion of local identity in the late Qing period.37
In the twentieth century, the salient regional divide shifted from "north" and
south" to "China" and "West." Paul Unschuld notes that the "illusion" of "Chinese
medicine" as a well-defined, unified, coherent system was created in response to
threats to abolish it. Especially in the 1920s and 1930s, urban intellectuals, accepting
then-fashionable socioevolutionary values of scientific progress, attacked Chinese
medicine as backward, superstitious, or fraudulent. Many of those who sought to
save Chinese medicine accepted these judgments and thus attempted to strengthen
it by modernizing it: professionalizing practice, standardizing education, systematiz-
ing knowledge, removing elements held to be superstitious, and grafting on elements
of Western medicine. In addition to informing modernizers' transformations, images
of Western medicine have provided contrasts that help to demarcate Chinese medi-
cine from Western biomedicine, and these too have informed innovations in praxis.
The models developed for science and modernization are not simple translations of
Western ideas but local visions, adapted selectively, contested, and altered in di-
verse practices.38
Bridie Andrews has pointed out processes by which Chinese medical practice was
both defined and altered through such attempts at modernization in the 1920s and
l 930s. Projects to standardize case histories, for example, entailed a reorganization
of nosology by disease (bing) rather than syndrome (zheng). Competing schools of
Chinese medicine, such as the Cold Damage and Warm Factor schools, tended to
distinguish themselves through differences in discerning syndromes. Organizing
case histories according to disease thus allowed for claims of fundamental unity in
Chinese medicine and for the development of an eclectic medicine drawing broadly
on multiple traditions.39
Ironically, then, Volker Scheid has shown how, beginning in the 1950s, the differen-
tiation of syndromes (bianzheng) was made the defining and unifying characteristic
3 Marta Hanson, "Robust Northerners and Delicate Southerners: The Nineteenth-Century Inven-
tion of a Southern Medical Tradition," Positions, 1998, 3:515-550; Hanson, "Inventing a Tradition
in Chinese Medicine: From Universal Canon to Local Medical Knowledge in South China, the
Seventeenth to the Nineteenth Century" (Ph.D. diss., Univ. Pennsylvania, 1997); and Hanson,
"Merchants of Medicine: Huizhou Mercantile Consciousness, Morality, and Medical Patronage in
Seventeenth-Century China," in East Asian Science, ed. Keizo et al. (cit. n. 28), pp. 207-214.
38 Unschuld, Medicine in China (cit. n. 13), pp. 250-251. For more on movements to abolish or
scientize Chinese medicine see Andrews, "Making of Modem Chinese Medicine" (cit. n. 5); Zhao
Hongjun, "Chinese versus Western Medicine" (cit. n. 5); Zhao, Jindai Zhongxiyi lunzheng shi (cit.
n. 5); and Croizier, Traditional Medicine in Modern China (cit. n. 5).
39 For explanations of "syndromes," also translated as "patterns," see Andrews, "Making of Modern
Chinese Medicine"; Farquhar, Knowing Practice (cit. n. 24); and Sivin, Traditional Medicine in Con-
temporary China (cit. n. 11). For an analysis of efforts to create a unified standard Chinese medicine
out of diverse Chinese medical practices see Andrews, "Making of Modem Chinese Medicine."

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302 TJ HINRICHS
of Chinese medicine, transforming medical practice in the process. For nearly two
millennia nosological systems had shifted between emphasizing diseases and em-
phasizing syndromes, and few authors had been consistent in this respect. From the
1950s, however, Scheid finds widespread efforts to systematize syndrome differenti-
ation. This practice has become central to demarcating Chinese from Western medi-
cine; the formulation "Chinese medicine differentiates syndromes, Western medi-
cine differentiates diseases" is now widely accepted. Syndrome differentiation was
conceived in a manner that allowed it to encompass conflicting methods and thus to
establish a common point of identity for diverse traditions. It also helped fit Chinese
medicine into Maoist doctrine-for example, by establishing a basis for unity be-
tween theory and practice and through reconstructing syndrome differentiation as
an Engelian "dialectical" process. By helping to mark Chinese medicine as distinct
from Western medicine and as politically correct, syndrome differentiation served
supporters of Chinese medicine in their struggle against those who sought to abolish
it as backward and superstitious, establishing its place in a centrally planned health
care system. It also allowed the incorporation of Western disease categories into
Chinese medical practice. In 1995, national standards for 406 diseases (using Chi-
nese medical, not biomedical, categories) and syndromes were set to facilitate teach-
ing, research, and record keeping, as well as to provide a model for future interna-
tional standards for Chinese medicine.40
The process by which syndrome differentiation has emerged as a defining feature
of Chinese medicine has not been a linear one. Despite the political and pedagogical
utility of the new medical praxis that it facilitated, and despite the political hazards
of dissent, some prominent physicians have contested such aspects of the new stan-
dards of syndrome differentiation as the abandonment of Chinese medical disease
categories and the abstraction of syndrome differentiation from complex processes
of diagnosis and treatment. The Cultural Revolution (1966-1976) saw various at-
tempts to make Chinese medicine more socialist and revolutionary. These included
efforts to strip away elements considered feudal and superstitious and to make it
more accessible and easier to learn in order to train more new doctors and make
medical care more available to the masses. Researchers focused more intensely on
integrating Chinese with Western medicine-for example, by simplifying or elimi-
nating syndrome differentiation in favor of biomedical disease categories. Much of
the integration with Western medicine thus involved reduction to biomedical views
of the body and disease; for example, much research was devoted to determining
the biomedical bases of Chinese diagnostics and therapeutics.41
Judith Farquhar has shown how a genre of essays on the lives of senior physicians
that emerged in the 1980s has helped to assert a vision of Chinese medicine based
40 Volker Scheid, "Plurality and Synthesis in Contemporary Chinese Medicine" (Ph.D. diss., Univ.
Cambridge, 1997); see Ch. 7 for the discussion of the 1995 standards. The linking of syndrome
differentiation (bianzheng) and dialectics (bianzheng) was assisted by the terms' homophony and
graphic and etymological kinship. Judith Farquhar has written extensively on the practice of syn-
drome differentiation in the People's Republic, in particular on the centering of praxis, and on multi-
ple perspectives and points for intervention as being essential to the process rather than deviations
from a norm. In addition to the discussion that follows see Farquhar, Knowing Practice; and Far-
quhar, "Time and Text: Approaching Chinese Medicine through Analysis of a Published Case," in
Paths to Asian Medical Knowledge, ed. Charles Leslie and Allan Young (Berkeley: Univ. California
Press, 1992), pp. 62-73.
41 Scheid, "Plurality and Synthesis in Contemporary Chinese Medicine," Ch. 7.

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on clinical practice and individual achievement against the dominance of laboratory

analysis and classroom teaching. Here syndrome differentiation once again plays a
central role in medical praxis. The individual virtuosity celebrated in this literature
is something attained after long years of practice and through ongoing engagement
with patients and canonical texts, in contrast to prevailing models of standardized
knowledge. Many of the senior physicians chronicled were prominent teachers and
writers who were instrumental in systematizing and institutionalizing Chinese medi-
cine in the first decades of the People's Republic. These biographies assert the unity
and continuity of Chinese medicine through the persons of those senior doctors,
who are seen to embody the essence of Chinese medicine and its connections with
past and future.42
We see here that, through time, medical practitioners, their allies, and their critics
have reconstructed and recreated medicine, the nature of medical healing versus
nonmedical healing, what makes for a quack or a competent doctor. They have been
engaged in projects of distinguishing "our medicine" from "what other people do,"
of constituting medical identity. Their constructions of medicine have included his-
torical claims, reevaluations of the past and the relations of present practice to it-
whether as a recapturing of a newly constituted essential past, as a continuation of
a long march of progress, or as a radical departure. Modem historians of Chinese
medicine, whether they take the position of ally, critic, or disinterested professional
scholar, have been and continue to be participants in the construction of Chinese
medicine and its relations to the past. They have both predicated their work on and
produced naturalized, bounded versions of Chinese medicine that are useful in shift-
ing or propagating medical identities but that lack reflexivity.
The authors examined here have taken as the object of their scholarship not these
versions of Chinese medicine but the processes by which Chinese medicine (or ruyi
medicine, or Warm Factor school medicine) is produced, including processes of
construction. These scholars have shown medical identity to be bound up with other
domains of identity: regional, occupational, class, national. They have shown that
the stakes in the construction of these medicines involve the development of new
forms of practice, the assertion of authority, the securing of livelihood, the defense
or enhancement of status. They have shown the construction of medicine to be in-
volved in manifold processes of change in medical praxis.
Transforming and Transmitting Medical Practice and Knowledge
As scholars have eschewed monolithic and reductionist models of change, abandon-

ing a neatly bounded notion of Chinese medicine as an object of inquiry, they have
turned attention to the complex processes by which medical praxis is produced and
transmitted. One of the ways in which Chinese medicine had achieved boundedness
under modem gazes was through the distilling of knowledge from practice. Recent
approaches to explaining change have tended to take priority away from this rarefied
object, returning knowledge back to practice, or praxis. The practices in ques-
tion include the feeling of pulses and the application of needles-medical praxis
42 Judith Farquhar, "Re-writing Traditional Medicine in Post-Maoist China," in Knowledge and the
Scholarly Medical Traditions, ed. Bates (cit. n. 29), pp. 251-276. See also Scheid's analysis in "Plu-
rality and Synthesis in Contemporary Chinese Medicine," Ch. 7.

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304 TJ HINRICHS
narrowly considered. The scholarly object, however, is not contained in the clinic,
the sickroom, or the perspective of the physician. Rather, it extends to processes of
transmission, learning, and career development; experiences of illness; negotiations
among healers, patients, relatives, community leaders, and officials; and the activi-
ties of publishers, entrepreneurs, and police officers.
As Chinese medicine had long been bounded in cultural space, so had it been
bound in time, born in the classics of antiquity. The discovery of Former Han (206
B.C.-9 A.D.) medical texts and objects in archaeological excavations in the early
1970s, along with new perspectives offered by recent scholarship, has allowed a
fundamental reworking of our understandings of early medicine.43 The preeminent
medical classic, Inner Canon of the Yellow Emperor (Huangdi neijing), was long
dated to the Warring States period and attributed to a single author, but it is now
dated to the first century B.C. and seen as a compilation of diverse primary texts.44
For a long time, a contrast had been drawn between pre-Han supernatural healing,
the province of shamans who combated demon- or ancestor-induced diseases, and
a rationalized Han medicine of balances and natural forces. From recent finds, how-
ever, we have learned that many practices widely accepted among Han elites were
still aimed primarily at dispelling pathogens, demons prominent among them, from
outside the body.45 New materials have contributed not only to a more varied and
43 Significant excavation sites include Wuwei, Gansu (dated early Han, exc. 1972); Mawandui,
Hunan (158 B.C., exc. 1973); Shuihudi, Hubei (Qin Period, exc. 1975); Zhangjiashan, Hubei (second
century B.C., exc. 1983-1984); and Yongxing, Sichuan (second century B.C., exc. 1993). See Donald
Harper, trans., Early Chinese Medical Literature: The Mawangdui Medical Manuscripts (Sir Henry
Wellcome Asian Series, 2) (New York: Paul Kegan, 1998) (this book includes a study as well as
translations); He Zhiguo and Vivienne Lo, "The Channels: A Preliminary Examination of a Lac-
quered Figurine from the Western Han Period," Early China, 1998, no. 21, pp. 81-123; Gao Dalun,
Zhangjiashan Hanjian Yinshu yanjiu (Research on the Han period bamboo slip text Yinshu from
Zhangjiashan) (Chengdu: Bashu, 1995); He Zhiguo, "Xi Han renti jingmai qidiao kao" (Investiga-
tions of the human body channels on a lacquered figurine of the Western Han), Daziran tansuo,
1995, no. 3, pp. 116-120; Ma Jixing, Mawangdui guyishu kaoshi (Investigations and explanations
of the ancient medical texts of Mawangdui) (Changsha: Hunan kexhue jishu chubanshe, 1992); Fu
Weikang, ed., Zhongguo yixue shi (The history of medicine in China) (Zhongyi jichu lilun xilie
congshu) (Shanghai: Shanghai zhongyiyao daxue chubanshe, 1990), pp. 42-53; and Yamada Keiji,
Shin hatsugen Chugoku kagakushi shiryo- no kenkyu (Studies of newly discovered materials for the
history of Chinese science), 2 vols. (Kyoto: Kyoto daigaku Jimbun kagaku kenkyujo, 1985).
44 Some revised understandings had been proposed before the new archaeological discoveries, but
those finds have increased scholarly consensus and improved our understanding of the Han context
of the text's production. For more on the Inner Canon see Nathan Sivin, "Huang ti nei ching," in
Early Chinese Texts: A Bibliographical Guide, ed. Michael Loewe (Early China Special Monograph
Series, 2) (Berkeley: Society for the Study of Early China and Institute of East Asian Studies, Univ.
California, 1993), pp. 196-215. For further scholarship that relates these archaeological finds to the
formation of the Inner Canon see Yamada Keiji, "The Formation of the Huang-ti Nei-ching," Acta
Asiatica, 1979, 36:67-89; Akahori Akira, "The Interpretation of Classical Chinese Medical Texts in
Contemporary Japan: Achievements, Approaches, and Problems," in Approaches to Traditional Chi-
nese Medical Literature, ed. Paul Unschuld (Dordrecht: Kluwer, 1989), pp. 19-28; and Akahori,
"Shin shutsudo shiry6 ni yoru Chugoku iyaku koten no minaoshi" (A reevaluation of China's ancient
medical classics based on newly excavated materials), Kampo no rinso- (Clinical application of Chi-
nese medicine), 1978, 25(11-12):1-16.
45 Such practices, in varying forms, have continued among members of the "elite" to the present.
On early medicine see Harper, trans., Early Chinese Medical Literature (cit. n. 43); Kudo Moto,
"Suikochi Shinkan 'Nichisho' ni okeru by6inron to kishin no kankei ni tsuite" (The relationship of
etiology to demons in the Shuihudi Qin bamboo slip "Rishu"), To-hgaku, July 1994, no. 88, pp.
33-53; Donald Harper, "The Conception of Illness in Early Chinese Medicine as Documented in
Newly Discovered Third and Second Century B.C. Manuscripts," SudhoffsArchiv, 1990, 74:210-235;
Lin Fu-shih, Handai de wuzhe (Shamans of the Han period) (Taipei: Daoxiang chubanshe, 1988),
esp. p. 117; Harper, "A Chinese Demonography of the Third Century B.C.," Harvard Journal of Asi-

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nuanced picture of Qin and Han healing practices but to an

by which the distinctive practices of the classical tradition e
On the basis of new archaeological discoveries, Vivienne L
ingly that, contrary to previous assumptions that the two s
common pool, "nurturing life" (or "cultivating vitality" [ yangs
distinct in significant respects from contemporary Han me
a contrast between pre-Canon medical texts, which focus o
ness and removing disease, and pre-Canon nurturing life te
tices aimed at cultivating health. Acupuncture points do no
medical texts, and descriptions of the body and of yin, yang, a
crude. In contrast to the spare language of medical texts, nurtu
a rich, sensuous, and sophisticated language to describe su
vitality. Lo finds direct links between this literature and the C
acupuncture points, features of the channels (mai), and the "pe
by yin, yang, and qi and their use in "landscaping the internal
that would become "a familiar feature of later Daoist and m
Lo's work complements that of Shigehisa Kuriyama, who h
perspective to the shift between archaic medicine and that of t
locating the contrast as one of magic versus rationality, Ku
gence of a body-centered approach in classical medicine. Wh
of many places a spiteful spirit might strike, and a Hippocr
more concerned with the effects of a patient's local environme
Canon medicine is intensely concerned with the body. Lik
this shift to a particular way of experiencing body and self
The imagination of wind sprang from a concrete experience of

place, a directly felt sense of seasonal drift and human moods.
apprehension of an ever shifting self in an ever changing univer
harmonize with cosmic breath, and habitually the two might
But the character of all winds, inner or outer, was that they alwa
contingency, the possibility of suddenly blowing in new and une
Kuriyama and Lo, then, while sharing their predecessors'

medicine as distinct from earlier healing practices, have loc
practices and experiences rather than in the realm of ideas and
those practices and experiences to changes in social, economic, o
Other historians of the early period have shown how proc
have connected physicians to and distinguished them from
min finds patterns of transmission of "secret techniques" c
atic Studies, 1985, 45:459-498; and Harper, "The 'Wu Shih Erh Ping Fan
gomena" (Ph.D. diss., Univ. California, Berkeley, 1982). Derk Bodde des
apotropaic practices of the Han, from the great nuo exorcisms to the wea
disease-causing demons, in Festivals in Classical China: New Year and
during the Han Dynasty, 206 B.C.-A.D. 220 (Princeton, N.J.: Princeton U
46 Vivienne Lo, "The Influence of Western Han Nurturing Life Literatu
Acumoxa Therapy" (Ph.D. diss., Univ. London, 1998); and He and Lo, "
also Harper, trans., Early Chinese Medical Literature; and Harper, "'Wu
47 Shigehisa Kuriyama, "The Imagination of Winds and the Developmen
tion of the Body," in Body, Subject, and Power in China, ed. Angela Zito
Univ. Chicago Press, 1994), pp. 37-38.

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306 TJ HINRICHS
physicians and adepts. Adepts are masters, frequently of occult knowledge (fangshi,
shushi; literally, "gentlemen who possess techniques"). Nathan Sivin looks at how
patterns of transmission established an elite individual's status as a physician. He
shows how the practices of textual transmission from teacher to disciple constituted
a "ritual induction into fictive lineages that existed to transmit from one generation
to the next charismatic revelations in writing, accompanied by explanations that
might be either written or oral."48
Scholarship on modes of transmission has greatly clarified later transformations
of medical praxis. Scholars have long noted a major transition in medicine between
the Song and the Ming, usually punctuated with the appearance of the "Four Great
Masters" of the Jin and Yuan. Accounts of this transition have tended to focus on
the content of medical theory; they fail to explain change in medicine, attributing
it to scientific progress or reducing it to larger trends such as the emergence of
neo-Confucianism. The new medicine was marked by the elite status of its physi-
cians, a sharpened focus on climatic factors, and a move away from matching pre-
scription remedies to diseases toward individually tailored diagnoses and remedies.
More recently, scholars such as Bodenschatz and Leung have looked beyond theory
and the broad outlines of social and historical change to the local dynamics that led
to and constituted these shifts and to changes in practices and processes of trans-
mission.49
Printing, which entered the scene in the tenth century, and changing social rela-
tions have a prominent role in many of these accounts. Chen Yuanpeng, for example,
has looked at the role of printing in making medical texts available for scholarly
study. Where ruling elites before the Song showed little interest in medical subjects
or in socializing with doctors, Chen has found increasingly complex networks of
social relations between physicians, local gentry, and officials, especially from the
Jin period. Wu Yiyi has found a shift in dominant modes of transmission, with pub-
lishers opening up access to medical knowledge and practice outside the master-
disciple relationship, a development contributing to the appearance of self-taught
physicians. He finds many medical "schools" to be based increasingly on claims to
common principles rather than on direct transmission of knowledge.50
Social relations and the role of printing remain important in studies of the later
imperial period as well, as in Yuan-ling Chao's study of Suzhou physicians. Marta
Hanson has examined the publishing and distribution of medical texts by Huizhou
merchants in the seventeenth century as a morally resonant means of increasing
social prestige. Such close analysis of the roles and processes of publishing, of how
authors and texts are chosen and for which markets, is also a key feature of Hanson's
approach in her studies of the establishment of the Warm Factor school in Suzhou.51
48 Li Jianmin, "Zhongguo gudai 'jinfang' kaolun" (Jinfang: The transmission of secret techniques
in ancient China), Zhongyang yanjiu yuan Lishi Yuyan yanjiusuo jikan, 1997, 68(1):117-166; and
Nathan Sivin, "Text and Experience in Classical Chinese Medicine," in Knowledge and the Scholarly
Medical Traditions, ed. Bates (cit. n. 29), p. 194.
49 Bodenschatz, "Medizin als neokonfuzianische Praxis" (cit. n. 33); and Leung, "Transmission of
Medical Knowledge from the Sung to the Ming" (cit. n. 35).
50 Chen Yuanpeng, Liang Song de "Shangyi shiren" yu "ruyi" (cit. n. 1); and Wu Yiyi, 'A Medical
Line of Many Masters: A Prosopographical Study of Liu Wansu and His Disciples from the Jin to
the Early Ming," Chin. Sci., 1994, no. 11, pp. 36-65.
51 Hanson, "Robust Northerners and Delicate Southerners" (cit. n. 37); Hanson, "Merchants of
Medicine" (cit. n. 37); and Hanson, "Inventing a Tradition in Chinese Medicine" (cit. n. 37).

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Bridie Andrews's work has shown how the selective assimilation of features of
Western medical and institutional models in the early twentieth century involved the
introduction of new processes of transmission and production of knowledge, such
as the mass production of standardized medical texts and teaching in schools and
hospitals. Such processes of transmission and their relation to modes of reasoning
and practice are at the center of Elisabeth Hsu's study of medical training in three
settings in Yunnan at the end of the 1980s.52 Hsu compared the transmission of
medical knowledge on the basis of fieldwork as a student enrolled at the Yunnan
Chinese Medical College, as a participant in the reading seminars of a senior doctor
in private practice, and as an observer at the healing performances of a neighborhood
qigong healer. She found numerous areas of standardization in the formal setting
of the Chinese Medical College, reinforcing the view that such institutions have
introduced greater uniformity in the practice of Chinese medicine. Systematization
and standardization of knowledge, which were understood as key to a scientific ap-
proach, were explicitly valued. "Standardization"-that is, treating pupils equally-
was also expected in the relationship between teachers and students. Student and
staff time and space were highly structured, controlled, and impersonal, although
there was great tolerance for some idiosyncrasies and respect for the privacy of
the space (of approximately two square meters) above each student's bed. Although
students were told not to apply the information in their textbooks mechanically, Hsu
saw much routinized treatment in the acupuncture wards of hospitals. While knowl-
edge and practice were considered integral to each other, she noted a separation of
theory from practice in classroom techniques that divorced the learning of theory
from practical situations and fixed the knowledge in classical texts in standard mod-
ern Chinese. She found continuity with earlier practices of transmission in, for ex-
ample, students' rote memorization of textbook passages.
The senior doctor's relationship with his students, characterized as a relationship
between mentor and followers, was more personal than such relationships at the
Chinese Medical College. He required his students to memorize substantial passages
of classical texts, not textbooks. They were not tested on this knowledge or even
expected to understand the texts. Understanding was expected to emerge not through
explication in modern Chinese but as sudden insight in the course of future practice.
The senior doctor referred to passages of classical texts in order to clarify particular
situations found in medical practice. Like the relationship between teacher and stu-
dent, the knowledge conveyed was taken to be profound and personal.
A disciple of the qigong healer, Hsu found, was dependent on direct oral transmis-
sion, which was secret. Here the written word itself was potent, the power to heal
coming not from the meaning, either personal or fixed, of the text, but from correct
performance, with correct pronunciation, of the incantation. Hsu showed that in
these three contexts the nature of the teacher-student (or mentor-follower or master-
disciple) relationship and the orientation toward the text had profound implications
for the nature of the knowledge conveyed.
These studies have tended to center on the social relations of physicians or medi-
cal teachers and students in the transmission of medical knowledge while bringing
broader sets of social relations to bear on the analyses as well. Several recent works
52 Andrews, "Making of Modem Chinese Medicine" (cit. n. 5); and Elisabeth Hsu, "Transmission
of Knowledge, Texts, and Treatment in Chinese Medicine" (Ph.D. diss., Univ. Cambridge, 1992).

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308 TJ HINRICHS
have begun with such a wider scope, dealing with the "selective assimilation" of
Western medical and public health approaches in twentieth-century China as a nego-
tiated process. Among the features that separate these from earlier works is abandon-
ment of the assumptions that Western medicine and institutions were superior and
that Western models were accepted because of their greater prestige or "imperialist"
pressures; instead, they pay closer attention to the roles of diverse actors outside the
state. Earlier approaches had pictured the displacement of indigenous by Western
models as caused by native weakness or attributed the belated adoption of Western
medicine and institutions to ignorance, corruption, and self-seeking. We are now
getting a picture of the rejection or adaptation of particular Western models in partic-
ular situations for varied purposes. We are seeing processes of integration between
Western and Chinese models, rather than their complete incompatibility and the
substitution of one for the other. Finally, we are seeing ever-shifting resistance to or
use of these models by diverse groups in varied and unexpected fashions.53
We can see this in Carol Benedict's study of responses to bubonic plague in the
nineteenth century. Benedict rejects the view that Western-style state-centered pub-
lic health measures were superior and the reading of acceptance or rejection of these
as an issue of rational behavior. She looks closely at the complex considerations of
those who implemented such policies and at the reasoning of those who rejected or
accepted them. British administrators responded to the 1894 epidemic of bubonic
plague in Hong Kong with draconian measures against the homes and bodies of
Chinese residents, a reaction based not only on their understandings of the germ
theory (which did not include transmission via the rat flea vector) but on views of
the Chinese as dirty and as sources of contagion. Chinese resistance to, for example,
hospitalization was based not on a stubborn clinging to tradition in the face of a
superior medical system, as British administrators maintained, but in large part on
the fact that fatality rates in the clinics ran as high as 90 percent.54
Caroline Reeves's study of the early years of the Chinese Red Cross Society, an
indigenous, quasi-private organization founded in 1904, shows the development of
new forms of organization and charitable activity that combined Chinese with West-
ern models. Besides having links to an international organization, the Chinese Red
Cross established quarantine hospitals and provided Western-style medical care. On
the other hand, it also engaged in "traditional" forms of charitable activity. Reeves
demonstrates a growing participation in civic life by increasingly broad segments
of the Chinese population and subverts the static conception of a one-way flow of
ideas from the center, whether the state or the West, to the periphery, whether the
community or China, to show how the local and the global interacted.55
In the imperial period, while China had forms of "medical governance" or charity,
including disaster relief, the clearing of waterways (thought by some to help prevent
epidemics), and the distribution of medicines, these were not identified or conceived
53 "Selective assimilation" is the term favored by Bridie Andrews; see "Making of Modem Chinese
Medicine." See also Andrews, "Tuberculosis and the Assimilation of Germ Theory in China, 1895-
1937," J. Hist. Med. Allied Sci., 1997, 52:114-157; Zhao Hongjun, "Chinese versus Western Medi-
cine" (cit. n. 5); Zhao, Jindai Zhongxiyi lunzheng shi (cit. n. 5); Benedict, Bubonic Plague in
Nineteenth-Century China (cit. n. 22); and Carol Benedict, "Framing Plague in China's Past," in
Remapping China: Fissures in Historical Terrain, ed. Gail Herschatter et al. (Stanford, Calif.: Stan-
ford Univ. Press, 1996).
54 Benedict, Bubonic Plague in Nineteenth-Century China; and Benedict, "Framing Plague."
55 Reeves, "Power of Mercy" (cit. n. 27).

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as something quite comparable to modem Western notions of "public health." In a

study of the carving out of a sphere of "public health," Ruth Rogaski traces the
course of changing meanings and practices associated with the term, weisheng, that
was adapted to refer to Western-modeled public health measures, focusing on Tian-
jin between the mid-nineteenth and mid-twentieth centuries. The concept expanded
from more individual-oriented health or hygiene practices to sanitation policies
based on the germ theory. Rogaski follows the development and institution of
Western-modeled public health policies through complex processes of negotiation
and resistance. They were advocated and adopted by Chinese elites both as a means
of extending state control and for the purpose of asserting Chinese political auton-
omy against Western encroachment. Under the People's Republic of China, public
health mobilizations were tied closely to the nation-building project.56
Hugh Shapiro has examined the ways in which discourses of and behavior around
the categories of insanity and spermatorrhea changed early in this century. In 1930s
Beijing, the legal label of "insanity" served the purposes of police who had to re-
move people from the streets and the interests of medical professionals who wanted
to maintain subjects for study in psychiatric institutions. For patients, the label was
experienced and deployed as a means of escape and resistance. Spermatorrhea, tradi-
tionally an affliction of the well-to-do, was from the 1920s increasingly a complaint
of the poor and socially marginal. It became increasingly less associated with the
overexertions of labor, study, and sexual indulgence and more identified with sexu-
ally transmitted diseases and discourses of neurasthenia adapted from the West. In
the cases of both insanity and spermatorrhea, Shapiro traces a complex interplay
between healer and patient views and between Western medical and local under-
standings of the body. These understandings became implicated in sexual, political,
"West"/"China," and nationalistic preoccupations of the time.57
The shift of attention from essences, continuities, and linear progress to multifac-
eted processes of change-transmission, transformation, appropriation, negotiation,
resistance, reconfiguration, construction-exposes the complexities and discontinu-
ities of change. As change is shown to be nonlinear, so are practices shown to be
nonunitary. While the dimensions of time and space are not properly separated, cer-
tain approaches have been particularly suited to dealing with the diversity of Chinese
medical practices.
FROM UNITIES TO DIVERSITIES
Where heterogeneity has been noted in medical traditions, it is usually associated

with the absence of institutional bases for standardization and professional identity
that is considered characteristic of premodernity. The institutional bases of tradi-
tional Chinese medicine in contemporary mainland China-such as ongoing at-
tempts to achieve standardization and unification since early in the century and the
centralized control of education and regulation of practice since the 1950s-do ap-
pear to be contributing to homogeneity. Nevertheless, it has been apparent to many
observers that in some respects these features have introduced additional elements
56 Rogaski, "From Protecting Life to Defending the Nation" (cit. n. 27).

57 Hugh Shapiro, "The View from a Chinese Asylum: Defining Madness in 1930s Peking" (Ph.D.
diss., Harvard Univ., 1995); and Shapiro, "The Puzzle of Spermatorrhea in Republican China," Posi-
tions, 1998, 6(3):551-596.

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310 TJ HINRICHS
of change and diversity; moreover, other factors contribute to ongoing diversity

within and outside institutional settings. Movements to integrate Chinese and West-
ern medicine have further multiplied theoretical and practical diversity, contrary to
earlier predictions that such integration could lead to the reduction of Chinese medi-
cine to isolated techniques and drugs incorporated into a dominant biomedical
paradigm.58
The plurality of Chinese healing practices, "traditional" or "modem," has been an
increasing focus of scholarly interest. Three broad areas in recent scholarship con-
duce to revealing heterogeneity as well as identifying sources of homogeneity: local
studies, studies of diverse health practices, and attention to multiplicity within and
between bodies and selves.
Geography
The archaeological finds of recent decades are promoting an increasing appreciation

of regional variation in ancient Chinese cultures. This is also true to some extent of
the finds that have revealed so much about early Chinese medicine, although they
point strongly to a common elite medical culture as well. In scholarship on later
periods, for which local sources such as individuals' collected writings, local gazet-
teers, inscriptions, and archival sources are more abundant, this trend toward consid-
ering medical diversity is more marked. As Marta Hanson's work shows, medical
traditions have been constructed in relation to geographically based differences. This
points as well to processes by which geographically distinct practices were created,
made more distinct, or combined.59 While for some time scholarship had been fo-
cused on the divisions between China and the West, more recently researchers have
been interested in both more global and more local perspectives.
With the spread of Chinese medicine around the world, we are seeing an increas-
ing number of studies of Chinese medicine as practiced outside China. This has long
been the case for Japan, where varieties of Chinese medicine have been practiced
for centuries; now we have studies of Chinese medicine in, for example, the United
States and Europe.60 Scholars are finding it necessary to specify whether they are
58 On factors contributing to homogeneity see Hsu, "Transmission of Knowledge, Texts, and Treat-
ment" (cit. n. 52); and Sivin, Traditional Medicine in Contemporary China (cit. n. 11), p. 23. On
factors contributing to diversity see Unschuld, Medicine in China (cit. n. 13), p. 260; Scheid, "Plural-
ity and Synthesis in Contemporary Chinese Medicine" (cit. n. 40); and Hsu, "Transmission of
Knowledge, Texts, and Treatment."
59 See Hanson, "Inventing a Tradition in Chinese Medicine" (cit. n. 37); and Hanson, "Merchants
of Medicine" (cit. n. 37). See also Bodenschatz, "Medizin als neokonfuzianische Praxis" (cit. n. 33).
On the archaeological finds see Jessica Rawson, ed., Mysteries of Ancient China: New Discoveries
from the Early Dynasties (London: British Museum Press, 1996). On those pertaining more specifi-
cally to medicine see Li Jingwei and Zhu Jianping, "Jin wunian lai Zhongguo yixueshi yanjiu de
jinzhan" (cit. n. 18).
60 E.g., Linda Barnes, "Alternative Pursuits: A History of Chinese Healing Practices in the Conte
of American Religions and Medicines with an Ethnographic Focus on the City of Boston" (Ph
diss., Harvard Univ., 1995); Elisabeth Hsu, "Outline of the History of Acupuncture in Europe
Journal of Traditional Chinese Medicine, 1989, 29:28-32; Akahori Akira, Kampoyaku (Chines
pharmaceutical medicine) (Tokyo: Daiichi hoki, 1988); Margaret Lock, East Asian Medicine in U
ban Japan: Varieties of Medical Experience (Berkeley: Univ. California Press, 1980); and Yasu
Otsuka, "Chinese Traditional Medicine in Japan," in Asian Medical Systems, ed. Leslie (cit. n.
pp. 322-340.

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looking at Chinese medicine as practiced in China-and, if so, where in China-

or elsewhere.
For some time Japanese scholars have been interested in historic connections be-
tween cultures, as between India, China, Korea, and Japan, and in East Asia as a
unit for the study of medical history.6' In China, interest in historical relations be-
tween Chinese and other cultures has increased since the 1980s, with an impact on
studies of medicine. China has also seen a growth in studies of the medical practices
of ethnic minorities. With increasing interest in local cultural identities, both Taiwan
and China have seen intensified work in studies of local medicine and health prac-
tices.62 These studies challenge the view of China, and thus of Chinese medicine, as
bounded and monolithic. They are beginning to build a picture of regional variation
and to clarify the processes by which medical practices spread and, in spreading,
transform.
While anthropological work has long been concerned with local cultures, with
the village rather than with China as a whole, regionally delimited focuses are an
increasingly well-established trend in the practice of Chinese history. Through these,
we are beginning to get a finer picture of historic local variation in Chinese healing
cultures. Besides locally focused histories, we are also seeing more local detail in
61 Earlier examples of histories of East Asian medicine include Otsuka Keisetsu, Thyi igakush
(History of medicine in East Asia) (Tokyo: Shunyod6 shoten, 1982); Fujikawa YiI, Toyc igaku igak
bunkashi (Cultural history of East Asian medicine) (Kyoto: Shibunkaku shuppan, 1980); and Naga
hama Yoshio, Toy5 igaku gaisetsu (Outline of East Asian medicine) (Osaka: Sogensha, 1961). Stud
ies of religious influences on Japanese culture have also included works relevant to the history of
medicine. Kubo Noritada has written extensively on the koshin (in Chinese, gengshen) cult, from it
development in the context of Daoist practices in China to its historical transformations in Japan.
One of the few Daoist cults to take root in Japan, it is devoted to expelling the demonic "corps
worms," three of a multitude of spirits taken to inhabit the body from birth. These "corpse worms
exert themselves to undermine their host's health, hoping to be freed from the body with its early
demise. See Kubo Noritada, Koshin shink5 no kenkya: Nichi-Cha shaky5 bunka koshM shi (Study of
koshin beliefs: History of connections between the religious cultures of Japan and China) (Tokyo:
Nihon gakujutsu shink6 kai, 1961); Livia Kohn, "Koshin: A Taoist Cult in Japan, Pt. 1: Contemporary
Practices; Pt. 2: Historical Development; Pt. 3: The Scripture-A Translation of the Koshinky6,'
Japanese Religions, 1993, 18(2):113-139, 1995, 20(1):34-55, 20(2):123-142. Also note analyses of
Daoist "nurturing life" practices in Korea and Japan in Sakade Yoshinobu, Dokky5 to yosei shis
(Taoism and cultivating life thought) (Tokyo: Perikansha, 1992), pp. 257-266; analyses of influences
among ancient medical cultures in Kan6 Yoshimitsu, Chtigoku igaku no tanJf (The birth of Chines
medicine) (Toy6 sosho, 2) (Tokyo: Tokyo daigaku shuppankai, 1987); and the East Asian focus o
the conference volume Toyo igaku nyumon-Nichi-Cha shimpojiumu no kiroku (Introduction to East
Asian medicine: Proceedings of Japan-China Symposium), ed. Nihon Toy6 igakkai (Tokyo: Yomiuri
shimbunsha, 1990).
62 Interest in historical relations between China and other cultures is noted in Li Jingwei and Zhu
Jianping, "Jin wunian lai Zhongguo yixueshi yanjiu de jinzhan" (cit. n. 18). See, e.g., Ma Boying,
Gao Xi, and Hong Zhongli, Zhong-Wai yixue wenhuajiaoliu shi (The history of the flow of medical
culture between China and foreign countries) (Shanghai: Wenhua chubanshe, 1993); and Wang
Xiaoxian, Sichou zhi lu yiyaoxuejiaoliu yanjiu (Study of the exchange of medical and pharmaceutical
learning along the Silk Road) (Urumchi: Xinjiang renmin chubanshe, 1994). On the medical prac-
tices of ethnic minorities see Li and Zhu, "Jin wunian lai Zhongguo yixueshi yanjiu de jinzhan." On
local medicine and health practices see Lu Zhaoji, "Cong Zhonghua yishi zazhi kan woguo de yishi
yanjiu" (cit. n. 17), p. 5; and Lin Chung-hsi and Fu Daiwie, "Lishi zhong de Taiwan kexue: guanyu
'Taiwan kexueshi' yanjiu de huigu yujiantao" (Taiwan's science in history: Review of the historiogra-
phy of "Taiwan's history of science"), Xinshixue, 1995, 6(4):165-199. This scholarship is too prolific
to cite comprehensively, but monograph-length examples include Ceng Yong, ed., Xiangyi yuanliu
lun (On the sources of Xiang medicine) (Changsha: Hunan kexue jishu chubanshe, 1991); and Yang
Jianrui, ed., Qizhou zhongyao zhi (Chronicle of Qizhou's Chinese pharmaceutics) (Shijiazhuang:
Hebei kexue jishu chubanshe, 1987).

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312 TJ HINRICHS
studies, for example, of particular plague god cults. Clear delineation of the geo-
graphic spread of such cults and their local contexts has been found indispensable
to their analysis.63
By focusing on local dynamics, on interactions between particular officials, other
bureaucratic personnel, clergy, landowners, merchants, physicians, and peripheral
and less empowered groups, we get a more nuanced picture of the negotiated pro-
cesses by which new forms of practice and knowledge emerge, elite and local cul-
tures interact, and various institutions become resources for asserting interests and
sources of conflict for different local groups and individuals.
Health Practices
The anthropological focus on local communities and the wider array of popular ex-
periences and practices has, in combination with more broad-based movements val-
orizing nonelite cultures, influenced the fields of history in general and medical
history in particular. A focus on daily life apparent across a wide range of Western
historical scholarship is increasingly influential in Taiwan.64 Great diversity is imme-
diately apparent when we decenter medicine and look at what people do to maintain
health and manage illness. Reviewing some of the Taiwanese scholarship in 1995,
Tu Cheng-sheng argued that the handling of childbirth, illness, health, old age, and
death are all essential aspects of life and therefore of a social history that takes so-
cial life seriously. A shift of attention from broad forces of dialectical materialism
and from revolutionary movements to healing in practice is also evident in recent
mainland scholarship.65 The last few years have seen more works attempting to mine
63 See, e.g., Paul Katz, Demon Hordes and Burning Boats: The Cult of Marshal Wen in Late Impe-
rial China (New York: State Univ. New York Press, 1995); Terry F Kleeman, A God's Own Tale:
The Book of Transformations of Wenchang, the Divine Lord of Zitong (SUNY Series in Chinese
Philosophy and Culture) (Albany: State Univ. New York Press, 1994); and Tanaka Issei, Chagoku
kyoson saishi kenkya: chihJ geki no kankyo5 (Village festivals in China: The backgrounds of local
theaters) (Tokyo: Toy6 bunka kenkyd jo, Tokyo daigaku, 1989).
64 This basic shift in approach emerged in the West in the 1970s and 1980s. See, e.g., Kleinman,
Patients and Healers in the Context of Culture (cit. n. 13); Sivin, "Social Relations of Curing in
Traditional China" (cit. n. 13); Sivin, "Ailment and Cure in Traditional China" (cit. n. 13); Topley,
"Chinese Traditional Etiology and Methods of Cure in Hong Kong" (cit. n. 10); and Marjorie Topley,
"Chinese and Western Medicine in Hongkong: Some Social and Cultural Determinants of Variation,
Interaction, and Change," in Culture and Healing in Asian Societies, ed. Kleinman et al. (cit. n. 13),
pp. 111-142. These works take plurality as a central problem. See also Unschuld, Medicine in China
(cit. n. 13). This focus in recent Taiwanese scholarship has been explicitly supported by the small
group "Disease, Medicine, and Culture," founded in 1992, and by the journal Xinshixue ("New His-
tory"), founded in 1990. In the special issue of Xinshixue devoted to the "History of Popular Culture
and Daily Life" (1992, 3[4]), Tu Cheng-sheng proposes a Chinese approach to social history that
centers on social life. Tu advocates treating "human groups" (renqun) more organically and holisti-
cally, going beyond the divisions of government, economy, and society (narrowly defined) and their
causal relations that are characteristic of Marxist (influential in the People's Republic) and American
social science (influential in Taiwan) models. Tu's "new social history" would go to unconventional
sources such as encyclopedias and miscellanies and would build on previous scholarship but expand
to encompass the material, social, and spiritual aspects of daily life. This is a social history that
eschews treating society as a separable component of history but looks instead at the entirety of
history from the viewpoint of society. See Tu, "Shenmo shi xin shehui shi" (cit. n. 23).
65 Tu Cheng-sheng, "Zuowei shehuishi de yiliaoshi" (cit. n. 21). For work on the mainland see Li
Jingwei and Zhu Jianping, "Jin wunian lai Zhongguo yixueshi yanjiu de jinzhan" (cit. n. 18); and
Lu Zhaoji, "Cong Zhonghua vishi zazhi kan woguo de yishi yanjiu" (cit. n. 17).

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fiction and other sources for more diverse views of childbirth, contraceptive, and
health practices, patients and illnesses, and healers and healing practices.66
We can see a shift of attention from sources of coherence to analyses of plurality
even in work concerned with the perspectives and current practices of orthodox
Chinese medicine. Volker Scheid takes the plurality and contradictions of Chinese
medicine, with the attendant theoretical problems of developing a nonessentializing,
nonreductionistic analytic approach, as the focus of his work on Chinese medicine
in contemporary China. He finds the variation in the ways contemporary doctors of
traditional Chinese medicine diagnose and treat so great that, he suggests, "it would
be most unusual, indeed, if after consulting ten senior doctors for the same complaint
one would not walk away with ten different herbal prescriptions." Instead of at-
tempting to extract fundamental unities out of the chaos of ethnographic data, Scheid
focuses on the processes by which medical practice and knowledge emerge. Rather
than finding Western and Chinese medicine incommensurable, as do approaches
that treat them as discrete and abstracted systems, he finds effective integration in
clinical practice.67
Studies in anthropology and religion have also long looked at varieties of health-
related practices considered to be outside the scope of medicine; thus, considered
broadly, the plurality of health care practices has long been apparent. More recent
works have extended the analysis of plurality in Chinese healing practices and taken
it in new directions. The disciplinary isolation of the sacred from the secular has
broken down. Varieties of care are treated less as isolated systems of, for example,
Buddhist, Daoist, shamanic, or medical healing.68
Daoist and religion studies have spawned numerous works relevant to health and
healing practices, from investigations of esoteric vitality cultivation practices to sha-
manic healers to plague god cults.69 Numerous recent works have dealt with these
66 See, e.g., Che-chia Chang, "The Therapeutic Tug-of-War: The Imperial Physician-Patient Rela-
tionship in the Era of Empress Dowager Cixi (1874-1908)" (Ph.D. diss., Univ. Pennsylvania, 1998);
Daria Berg, "Die Heilkunde Chinas im Spiegel des Romans Xingshi yinyuan zhuan aus dem 17.
Jahrhundert," ChinaMed, 1995, 3(6):59-61; Berg, "The Xingshi yinyuan zhuan: A Study of Utopia
and the Perception of the World in Seventeenth-Century Chinese Discourse" (Ph.D. diss., Oxford
Univ., 1994); Christopher Cullen, "Patients and Healers in Late Imperial China: Evidence from the
Jinpingmei," History of Science, 1993, 31:99-150; Zhu Hong, "Women, Illness, and Hospitalization:
Images of Women in Contemporary Chinese Fiction," in Engendering China: Women, Culture, and
the State, ed. Christina K. Gilmartin et al. (Cambridge, Mass.: Harvard Univ. Press, 1994), pp. 318-
338; Francesca Bray, Technology and Gender: Fabrics of Power in Late Imperial China (Berkeley:
Univ. California Press, 1997); Bray, "A Deathly Disorder: Understanding Women's Health in Late
Imperial China," in Knowledge and the Scholarly Medical Traditions, ed. Bates (cit. n. 29), pp. 235-
251; Charlotte Furth, A Flourishing Yin: Gender in China's Medical History, 960-1665 (Berkeley:
Univ. California Press, 1999); Yoshimoto Shoji, "Kimpeibai to doky6 igaku" (The Jinpingmei and
Daoist medicine), Tohei shuikyo (Eastern religion), June 1992, no. 79, pp. 36-52; and Yoshimoto,
"Kimpeibai ni mieru ChUgoku igaku" (Chinese medicine as seen in the Jinpingmei), Nihon ishigaku
zasshi, 1992, 38(1):133-161.
67 Scheid, "'Plurality and Synthesis in Contemporary Chinese Medicine" (cit. n. 40), Ch. 2, pp. 2
1 (quotation).
68 See, e.g., Hsu, "Transmission of Knowledge, Texts, and Treatment" (cit. n. 52).
69 De Groot is still a rich source for historical accounts and for the late nineteenth-century practices
he observed in Fujian. See J. J. M. De Groot, The Religious System of China: Its Ancient Forms,
Evolution, History and Present Aspect, Manners, Customs, and Social Institutions Connected There-
with, 6 vols. (1892-1910; rpt., Taipei: Southern Materials Center, 1982). Also of note is Henri
Maspero, "Methods of 'Nourishing the Vital Principle' in the Ancient Taoist Religion" (1937), rpt.
in Maspero, Taoism and Chinese Religion, trans. Frank A. Kierman (Amherst: Univ. Massachusetts

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314 TJ HINRICHS
subjects by integrating contemporary ethnographic observations and anthropologi-

cal perspectives with detailed historical research, focusing on particular regions or
particular cults, and taking care not to generalize from local cases to China as a
whole. Besides demonstrating great multiplicity in representations and practices,
recent studies of plague god cults and plague expulsion festivals have given us a
richer picture of regional variation in religious responses to epidemics in China.70
While these have been well-established areas of anthropological inquiry, the old
divisions between the sacred and the secular have tended to mark them as the arena
of apotropaic healing and magic, domains apart from medical history.7' Historians
distinguished rational or "scientific" aspects of Chinese medicine from "supersti-
tion," valorizing the former as evidence of progress and denigrating the latter as
"vestiges" of an unenlightened past. The story of early periods was that of the vic-
tory of medicine and rationalism over shamanism and superstition.
Some earlier writings on Chinese medicine related it in simplistic ways to Daoism,
often taking the latter so broadly as to include anything to do with, for ex-
ample, yin/yang thought, breath cultivation techniques, or popular religion.72 Schol-
arship coming out of religious and Daoist studies has long drawn attention to the
Press, 1981), pp. 431-554. Japanese and French scholars turned their attention to religious health
practices in the 1960s. See also the studies in Kleinman et al., eds., Culture and Healing in Asian
Societies (cit. n. 13), e.g., Ahern, "Sacred and Secular Medicine in a Taiwanese Village: A Study of
Cosmological Disorders"; and Gould-Martin, "Ong-ia-kong: The Plague God as Modern Physician."
Treatments of Buddhist healing include Raoul Birnbaum, "Chinese Buddhist Traditions of Healing
and the Life Cycle," in Healing and Restoring: Health and Medicine in the World's Religious Tradi-
tions, ed. Lawrence E. Sullivan (New York: Macmillan, 1989), pp. 33-57; Birnbaum, The Healing
Buddha (Boulder, Colo.: Shambhala, 1979); Unschuld, Medicine in China (cit. n. 13), pp. 132-153;
and Paul Demieville, Buddhism and Healing: Demievilles Article "Byo" from Hobogirin (1937),
trans. Mark Tatz (Lanham, Md.: Univ. Press America, 1985).
70 See, e.g., Michael Szonyi, "The Illusion of Standardizing the Gods: The Cult of Five Emperors
in Late Imperial China," Journal of Asian Studies, 1997, 56(1):113-135; Katz, Demon Hordes and
Burning Boats (cit. n. 63); Lin Fu-shih, Guhun yu guixiong de shijie: bei Taiwan de ligui xinyang
(The world of orphaned spirits and ghostly heroes: Beliefs in malicious spirits in Northern Taiwan)
(Beixian xiangtu yu shehui daxi, 4) (Banqiao, Taiwan: Taibeixian li wenhua zhongxin, Daoxiang
chubanshe, 1995); Kleeman, God's Own Tale (cit. n. 63) (on plague-suppressing functions of this
Sichuan-based cult see pp. 43, 107-111); Guo Jing, Nuo: qugui, zhuyi, choushen (Nuo: Exorcising
demons, expelling epidemics, thanking the gods) (Shenmi wenhua congshu) (Hong Kong: Sanlian
shudian, 1993); and Li Fengmao, "Donggang wangchuan, Hewen, yu songwang xisu zhi yanjiu,"
Dongfang zongjiao, 1993, 3:229-265.
71 Although Kleinman's earlier work also focused on shamanic healers, it accepted and continued
division of the sacred and secular realms.
72 See the discussion in Nathan Sivin, "On the Word 'Taoist' as Source of Perplexity: With Special
Reference to the Relations of Science and Religion in Traditional China," in Medicine, Philosophy,
and Religion in Ancient China (cit. n. 25), pp. VI.303-330. Increasingly scholars are following Sivin
and Strickmann in distinguishing between religious and philosophical Daoism and adopting more
restricted definitions of the former, such as Strickmann's proposed limitation to groups that recognize
Zhang Daoling as their patriarch: Michael Strickmann, "On the Alchemy of T'ao Hung-ching," in
Facets of Taoism: Essays in Chinese Religion, ed. Holmes Welch and Anna Seidel (New Haven,
Conn.: Yale Univ. Press, 1979), pp. 123-192. See, e.g., Katz, Demon Hordes and Burning Boats (cit.
n. 63), pp. 37-38. Elena Valussi has challenged the loose application of the category "Daoist" to all
"nurturing life" practices. In a textual study of Sun Simiao's (581 ?-682) section on "nourishing inner
nature" (yangxing) in his medical treatise Prescriptions Worth a Thousand in Gold (Qianjin yaofang),
she finds that it lacks, for example, the "mystical search for a higher level of truth or understanding,
or even for immortality." Rather, she finds evidence that he is "referring to very well-known and
widely spread practices in his own time, practices that had a long tradition in the Chinese history of
healing and that were probably available and used by the majority of people." See Elena Valussi,
"The Chapter on 'Nourishing Inner Nature' in Sun Simiao's Qianjin yao fang" (M.A. thesis, School
of Oriental and African Studies, Univ. London, 1996).

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connections between longevity and immortality cultivation techniques and medi-

cine. It can hardly be ignored that ridding the body of disease and maintaining health
are integral to immortality and longevity practices, that several medical classics ap-
pear in the Daoist Canon, that longevity techniques are included in more compre-
hensive medical works, and that all these contain shared views of health and vitality.
The division between sacred and secular has posed a problem in much of this litera-
ture, which tended to treat the medical object as natural and the Daoist object as spir-
itual.73
Moving beyond areas of clear overlap between the traditionally distinct fields of
Daoism and medicine to shamanic healing and plague god cults, research has been
vexed by some of the central problems of Chinese history, anthropology, and reli-
gious studies: clarifying relations between Daoism, Buddhism, and popular religion,
between elite and popular culture, between state and local cults, and between "Chi-
nese" and local cultures. A persistent problem in these works has been the demarca-
tion of these various spheres. Recent writers have tackled these problems through
geographically focused and historically extended studies, rigor and specificity in
identifying Daoist and other influences, and attention to a wide range of sources in
determining the roles of different actors involved in the emergence, practice, and
spread of particular cults. Also notable among scholars working in these areas has
been the extensive crossover between anthropology and history in their works, in
the secondary materials on which they rely, in the methods they employ, and in the
forums in which they publish.
Putting together the flood of recent anthropological, literary, and historical schol-
arship that has come out of mainland China since the 1980s, and building on sub-
stantial primary research, Guo Jing has produced a useful overview of nuo (exor-
cistic) festivals for the expulsion of plague demons. Guo describes not only
historical change, but geographic, ethnic, and social (identifying, for example, d
tinctive palace, village, and military nuo) diversity in nuo practices. He bases his
work in part on studies of theatrical aspects of nuo performances such as songs,
dances, masks, makeup, and costumes. Such studies have been fruitful in mapping
73 On studies relating medicine to Daoism in the context of Japanese Daoist studies see Livia Kohn,
"Taoism in Japan: Positions and Evaluations," Cahiers d'Extreme-Asie, 1995, 8:389-412, on p. 392.
Some recent works that deal with Daoist health practices and medicine include Sakade Yoshinobu,
Doky5 to yosei shise (cit. n. 61); and Yoshimoto Shoji, Dokyel to fur5 chlju no igaku (Daoism and
the medicine of non-aging and long life) (Tokyo: Hirakawa shuppan, 1989), a work that has been
translated into Chinese and published in Taiwan and the People's Republic and also into Korean
("Kimpeibai to doky6 igaku" [cit. n. 66], p. 47 n 1). For a shorter overview see Yoshimoto, "Doky6
to Chugoku igaku" (Daoism and Chinese medicine), in Doky5: Diky5 no tenkai (Daoism: The devel-
opment of Daoism), ed. Fukui Kojun et al. (Tokyo: Hirakawa shuppan, 1983), pp. 257-310. There
are essays by major scholars in Kohn, ed., Taoist Meditation and Longevity Techniques (Michigan
Monographs in Chinese Studies, 61) (Ann Arbor: Center for Chinese Studies, Univ. Michigan, 1989);
and in Sakade Yoshinobu, ed., Chfigoku kodai yosei shisel no selgelteki kenkyu (Collective studies on
the ideas of cultivating life in ancient China) (Tokyo: Hirakawa shuppansha, 1988). See also Cather-
ine Despeux, La moelle du phenix rouge: Sante et longue vie dans la Chine du XVI sikcle (Paris:
Tr6daniel, 1988); Despeux, Prescriptions d'acuponcture valant mile onces d'or (Paris: Tr6daniel,
1987); Ute Engelhardt, Die klassische Tradition der Qi-Ubungen: Eine Darstellung anhand des
Tang-zeitlichen Textes Fuqi jingyi lun von Sima Chengzhen (Munchener Ostasiatische Studien, 44)
(Wiesbaden: Steiner, 1987); and Judith Magee Boltz, "Taoist Rites of Exorcism" (Ph.D. diss., Univ.
California, Berkeley, 1985). For a discussion of some of the problems inherent in dealing with the
natural and transcendent in Daoist practice and a review of Engelhardt's Die klassische Tradition der
Qi- Ubungen see Kohn, "Medicine and Immortality in T'ang China," Journal of the American Orien-
tal Society, 1988, 108(3):465-469.

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316 TJ HINRICHS
affiliations across regions, ethnic groups, and community levels, links between
songs used in theatrical performances, songs for religious rites, and folk songs, and
shamanic aspects of performance.74
Li Fengmao has clarified a transition in nuo culture that saw the emergence and
development of new demonic explanations of and new ritual responses to epidemics
in the Six Dynasties period (420-589). Key developments include the influence of
the imperial bureaucratic model in understandings of godly and demonic behavior
and the understanding of epidemics as a bureaucratically administered divine pun-
ishment. While Li finds Daoism influential in the emergence of these new models
of the divine, he also see a complex interaction between Daoism and popular culture
in the development of cults to these deities and rites for welcoming and expelling
plague gods.5
Paul Katz has observed tendencies among Daoism studies scholars to view local
cults as subordinate to Daoism and among social historians to see little influence of
Daoism on the local cults they study. In his work on the emergence and spread of
cults of the plague-fighting god Marshal Wen in Zhejiang, Katz attempts to go be-
yond these polar perspectives by looking more closely at the involvements of Daoist
priests and lay believers. Rather than a unidirectional process of standardization
whereby local cults are superscribed by dominant Daoist, state, or literati represen-
tations, Katz finds evidence for extensive interaction, the coexistence of multiple
representations of the cult, and the varying involvement over time and place of
Daoist priests and varieties of lay believers. He argues for seeing this as a process
of "reverberation," a constant exchange between numerous individuals, traditions,
and locales.76
Michael Szonyi has explored multiple representations in the case of another
plague god cult, that of the Five Emperors in Fujian in the late imperial period.
Where the local cult appears, in official sources, to have been replaced by the ortho-
dox Five Manifestations cult, Szonyi finds that this did not alter local practices and
representations. He focuses on the role of local elites in representing the cult to the
outside world and mediating between demands for conformity to universal models
and faithfulness to efficacious local gods.77
Integral to the broader historiographic shift that seeks to put daily life and nonelite
cultures at the center of inquiry has been a boom in studies of women and gender.
The diverse roles of women-as bearers of and carers for children, controllers of
reproduction, cultivators of their own health, patients, healers, and intermediaries
between healers and the sick-had been obscured in mainstream elite medical
74 Guo Jing, Nuo (cit. n. 70). Besides Guo and the studies he cites, see also Tanaka Issei, Chfigoku
kyoson saishi kenkyil (cit. n. 63). Tanaka's study is based on five years of field research across coastal
and southern China and overseas Chinese communities in Southeast Asia and on extensive histori-
cal research.
75 Li Fengmao, "Daozang suoshou zaoqi daoshu de wenyiguan: yi Niiqing guilu he Dongyuan
shenzhoujing weizhu" (Early views of plague as collected in the Daoist Canon, focusing on Niiqing
guilu and Dongyuan shenzhou jing), Zhongyang yanjiu yuan Zhongguo wenzhen yanjiu jikan, Mar.
1993, no. 3, pp. 417-454; and Li, "Xingwen yu songwen: daojiao yu minzhong wenyi guan de jiaoliu
he fenqi" (Spreading plague and expelling plague: Interactions of and distinctions between Daoist
and popular understandings of pestilence), in Minjian xinyang yu Zhongguo wenhua guoji yantaohui
lunwenji (Proceedings of the international conference on popular beliefs and Chinese culture), ed.
Hanxue yanjiu zhongxin (Taipei: Hanxue yanjiu zhongxin, 1995), pp. 373-422.
76 Katz, Demon Hordes and Burning Boats (cit. n. 63).
Szonyi, "Illusion of Standardizing the Gods" (cit. n. 70).

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source materials. Besides its general focus on the lives of

of the new work has been specifically informed by femin
of the naturalized gendered body. These works have explo
in China as passive, footbound objects of patriarchal oppression. Instead, they show
that women have played diverse roles, participated in gendered and status relations
of power in complex ways, and appropriated and resisted power to serve their own
ends.
In a series of articles, Lee Jen-der has looked at fertility, health during pregnancy,
childbirthing, and child-care practices between the Han and the Tang periods, draw-
ing on a variety of sources to unearth common practices as well as medical views.
She provides a rich picture of the roles of figures such as wet-nurses, midwives, and
birthing assistants, the ways in which mothers' health was protected, and the sources
of danger to children during pregnancy, birth, and nursing. Lee has shown a shift
in materials on reproduction technologies, from bedchamber techniques to medical
approaches, between the third and seventh centuries. She sees reproduction emerg-
ing as central to medical discourse on the female body in the seventh century and
suggests that this was a key factor in the emergence of fuke ("department of women's
medicine," 'gynecology") as a distinct specialty.78
Charlotte Furth has looked at the history of the learned tradition of fuke from its
emergence as a medical specialty in the Song through the Ming periods. While the
body of classical medicine had been androgynous, in the Songffike medicine devel-
oped a practice differentiating female bodies as dominated by Blood function over
Qi function. Practitioners and texts focused on menstrual regulation for maintaining
health and developed prescriptions for women that aimed at Blood function. While
menstrual regulation continued to be important in elite medicine, by the end of the
Ming changes in medical approaches to the circulation tracts and visceral systems
and to sexual restraint led to a de-emphasis on body and therapy differentiation by
gender. Furth looks at the construction of the gendered body in relation to tensions
between the "androgynous body of generation" of classical medicine and the "fe-
male gestational body"; between a transformational, plastic view of the body and a
view of generation in which yin and yang have equally important roles and a strict
social hierarchical differentiation and segregation based on gender and on the pollu-
tion associated with gestation.79
78 Lee Jen-der, "Han-Sui zhi jian de 'shengzi buju' wenti" (The problem of "birthing but not rais-
ing" between the Han and Sui), Zhongyang yanjiu yuan Lishi yuyan yanjiusuo jikan, 1995,
66(3):747-812; Lee, "Han-Tang zhijian qiuzi yifang shitan: jianlun fuke lanshang yu xingbie lunshu"
(Medical approaches to seeking children between the Han and Tang), ibid., 1997, 68(2):283-367;
Lee, "Han-Tang zhijian yishu zhong de shengchan zhi dao" (Childbirth in the medical writings of
Han to Tang), ibid., 1996, 67(3):533-654; and Lee, "Reproductive Medicine in Late Antiquity and
Early Medieval China-Gender Discourse and the Birth of Gynecology," ibid., 1997, 68(2):283-
367.
7 I capitalize "Blood" and "Qi" here to mark them as technical Chinese medical terms. See Furth,
Flourishing Yin (cit. n. 66); Charlotte Furth, "Androgynous Males and Deficient Females: Biology
and Gender Boundaries in Sixteenth- and Seventeenth-Century China," Late Imperial China, 1988,
9(2):1-31; Furth, "Blood, Body, and Gender: Medical Images of the Female Condition in China,
1600-1850,;" Chin. Sci., 1986, no. 7, pp. 43-66; Furth, "Concepts of Pregnancy, Childbirth, and
Infancy in Qing Dynasty China," J. Asian Stud., 1987, 46(1):7-35; Furth, "Rethinking Van Gulik:
Sexuality and Reproduction in Traditional Chinese Medicine," in Engendering China, ed. Gilmartin
et al. (cit. n. 66), pp. 125-146; and Furth and Ch'en Shu-yueh, "Chinese Medicine and the Anthro-
pology of Menstruation in Contemporary Taiwan," Medical Anthropology Quarterly, 1992,
6( I):27-48.

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318 TJ HINRICHS
Furth also looks at the social relations pertaining to women's healing in the six-
teenth and seventeenth centuries, a period for which the sources necessary for such
analysis are more abundant. Where analyses limited to elite medical materials exam-
ined theory and the authoritative role of the elite medical doctor, Furth focuses on
healing practices and negotiations with diverse male and female healers. In these
negotiations she finds the relations of male and female authority and hierarchy
played out in complex ways. She shows that illness, gestation, and birth were man-
aged at home through varieties of family-based knowledge and care. Furth finds that
print culture did not displace oral and handwritten modes of transmission of medical
knowledge and skills in home and lineage contexts. In her studies of the genre of
case histories that emerged in the Ming, Furth finds that patients' concerns differed
from those of physicians and that patients influenced the clinical encounter in impor-
tant ways.80
Joanna Grant has compared the treatment of female and male patients in a collec-
tion of case histories of the sixteenth-century Anhui Province physician Wang Ji
(1463-1539). Grant finds greater differences between the treatment of women
whose disorders are related to reproduction and those whose illnesses are not than
between the treatment of men and women. Noting that "depletion," a central medical
concern of Wang Ji's, was diagnosed more often in men than in women, she relates
this tendency to concern over financial, moral, and physical "overspending" by men
in a context of commercial prosperity and social flux.81
Francesca Bray has uncovered reproductive cultures that gave elite women in late
imperial China more control in negotiating their fertility than had been previously
suspected. Bray has also found great differentiation in maternal roles related to sta-
tus and divisibility of the social and biological aspects of motherhood, for example,
among wives and concubines. Rather than reducing reproductive cultures or differ-
entiation of maternal roles to technology (e.g., reproductive technologies) or to so-
cial constructions, Bray treats technology and social construction as intertwined pro-
cesses.82
Yi-Li Wu has looked at Qing period lineages in Zhejiang that specialized infuke,
focusing especially on the famous Buddhist lineage of the Bamboo Grove Monas-
tery. Bamboo Grove monks practiced a routinized form of medicine derogated in
elite ruyi texts that extolled an individualized approach to treatment. Wu finds, how-
ever, that these texts cannot properly be considered as strictly "lower class," since
publications of Bamboo Grove texts were commissioned and funded by members
of the elite, including some officials, and even by some who explicitly criticized the
impropriety of women's association with monk healers.83
In investigating child care in the later imperial period, Hsiung Ping-chen has
80 Furth also finds in the case histories much everyday language-and resonances for medical
constructs in everyday language: Furth, Flourishing Yin. Yi-Li Wu has found the language of daily
life common in the fuke texts she studies and suggests these echo patients' descriptions of their
symptoms: Wu, "Transmitted Secrets: The Doctors of the Lower Yangzi Region and Popular Gyne-
cology in Late Imperial China" (Ph.D. diss., Yale Univ., 1998). The popular resonances of medical
language are analyzed in Bray, "Deathly Disorder" (cit. n. 66).
81 Joanna Catherine Grant, "Wang Ji's Shishan yi'an: Aspects of Gender and Culture in Ming Dy-
nasty Case Histories" (Ph.D. diss., Univ. London, 1997).
82 Bray, Technology and Gender (cit. n. 66), Pt. 3: "Meanings of Motherhood: Reproductive Tech-
nologies and Their Uses," pp. 317-334; and Bray, "Deathly Disorder" (cit. n. 66).
83 Wu, "Transmitted Secrets" (cit. n. 80).

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mined diverse sources to show, for example, theories of child physiology and devel-
opment, how pediatric medicine developed into a distinct specialty from the Song
period, how different schools of pediatric medicine emerged, and how practices
pertaining to cord cutting and keeping newborns warm were disseminated.84
Looking at experiences of middle age and menopause among Chinese women
of different generations, Jeanne Shea finds variation between women of different
generations, women with different levels of education, and urban and rural women.
She also finds marked differences between all of these women and Japanese and
North American women. With Margaret Lock, Shea challenges common Western
assumptions, based on factors such as estrogen decline or the "empty nest," about
the universality of experiences of menopause and middle age. Instead, Shea finds
that for most Chinese women middle age is a time of relatively good health and
satisfaction with life. She finds generational differences related to the local political,
cultural, and economic conditions during which women go through key phases of
their life cycles. For example, midlife is a more salient period for women who expe-
rienced it after the late 1970s, when it became a more common topic in the press.
She finds experience more contingently related to local cultures, historical condi-
tions, and social status than to biology or psychology.85
One of the themes running through recent works on gender is the gendered body.
Feminist critiques have contributed significantly to particularizing and denaturaliz-
ing bodies as objects of scholarship. Plurality emerges from the differentiation of
both bodily experience and of gazes on bodies: gendered body(ies), ritual body(ies),
southern body(ies), medical body(ies), disabled body(ies), Daoist body(ies). These
themes run through many of the works I have discussed.86 In part, this plurality
is entailed in a shift from essences-the "essential Chinese body"-to contingent
processes of bodily experience; major nodes of contingency can be found not only
in Chineseness but in diverse vectors of identity and experience. Besides the multi-
plicity of such particularized bodies, recent work introduces other forms of plurality
through a focus on the multiplicity and contingency of body and self.
Bodies and Selves
Scholars working in diverse fields and from various perspectives have analyzed dif-
ferences between Chinese and Western views and experiences of body and self. A
contrast is usually made between the bounded individuals, naturalized bodies, and
mind/body dichotomies of European traditions and Chinese bodies and selves that
are conceived and experienced as processual, as multiple, as integrated in terms of
mind and body, and as intimately linked with social, environmental, and cosmic
84 Hsiung Ping-chen (Xiong Bingzhen), Youyou: chuantong Zhongguo de qiangbao zhi dao (In
fancy: The way of the diaper in traditional China) (Taipei: Lianjing, 1995). See also Charlotte Furth
"From Birth to Birth: The Growing Body in Chinese Medicine," in Chinese Views of Childhood, ed
Anne Behnke Kinney (Honolulu: Univ. Hawaii Press, 1995), pp. 157-191.
85 Jeanne Shea, "Revolutionary Women at Middle Age: An Ethnographic Survey of Menopaus
and Midlife Aging in Beijing" (Ph.D. diss., Harvard Univ., 1998); and Margaret Lock, Encounters
with Aging: Mythologies of Menopause in Japan and North America (Berkeley: Univ. California
Press, 1993).
86 See, e.g., Angela Zito and Tani Barlow, "Introduction," in Body, Subject, and Power in Chin
ed. Zito and Barlow (cit. n. 47), pp. 1-19. See also the works by Francesca Bray, Charlotte Furt
Shigehisa Kuriyama, Marta Hanson, Vivienne Lo, Volker Scheid, and Kristofer Schipper that I cite
in this essay.

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320 TJ HINRICHS
contexts.87 There is some danger in this contrast of new forms of essentialism and
orientalism.88 To begin with, the model of Western selves and bodies used for this
contrast is increasingly unrepresentative of post-Freudian, cyberspaced postmod-
erns. With these cautions, however, careful attention to body and self in China re-
mains critical for overcoming distorting assumptions and for uncovering pluralities
and contingencies at the core of experience.
We can see experiences and constructions of body and self serving as fruitful
points of departure for new approaches in the study of Chinese medical practice
among a number of recent scholars.89 A distinctive feature of Shigehisa Kuriyama's
work has been attention to orientations of body and selfhood in the experience and
practice of healing, including processes by which distinctive medical approaches
are developed. In the case of body-centered classical medicine, Kuriyama finds an
emerging sense of
87 See esp. the essays collected in the SUNY "self" series: Roger T. Ames, Thomas P. Kasulis, and
Wimal Dissanayake, eds., Self as Body in Asian Theory and Practice (Albany: State Univ. New York
Press, 1993), Self as Person in Asian Theory and Practice (1993), and Self as Image in Asian Theory
and Practice (1995); in Zito and Barlow, eds., Body, Subject, and Power in China; and in John Hay,
ed., Boundaries in China (London: Reaktion, 1995). See also Miyakawa Hisayuki, "Doky6 teki
shintairon ni okeru shichti to kompaku" (Cadaverous worms and plural souls in the Daoist doctrine
of the human body), in Chagoku teki jinseikan-sekaikan (Views of human life and world views in
China), ed. NaitO Motoharu (Tokyo: I-oh6 shoten, 1994), pp. 259-27 1; Kristofer Schipper, The Taoist
Body, trans. Karen C. Duval (Berkeley: Univ. California Press, 1993); and Hay, 'Arterial Art," Stone
Lion Review, 1983, 11:70-84. On "body culture" and sports in contemporary China see Susan
Brownell, Training the Body for China: Sports in the Moral Order of the People ' Republic (Chicago:
Univ. Chicago Press, 1995).
88 We might note that many of the attributes of Chinese bodies and selves put forward in recent
work echo the very attributes I identify here as characteristic of recent scholarship on Chinese medi-
cine. These features of Chinese selfhood may have gained both a greater saliency and a greater
attraction in their homologies with postmodern reactions against modem Western paradigms. I see a
risk here of romanticizing Chineseness and underplaying, for example, the reductionisms, alien-
ations, dichotomizing, and objectifying of bodies and selves in Chinese contexts. I would say, how-
ever, that the writers I discuss here have been aware of these hazards and have successfully navigated
around them.
89 Among those already discussed are Judith Farquhar, Charlotte Furth, Marta Hanson, Vivienne
Lo, Arthur Kleinman, and Volker Scheid. See also the analyses of body in relation to the early state
and cosmology in Nathan Sivin, "State, Cosmos, and Body in the Last Three Centuries B.C.," Harvard
J. Asiatic Stud., 1995, 55(11):5-37; and Robin D. S. Yates, "Body, Space, Time, and Bureaucracy:
Boundary Creation and Control Mechanisms in Early China," in Boundaries in China, ed. Hay (cit.
n. 87), pp. 56-80. On experiences of body, self, and healing in popular qigong practices in contempo-
rary China see Nancy N. Chen, "Urban Spaces and Experiences of Qigong," in Urban Spaces in
Contemporary China, ed. Deborah S. Davis et al. (Cambridge: Woodrow Wilson Center Press and
Cambridge Univ. Press, 1995), pp. 347-361; and Thomas Ots, "The Silenced Body-The Expressive
Leib: On the Dialectic of Mind and Life in Chinese Cathartic Healing," in Embodiment and Experi-
ence: The Existential Ground of Culture and the Self, ed. Thomas Csordas (Cambridge: Cambridge
Univ. Press, 1994), pp. 116-138. An important strand of body-focused scholarship shows how dis-
courses of science and modernity and government policies have constructed and naturalized, e.g.,
gender differences and sexual identities, contributing to the regulation of these areas of life. See
Brownell, Training the Body for China (cit. n. 87); and Frank Dikdtter, Sex, Culture, and Modernity
in China: Medical Science and the Construction of Sexual Identities in the Early Republican Period
(Honolulu: Univ. Hawaii Press, 1995). Matthew Kohrman has examined the construction of the
"physically disabled" man, focusing on the Disabled Persons' Federation, the history of discourses
on the "physically disabled" that informed the federation's policies, the particular interests and inter-
national context of its creation in 1988, and variable responses of people in embracing or avoiding
the federation. Kohrman finds greater participation in the federation among urban men, who have
access to more tangible benefits, than among rural men, who are more concerned to negotiate margin-
alization and objectification within their communities. See Matthew Kohrman, "Damaged Bodies:
History and the Phenomenology of Disability in Modern China" (Ph.D. diss., Harvard Univ., forth-
coming).

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a self in which thoughts and feelings mysteriously arise, of

of the earth. Anchored in neither reason nor volition, the self
impulses whose origins are unfathomable. Individuals, in this view, are not distinct
essences-Orphic souls, say, cast into the darkness of matter-or immaterial minds set
against material bodies. Rather, individuation simply mirrors the plurality and unpre-
dictability of winds. Different localities have different airs, individuals have personal
breaths, and ... individualized orifices on the body's surface mediate the confluence of
cosmic, local, and personal winds.90
Here we find plurality and unpredictability at the center of a classical medical body.
Reduction to biological or psychological mechanisms, like the separation of the
sacred from the secular, has obscured a focus of illness and healing that was at one
time common and was based on a view of the body and self as multiple and perme-
able. The "corpse worms" and "worms of consumption," demonic entities that pro-
duce illness, have been conflated with tuberculosis bacteria, helminthic parasites,
and psychological projections of the instincts.91 These descriptions distort rather
than elucidate bodily experience, losing their footing not only in projecting contem-
porary categories on people who would not recognize them but also in their assump-
tions about bounded individuals (hosts invaded by parasites) and minds divided from
bodies (projected instincts). In medieval through late imperial China the "corpse
worms" were depicted in Daoist and medical texts as three of a multitude of spirits
that inhabited the body from birth. Various spirits guarded and managed the various
organ systems, and certain disorders (or simply dreams) came about when they went
roaming outside the body. The corpse worms sought the early demise of the person
so that they would be free to roam independently. Sometimes they communicated
and conspired with external demons, helping them occupy the body. Upon entering
the body, demonic beings sometimes took form as worms, producing disorders such
as "consumption" by gnawing at the internal viscera, often the lungs. Sometimes
these noxious beings infested the rooms and clothing of the sick. Sometimes they
left one person at death to infest family members or people nearby. Such descriptions
not only bring us closer to experiences of illness and health in medieval to late
imperial China but give us a different perspective on a range of disorders and
90 Kuriyama, "Imagination of Winds" (cit. n. 47), p. 34. See also Kuriyama, "Visual Knowledge
Classical Chinese Medicine" (cit. n. 29); Kuriyama, "Varieties of Haptic Experience" (cit. n. 29
Kuriyama, "Interpreting the History of Bloodletting" (cit. n. 29); Shigehisa Kuriyama, "Concepts
Disease in East Asia," in The Cambridge History of Human Disease, ed. Kenneth Kiple (Cambri
Cambridge Univ. Press, 1993), pp. 52-59; and Kuriyama, "Between Mind and Eye: Japanese An
omy in the Eighteenth Century," in Paths to Asian Medical Knowledge, ed. Charles Leslie and Al
Young (Berkeley: Univ. California Press, 1992), pp. 21-43.
91 Corpse worms are innate, while worms of consumption are acquired. However, they are some-
times linked in Daoist texts. See Andrews's discussion of early attempts to conflate the worms of
consumption with the germs of tuberculosis: Andrews, "Tuberculosis and the Assimilation of Germ
Theory" (cit. n. 53). Analyses of the corpse worms as parasites include Song Daren, "Zhongguo
gudai renti jisheng chongbing shi" (History of parasitic diseases in ancient China), Yishi zazhi, 1948,
2(3-4):44-55; Xiao Shuxuan, "Jiehe bing zai Zhongguo yixue shang zhi shi de fazhan" (Tuberculo-
sis in the historical development of Chinese medicine), ibid., 1951, 3(1):25-33, 3(2):29-40, 3(3):19-
30, 3(4):13-22; Reinhard Hoeppli and I Ch'iang, "Selections from Old Chinese Medical Literature
on Various Subjects of Helminthological Interest," Chinese Medical Journal, 1940, 57:380-382;
Hoeppli and Ch'iang, "The Origin of Human Helminths According to Old Chinese Medical Litera-
ture," Monumenta Serica, 1938, 3(2):579-601; and Hoeppli, Parasites and Parasitic Infections in
Early Medicine and Science (Singapore: Univ. Malaya Press, 1959). For a psychological interpreta-
tion see N. H. van Straten, Concepts of Health, Disease, and Vitality in Traditional Chinese Society
(Wiesbaden: Steiner, 1983), pp. 44-50.

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322 TJ HINRICHS
practices, from "possession" to the employment of spirit specialists in avoiding epi-

demic contagion. Different healers might take markedly different approaches to
these types of disorders, some regulating or boosting the qi in order to strengthen the
body's hold on straying spirits, some negotiating with the spirits, and some calling on
more powerful spirits in order to expel the infesting demons.
Here we find plurality on three levels: the plurality of a personhood populated by
a multitude of beings, a plurality of healing strategies, and a plurality of ways of
looking at the body. Although descriptions of demonic infestation of the body and
of disease were usually treated separately in medical texts, the view of the body as
"populated" was not necessarily incompatible with a focus on configurations of
winds or qi, and we find these views combined eclectically in the writings of some
authors.92
The permeability of self and the indivisibility of mind(s)/spirit(s)/body(ies) is
conceived here very graphically. In some contexts, however, it is more difficult to
translate the refusal to demarcate self rigidly from other and to fix experience in
either the mind or the body. Modem discourses of biomedicine and psychology
and to some extent Western languages as well-insist on such fixity. Circumventing
these limitations has taken theoretical and linguistic creativity.
Arthur and Joan Kleinman have developed a model for medical anthropology that
posits experience, applied here to the suffering of illness, as "the intersubjective
medium of social transactions in local moral worlds." While generalized for the
field of medical anthropology and applied to American case studies as well, the
intersubjective emphasis of the approach is informed by decades of engagement
with Chinese culture. The Kleinmans have found that both individual-based and
psychoanalytic assumptions, as well as the "sociocentric/egocentric dichotomy" by
which non-Western cultures are sometimes distinguished from Western cultures in
the experience and conceptualization of selfhood, are inappropriate to Chinese
culture.93
Judith Farquhar has also found Western approaches that put knowledge before
action and seek a single dominant perspective inadequate. Rather, she finds multi-
plicity and contingency to be central to the medical body and practice of traditional
Chinese physicians in the contemporary People's Republic of China. This medical
body is constructed as a defining characteristic of Chinese medicine, analogous to
the opposition of syndrome and disease differentiation often cited as distinguishing
92 The latter view also takes the body to contain multiple systems and to be permeable to the outer
world; spirits are also configurations of qi. For a description of the "populated" body of Daoism see
Schipper, Taoist Body (cit. n. 87), pp. 108-112. For discussions of corpse worms and practices aimed
at expelling them see Miyakawa Hisayuki, "Medical Aspects of the Daoist Doctrine of the Three
Cadavers," in East Asian Science, ed. Keiz6 et al. (cit. n. 28), pp. 345-350; Miyakawa, "Doky6 teki
shintairon" (cit. n. 87); Kuriyama, "Concepts of Disease in East Asia" (cit. n. 90), pp. 56-57; and
Kubo Noritada, Koshin shink6 no kenkya (cit. n. 61). For discussions of infesting demonic worms,
related disorders, and related practices see Li Jianmin, "Contagion and Its Consequences: The Prob-
lem of Death Pollution in Ancient China," paper presented at the Twenty-first International Sympo-
sium on the Comparative History of Medicine-East and West, Mishima, Japan, 1 Sept. 1996; Li,
"Suibing yu 'changsuo': chuantong yixue dui suibing de yizhong jieshi" (Sui [haunting, possession]
disorders and "place": One explanation for sui disorders in traditional medicine), Hanxue yanjiu
(Chinese studies research), 1994, 12(1):101-148; Hinrichs, "Medical Transforming of Governance
and Southern Customs" (cit. n. 10); and Michel Strickmann, "Magical Medicine: Therapeutic Rituals
in East Asian Tradition," unpublished MS, 1989.
93 Kleinman, Writing at the Margin (cit. n. 15), pp. 95-119, on p. 97; and Kleinman and Kleinman
"How Bodies Remember" (cit. n. 24).

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Chinese from Western medicine. The Chinese medical body is contrasted with the
Western anatomical one as lacking a stable point of view or hierarchical ordering of
structures (such as cells, tissues, organs). The focus is on multiple functional sys-
tems of physiology and pathology that are not hierarchically related but intercon-
nected and mutually irreducible. The boundary between body and environment is
permeable. In contrast to the biomedical focus on lesions in particular bodily struc-
tures, in Chinese medicine disorders are not confined to single subsystems but prop-
agate across them and can be treated from different directions. In contemporary
traditional Chinese medicine, then, medical intervention entails choosing one of nu-
merous possible perspectives for analyzing and treating a disorder. Furthermore,
perspective, analysis, and treatment can evolve together over the course of a
treatment.94
Like physicians approaching this Chinese body, scholars approaching "Chinese
medicine" are increasingly seeing it as multiple and unpredictable: not hierarchi-
cally structured, not a neatly bounded system, and not amenable to single points of
view. Those choosing, among numerous options, to focus on bodily practices and
experiences of self are revealing that forms of multiplicity, contingency, processual-
ity, and permeability are not marginal or incidental but central to illness, healing,
and health in Chinese contexts.
CONCLUSION
The emerging map of Chinese medicine centers the flux of life-processual, hetero-
geneous practices and experiences. It is more concerned with boundaries as con-
structions on the cultural landscape than as immobile natural features of terrain.
By refusing to fix a single authoritative perspective or defining structure, this work
mandates a different sort of navigational approach.
Centering elite medical theory had the advantage of allowing scholars to limit
the scope of their research to elite medical texts. Historians could reconstruct the
governmental structures relevant to medical education and disaster relief through a
review of standard histories and other published government documents. Historians
interested in medical progress could make this evaluation by matching earlier medi-
cal theories to current biomedicine and by testing the efficacy of earlier prescriptions
in the laboratory. Describing ideas as reflections of class structures, political sys-
tems, or religions, the scholar need not demonstrate concretely how one translates
into the other. Fixed perspectives and reductionism satisfy a particular aesthetic of
elegance.
Scholars concerned with multifold processes of change, the production of praxis
in local worlds, lived experience, diverse healers, and daily life, on the other hand,
cannot easily limit the sources they examine. They must develop new ways of inter-
rogating the available sources, which were generally not written to convey informa-
tion about women, children, or the illiterate. In order to achieve dialogue with their
sources, they must maintain a self-reflexive vigilance toward their own assumptions.
If they are to take indigenous categories and experience seriously, they must learn
from these as well as from theoretical perspectives developed for non-Chinese histo-
ries or for ethnographies of non-Western Others.
94 Farquhar, "Time and Text" (cit. n. 40); Farquhar, "Re-writing Traditional Medicine in Post-
Maoist China" (cit. n. 42); and Farquhar, Knowing Practice (cit. n. 24).

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324 TJ HINRICHS
While scholars are making a good start, there is much to be done just to fill gaps
and extend existing lines of inquiry. How have medical Selves and Others been iden-
tified and constructed in the many times, places, and local worlds still unstudied?
How have diverse healers distinguished themselves from competitors? How have
others distinguished them? When, where, and how did nonelites come to patronize
physicians, become physicians, and learn medicine-and what did they do?
Through the Song there is a common plaint among elites that "southerners" are
ignorant of and have no access to medicine. How did this change, and what sorts of
medical practices emerged in the process? When and how were orthodox medical
views of the body produced, resisted, or selectively adapted by these "southerners"
or by others? Did such Others transform medical practices in ways that influenced
those practices elsewhere in China?
In what ways have eating, excreting, breathing, focusing attention, sitting, moving,
speaking, looking, dressing, washing, touching, nursing, birthing, and making love
been performed, seen, and felt by people other than the adepts who refined, re-
corded, and cultivated such practices? How did these gain from and contribute to
healing practices? How were they transmitted within families and otherwise? In
what ways have people conceived health in relation to locale? gender? age? status?
How have medical discourses been selectively taken into political discourses, and
political into medical, and transformed? How have bodies mediated economic, polit-
ical, and social relations? How have illness, health, and healing been negotiated
among healers, patients, family, gods, and demons? How has the protection of com-
munities from disease been negotiated?
Scholars of Chinese medicine have always been boundary crossers, whether work-
ing in the margins of their medical practices or of their philological scholarship,
turning to medical history from a background in science, or turning to China from
a background in the history of Western science. As Tu Cheng-sheng, Nathan Sivin,
and Arthur Kleinman have noted, the study of Chinese medicine has been a pursuit
at the margins, whether of Chinese history, history of science, or medical anthropol-
ogy. As interest in the marginal areas of life has grown in recent years, so has this
field. As acceptance of Chinese medicine as a viable alternative to biomedicine has
grown, so has the interest of students, funding agencies, and publishers. Where there
were tens of mainland historians of Chinese medicine in the 1950s, they are now
counted in the hundreds. The collation and printing of primary texts and the compi-
lations of reference materials pouring out of mainland publishing houses faster than
libraries can collect them are making historical scholarship both less and more for-
midable. Fieldwork in mainland China has been open to foreign scholars for two
decades now, making it possible for them to organize objects of inquiry that are
more "experience-near" and more open to contemporary Chinese diversity.
Scholars studying Chinese medicine have always held dialogues with scholars
in other departments, other institutions, and other countries. In the last two to
three decades, with the proliferation of international organizations, international
conferences, scholarly journals with international contributors and readership,
scholarly exchanges, and Internet resources, interconnections have been increas-
ing.95 These are contributing to productive cross-fertilization of scholarly knowl-
95 I include here groups and forums devoted to the history of science as well as those focused
specifically on medicine. International organizations that sponsor periodic conferences or publish

86.4.162.63 on Sun, 28 Nov 2021 19:25:18 UTC
edge. They are both making the localness of scholarly perspectives ever more appar-
ent and undermining the idea of the field's marginality, which assumes normative
structures and hegemonic centers. These shifting perspectives, disappearing bound-
aries, flows of information, and widening contacts offer challenges and opportunities
and can be expected to produce continuing transformations of "Chinese medicine."
journals include the International Society for the History of East Asian Science, Technology, and
Medicine; International Association for the Study of Traditional Asian Medicine; and Zhongguo
kejishi xuehui (Association for the study of the history of Chinese science and technology). Recent
international conferences organized by other institutions include the Medicine and Chinese Society
Symposium, Academia Sinica, Taipei, Taiwan, 26-28 June 1997; and the Lu Gwei-Djen Memorial
Workshop on Innovation in Chinese Medicine, 9-11 March 1995, Needham Research Institute, Cam-
bridge, England. The Groupe de Recherche sur l'Histoire des Sciences et des Techniques en Chine,
en Cor6e et au Japon at the Centre National de la Recherche Scientifique, Paris, is planning future
workshops on Chinese medicine. Specialized scholarly journals include Nihon ishigaku zasshi (Japan
journal of studies in medical history, est. 1941), Zhonghua yishi zazhi (China journal of medical
history, orig. publ. 1947 as Yishi zazhi [Journal of medical history]), Chinese Science (est. 1975), and
Yi guwen zhishi (Ancient medical textual knowledge, est. 1984). Internet resources include the Chi-
nese Science Web page (<http://www.albion.edu/fac/hist/chimed/>, est. 1997); the Chinese Medicine
Web page (<http://www.soas.ac.uk/needham/chimed/>, est. 1997), edited by Yi-Li Wu; the Need-
ham Research Institute Web page (<http://www.soas.ac.uk/needham/>, est. 1996), edited by Chris-
topher Cullen; the Golden Elixir-Resources on Chinese Alchemy Web page (<http://helios.
unive.it/-dsao//pregadio/index.html/>, est. 1996), edited by Fabrizio Pregadio; the East Asian Sci-
ence Discussion List (<easci@ccat.sas.upenn.edu>, est. 1994), run by Nathan Sivin; and the Chi-
nese Medicine Discussion List (<chimed@ccat.sas.upenn.edu>, est. 1997), run by TJ Hinrichs.

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New Geographies of Chinese Medicine

Stable URL: https://www.jstor.org/stable/301886

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C HINESE GAZETTEERS OF THE IMPERIAL PERIOD contain maps quite

(? 1999 by The History of Science Society. All rights reserved. 0369-7827/98/1301-0012$02.00

Osiris, 1998, 13:287-325 287

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in contradistinction to and according to contemporary models of Western medicine.5

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Needham and Lu Gwei-Djen, with whom he collaborated on Chinese medical

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exotic to Western audiences. This popular interest motiva

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background for their studie

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These breakdowns in disciplinary boundaries are reconfiguring "Cninese medi-

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and the retreat from the tr

FROM ESSENCES TO PROCESSES

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medical systems-the very idea, w

The greatest challenge to approaches based on essential oppositions such as those

30 Kleinman, Writing at the Margin (cit. n. 15), p. 6.

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government-distributed medicines. Officials reacted by producing and distributing

31 Hinrichs, "Medical Transforming of Governance and Southern Customs" (cit. n. 10).

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of Cold Damage disorders to a distinct class of year-round disorders prevailing in

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on clinical practice and individual achievement against the dominance of laboratory

Transforming and Transmitting Medical Practice and Knowledge

As scholars have eschewed monolithic and reductionist models of change, abandon-

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nuanced picture of Qin and Han healing practices but to an

The imagination of wind sprang from a concrete experience of

Kuriyama and Lo, then, while sharing their predecessors'

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as something quite comparable to modem Western notions of "public health." In a

FROM UNITIES TO DIVERSITIES

Where heterogeneity has been noted in medical traditions, it is usually associated

56 Rogaski, "From Protecting Life to Defending the Nation" (cit. n. 27).

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of change and diversity; moreover, other factors contribute to ongoing diversity

The archaeological finds of recent decades are promoting an increasing appreciation

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looking at Chinese medicine as practiced in China-and, if so, where in China-

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subjects by integrating contemporary ethnographic observations and anthropologi-

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connections between longevity and immortality cultivation techniques and medi-

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