feature · ..
Styles of practice in
Chinese medicine
Managing plurality
By Volker Scheid
A great strength of Chinese medicine is its plurality. It underpins
a resilience that has seen it thrive for more than 2000 years
and flourish in a wide array of cultural and historical settings.
Yet, individual practitioners often experience this plurality as
a painful challenge and a weakness rather than a strength .
Effective management is the art of emphasising the benefits
of plurality while reducing its negative effects. This article is
an attempt to map out a path along which such management
may be developed. Part I surveys how Chinese medicine has
tried to manage plurality throughout its history and ask~: to
what extent these methods are still appropriate for ou< c wn
times. Part 2, in the January 2021 issue of The Lantern, wi ll
explore qi physiology to flesh out the concept of meta-practice,
suggested here as a solution to the problematic of plurality.
I
N MY BOOK Chinese Medicine in Con-
temporary China: Plurality and Synthesis,
which is based on fieldwork in a variety
of clinical settings in 1990s Beijing, I showed
the plurality of Chinese medicine to be con-
stituted by two interlinking phenomena:
1 2. I have examined various aspects of these: Scheid,
diversity and heterogeneity.
Diversity denotes the existence of many
different ways of practising Chinese medicine
at any moment in time. Heterogeneity refers
to the fact that each of these ways of practising
1. Scheid, V. (2002) Chinese Medicine in
Contemporary China: Plurality and Synthesis. Duke
University Press, Durham.
U vol: 17-3
is an assemblage of elements drawn from a
wide array of cultures and times.
Traditional Chinese medicine, for instance,
is a style of practice developed between the
late 1950s and mid 1980s that is embodied
most clearly in state-sponsored Chinese
medical textbooks. This style aligns various
elements from the Chinese tradition with
biomedical understandings of the body,
concepts of symptom patterns developed in
Edo and Meiji Japan, ideas of holistic science
that originated in 18th century Germany, and
the centrality of practice in Maoist thought
that itself is an amalgam of Marxist and
2
Chinese philosophies.
Another example is the thought and
practice of the enormously influential
17th century physician Yu Chang (Pwi i!§
1585-1665). Yu aligned his critique of post-
Song interpretations of the Shang Han
Lun (Treatise on Cold Damage, {i~iffie)
with Buddhist philosophies and Chan
(Zen) meditative practices, Neo-Confucian
metaphysics in vogue during the Ming
dynasty and innovative ideas regarding
the nature of epidemic disorders that were
developing in the Jiangzi delta region of
3
China during his lifetime.
V. & Karchmer, E. (2016) History of Chinese medicine,
1890- 2010. In Modern Chinese Religion II: 1850-2015,
vol. 1, (Eds, Goosaert, V., Kiely, J. & Lagerwey, J .) Brill,
Leiden, pp. 141-196. Scheid, V. (2016) Holism, Chinese
medicine and systems ideologies: rewriting the past
to imagine the future. In The Edinburgh Companion
to the Critical Medical Humanities, (eds, Woods, A. &
Whitehead, A.) pp. 68-87.
3. Scheid, V. (forthcoming 2020). Examining the
neglected influence of Buddhism on Chinese
 -
Going back even further to the origins of
the Chinese medical tradition, the conception
of medicine as expressed in the Huangdi
Neijing (Inner Classic :J:W~~ ) is not a
coherent system but a compilation of ideas
4 in the thickets of
by groups of author~. ~hese emerged from
conjoining prognosncanon practices based
on reading the movement of heavenly bodies
\\~th bodily sensitivities developed in the
course of sexual practices, newly developing
technologies of petty surgery (blood-letting
and lancing of boils) and weaving, and
cosmologies of systematic correspondence.5
The advantages of such heterogeneity
are clear. By assimilating elements from
different cultural and intellectual domains
into its practices wh ile abandoning others,
Chinese medicine has been able to flexibly
adapt to continuously changing contexts
of practice. For instance, by comparing the
relationship of organs and chan nels to that
between batteries and electric wi res, the
early 20th-century physician Peng Ziyi (~
r~ 1871-1949) created an alluring image of
bodily function for his early modem readers
but one that would have made no sense at
all to Huangdi and Qi Bo. Around the same
time, a new conception of the term zheng
as a manifestation pattern of d isease
emerged tha t replaced the much more loose
connection between disease, sym ptoms and
patterns in previous uses of the term. This
conception succeeded in emphasising the
uniqueness of Chinese medical practice
by, on the one hand, tying this conception
of zheng to ancient medical canons like
the Shang Han Lun , while simultaneously
allowing for a definition of d isease also in
6 febr ile illness, types of immune reaction, ways
biomedical terms. The piecemeal approach
to such synthesis, keeping some elements
medicine in late imperial China through the work of
Yu Chang. Bulletin of the History of Medicine.
4. Unschuld, Paul , Huangdi Neijing Su Wen: Nature,
Knowledge, Imagery in an Ancient Chinese Medical
Text. Berkeley: University of California Press, 2003.
5. Li Jianmin*~ (2CXXl) Si Sheng Zhi Yu: Zhou
Oin Han Maixue zhi Yuanliu j[1'.z:Ji;X : ~ ~~/ll'c.Ifn.
Z imtim (The Boundary of Life and Death : The Origin
and Development of the Concepts of Vessels and
Blood during the Zhou, Qin and Han) . Zhongyang
yanjiuyuan lishi yuyan yanjiusuo, Taibei . Lo, V. Looms
of Life: t he warp and the weft of the body's intenor
design. Paper presented at Looms of Life: Weaving,
Medicine and Knowledge Prod uction in Early Ch ina,
conference held at UCL, London, March 201 7·
6. Lei, Sean Hsiang-lin, Neither Donkey No r Ho_ rse:
Medicin e in the Struggle Over China's Modernity
167-192 -
Chicago: University of Chicago Press, 2014, PP
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of existing practice while modi fying others,
furthermore allows for a sense of continuity
over time. The diversity of different styles Chinese medicine is
of practice existing side by side, meanwhile, inextricably enmeshed
means that if one approach fails others are
always available and treatment failure never,
interpretation.
therefore, threatens the tradition as a whole.
There are, however, also downsides to
this plurality articulated for centuries by
authors wri ti ng about Chinese medicine. On
an individual level one can detect in these
writings an enduring uncertainty about how
to select from the many different styles of
practice on offer and how to deal with the
issue of treatment failure. Is it attributable
to shortcomings of knowledge or character,
specific interpretations or treatment styles,
or even the tradition as whole? On a
philosophical level the existence of many
styles of practice raises the problem of how
di fferent styles might be positioned relative
to others. Has there been progress over ti me
or are all styles but attempts to recover the
perfect practice of the found ing fa thers?
As a practice that defines itself in rela tion to a
series of canonical texts and the commentar y
literature that has grown around it, Chinese
medicine is also inextricably enmeshed in the
I Volker Schei d
thickets of interpretation. The Republican-
combines academ ic
era scholar-physician Yun Tieqiao (ffl[~m research as a med ical
1879-1935) once remarked that scholars of humanities schol ar with
the Shang Han Lun could not avoid dealing clinical practice and
with the concept of the six jing t~ even if teachin g of Chinese
they could not agree among each other on medicine . He has pub-
what the term actually referred to (and, by lished two infl uentia l
implication, how it might best be translated): monographs on t he
as the acupuncture chan nels, di ffe rent areas development of Ch inese
of the body, moments in the progression of a medicine from the 17th
century to t he present:
of grouping symptom patterns, or expressions Chinese Medicine in
of a universal qi dynamic?7 At the last count, Contemporary China:
at least 30 different interpretations were in Plurality and Synthesis
circulation. Even if commentators agree on (Duke UP, 2002) and
what a term means and how it should be Currents of Tradition in
Contemporary China
translated, that meaning can still refer to
fundamentally different types of practice. (Eastland Press, 2007)
as wel l as over 30 peer-
Another example is the term zheng ~-
reviewed papers in aca-
Throughout the history of Chinese medicine
demic journals. He is the
it refers to symptoms grouped into a pattern,
main author of Formulas
& Strategies, 2nd ed.
7. Yun Tieqiao 1'ffltJt Shang Han Lun Yanjiu fl~_ llii
(Eastland Press, 2009) and
lilf9t (Research on the Treatise of Cold Damage), 1n
the Handbook of Chinese
Yun Tieqiao Yishu Heji 1'fflt!tfftl~~ (A Colle_ct,on
of Yun Tieqiao's Medical Works), 199-284. T1anJm : Medical Formulas
Tianjin kexue jishu chubanshe, 2010, 210. (Eastland Press, 2016).
Tb, Lante rn d
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bu t such pa tterning may be accomplished in
fun dame nta ll y different wa ys th at in th e pas t
1000 years have traversed a spectrum ran gi ng
Biomedicine is
fro m divine inspi ra tio n to protein mappi ng
not intrinsically 8
wi th the help of o mi cs bio tech no logies.
le ss d ivers e or
heterogeneous than From description to analysis
Ch inese medicine . In recent decades, an accepta nce of th e
There also exist essential plu ra lit y of C hinese medicine has
m ultiple points of been gai ning gro un d among scho lars and
practi tione rs. In this context , a defi n itio n of
o verlap between the
C h inese medicine as a d isti nctive and, by
traditions, historically
implicatio n. closed mt·d ical "system" reveals
and in the p resent,
itsel i to be a description not of wha t C hinese
ma king claims to med ici ne ac rn ally is and how it operates b ut
either constituting a strategy that seeks to distinguish "Ch inese
a bounded medical medicine" fro m o th er types of medi cine.
'system ' hard to H istori ans demonstra te tha t this stra tegy is
susta in. an effect of the wider d iscourse of moderni ty
that fo rces ever ythi ng that is no t "modern"
and, by implicatio n, "Western" or "scientific"
to define itself in o ppositio nal terms as
"trad itio nal': "C hinese': "ethnic'; "religio us•:
"magical" and so on. H istorians an d schol ars
of science, techn ology and medicine have
lo ng de monstrated the rh eto rical nature of
th is strategy and the great divi de between
modern ity and trad ition, the Wes t and th e
9
res t th at it implies.
Bio medicine, fo r instance, is not intrinsically
less d iverse o r heterogeneo us than Chinese
med icine. There also exist m ul tiple poi nts of
overlap between the traditions, historically
and in th e present, making claims to either
constitu ti ng a bo unded medi cal "system" hard
ro susta in. What clearly distinguish modern
bio med icine a nd pre-modern C hinese
medicine, however, are the social tools th at
bo th traditions developed to manage their
intrinsic plurality. O n th e who le, biomedi cine
relies o n burea ucratic mea ns of control
th at en fo rce stand ards of classifica tio n,
ho mogen ise contex ts of practice, and li nk
these contex ts togeth er into extensive trans-
local netwo rks. T h is is supported by a co ncept
of history as progressive th at allows fo r th e
8. Scheid , V. (2014) Convergent Lines of Descent:
Symp toms, Patterns, Constellations & the Emergent
Interface of Systems Biology and Chinese M edicin e.
East Asia Science, Techno logy and Society: An
International Journ al, 8, p p 107 -139.
9. See, for instance, Lato ur, B. (1993) We Have N eve r
Bee n Modern, Harva rd Unive rsity Press, Cam b ridge,
MA, and (2010) O n the Modern Cult of the Factis h
Gods. Duke University Press, Du rham NC.
iiiJ Vol: 17-3
consta nt replaceme nt of o ld knowlcdg,,, an d
practi ces wi th newe r eme rgent ones.
Given an o ri entatio n th at looks towards
the past fo r gui da nce o f action in th
prese nt, th a t opti o n is not available t~
C h inese med icine. Hence, th e social tools it
develo ped to ma nage diversity were different.
T he most im po rt a nt o f th ese have been
1i neage d isco urse and practices of personal
cu ltivati o n. As in th e case of biomedicine
th ese we re bo rrowed fro m o ther domains
of socia l practi ce, refl ec ting and , in turn
stabil ising taken-fo r-g ra nted but ultimate!;
discursive social rea lities.
Lineage discourse
Lineage d isco urse a llows for a plu ra lity of
"a uth en tic" (zheng IE ) practices to exist side
by side beca use, as in an ex tended fa mily,
di ffe rent pra ctices ca n cla im to be desce nded
fro m th e sa me ap ical ancestor (th e Huangdi
Neijing corpus, fo r insta nce, or th e work of
Zhang Z hongj ing), even as "heterodox" (xie
practices (sha man ism, fur ins tance, or
th e wrong interpretati o n o f nw d ,c,il canons)
ca n be excl uded fro m th e fi eld • t k gitimate
med icine fo r being o f "irreguLu i,cginnings"
(y i duan f t ~/Af ).
Lineage disco urse was th u. variously
deployed in la te imperial C h111.1 to so rt the
widely d ifferent readings o i the· ·,hang Han
Lun by th en in circul ati o n into th ,<: deemed
useful by a pa rticul ar wri ter ,id those
th at were no t. The fierce str u!,'.) , between
proponents o f cold d am age (s/J" nglian {M
~ ) and warmth disord er (u·,·,i/Jing ii&
m) therapeutics that erupted in th e 19th
century and threatened th e very co hesion of
th e C hinese medical tradition was likewise
co nd ucted largely through lineage discourse.
Fo r physicians opposed to warmth disorder
therapeutics, the innovatio ns proposed by
physicians like Ye Tianshi (~72± !66 4-
1746) were heterodox misreadings of the
·
ancient cano ns. 10
Others, mea nwhile, depicted Ye Tianshi
as th e most auth entic discipl e of Zhang
Zho ngj ing who, using a term borrowed from
Buddhist lineage discourse, had received
10. A typical example is Zhang Taiyan i;U::!k (2~,9\
Zh ang Taiyan Xiansheng Lun Shangh an ~\ Jc !R iLL 1)
follli(Mr Zhang Taiyan's Discussion of Cold Damage'
Wu Yue Hi tl/. and Lin Lin t+TI: (eds), Academy Press,
Beijing .

11
his dharma transmission. A solution,
represented in contemporaryTCM textbooks,
was finally iound by imagining the warmth
disorder current as constituting a legitimate
branch of the original cold damage tradition.
Tra nslating this social arrangement back
into the domain of clinical practice, six
chan nel/conformation/division (/iu jing A
tiifl diagnosis was deemed appropriate for
the treatment of cold damage disorders while
fo ur aspect (wei qi ying xue /ti#R;.l .Ila.) and
triple burner (san jiao -= ~ ) diagnoses were
12
defined as suitable for warmth disorders.
In his Wen Re Lun (Treatise on Warmth and
Hear ii\ll.~lffiij} Ye had explicitly stated, however,
that fo ur-aspect diagnostics was a method
applicable to both cold damage and warmth
disorders yet limited only to situations where
pathogens were in the exterior. Conservative
cold damage physicians, meanwhile, rejected
this innovation and claimed that six
channel/conformation/division (/i11 jing A
}Ji!) diagnosis was applicable to any disease
including warmth disorders. The standard
modern interpretation can only therefore be
interpreted as imposing a socially effective
solution on a still unresolved clinical problem.
Many similar examples cou ld be add uced.
The well-documented struggles abou t
whether or not Zhang Zhongjing should be
regarded as the ancestor of Chinese medical
therapeutics or as just another famous
physician nor essentially different from the
masters of the Ji n and Yuan dynasties like Li
Dongyuan ($JtV!i: 1180-1251) or Zhu Danxi
(*:ltrl 1281-1358) or even later eminent
practitioners like Xue Lizhai (ff :SZ'jffi 1480-
1558) or Yu Chang are a case in point.
Although ostensibly evaluating the value
and influence of medical writings, what was
really at stake in these debates were visions
of the world at large and of how life should
be lived: Did the most ancient past really
provide all the answers for life here and now,
or did the present require finding new and
perhaps different ways of thinking than
11, Zhang Nan fl.filj. (201 1) Yimen Banghe Hr~/4!
(A Stick to Beat Physicia ns). Zhongguo yiyao keji
chubanshe, Beijing .
12 -This "modern " sol ution was first suggested by Wu
tutong ~ ¥Iii! (1 81 3) Wenbing Tiaobian <, /!'1,/iii fLH:ll l'
Systematic Differentiatio n of Warmth Disorders) . In
Wu Jutong Ouanshu ~¥.\Jillil!i'I/J\i:m (The Complete
~edical Works of Wu Jutong). (Ed, Li Liukun * j'jhl1)
hongguo zhongyiyao chubanshe, Beijing, 1-128.
ALL THE
THINGS THAT
MADE you
feature
CHOOSE
those proposed in the classics?
Lineage discourse in the domain CHINESE
of Chinese medicine has thus always
primarily been a social tool : a method for
MEDICINE!
legitimating distinctive styles of practice
and for organising the wider field of medical _, Translations of
practice. Ir thereby assimilated and , in turn , classical texts
reflected the emergence of lineage as "a _, case histories
cultural tool for creating order" in southern
..... Practical techniques
China Uiangnan iDl-f) since the Southern
Song dynasty that from its very inception -., Embodied theory
involved the falsification of local and family ..... Yangsheng & Daoist
13
histories to that end. Given that Chinese philosophy
medicine from the Ming onward has been -., Provocative editorials
dominated by scholar physicians from the
..... PLUS a lashing of
Jiangnan region, it is not surprising that
they should have imported their wider socia l humour
practices and beliefs also into the domain of
medicine. For this reason, lineage discourse
in Chinese medicine invariably conjoi ns
beliefs, ideologies and the struggle for status
and social dominance with matters d inical.
Lineages, therefore, are rarely representations
of actual historical descent relationships hut
manipulated so as to create desi red lin..-s of
transmission from the past to the present.
In Chinese culture,lineages arc furrherm or..-
construcred through patrilineal descent from
grandfather ro father to son. As such. they
embody and aifirm male dominance and
all the cultural values that attach to it. Not
for nothing do we know wr y little about
female physicians in the history of Chinese
medicine, and it is perhaps no coincidence
that even as most practitioners of Chinese
medicine today are female, the gurus,
teachers and most visible transmitters of the
tradition, in China as well as in the West,
contin ue robe big men.
A final bur important point: in return for
providing members with a sense of identity
and allowing them to draw on a pool of
shared resources, lineages in China were
invariably organised to allocate the biggest
share of wealth, power and status accrued
by the lineage as a whole to its male leaders
and next of kin. Likewise, while any guru
depends on his acolytes as much as they
depend on him, exchange relationships
are rarely equal. At the end of the day, few
students learn all the skills of the master and
Subscribe
13. Zhang Xiaojun, "Lineage and family" , in Li Peilin
(ed .). Chinese Society - Change and Transformation,
London: Routledge, 2012: pp 68-69.
ON LINE
www.thelantern.com.a u
 feature _. ~,
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even if they did there would be room at the
top of the lineage for only one or two new
Cultivation became masters in every generation.
The question I would therefore like to
an explicit element in
pose is this: Given that we no longer live
the development of
in a cultural environment dominated by
clinical excellence only
lineage discourse, does lineage discourse
once scholars began still remain useful for ordering the field
to dominate elite
of Chinese medicine or are there perhaps
medical practice. more democratic, socially equal, historically
critical and self-reflective tools available? To
explore this question further I will turn to a
second important tool employed by Chinese
physicians to make their tradition work for _
them in practice, that of cultivation (xiu f~).
MMiBH,i
The importance of lineage discourse in
late imperial China owed much to the
Nee-Confucian scholar Zhu Xi *~
(1130-
1200), whose philosophies became state
doctrines in the course of the 14th century.
Borrowing from Chan Buddhism, Zhu Xi
had legitimised his own interpretation of
classical Confucian writings by creating for
it a lineage of authentic transmission that
placed him into a direct line to Confucius
and Mencius via a range of thinkers that
were important for Zhu Xi's philosophy but
that were not originally related to each other
through master-disciple relationships. Zhu
Xi also designed academies and ancestral
halls modelled on Buddhist temples and
their rules-based organisation and he wrote a
book on family rules that embedded lineage
ideology in the conduct of everyday life. He
was also influenced by Chan in developing
a curriculum of "self-cultivation" (zi xiu §
f~) that consisted of specific practices for
reading, learning and self-reflection and was
aimed at developing one's knowledge and
moral authority.
Of course, the importance of cultivation
in elite Chinese culture, like the notion of
lineage,predates Zhu Xi and even the arrival of
Buddhism in China. But cultivation became
an explicit element in the development of
clinical excellence only once scholars began
to dominate elite medical practice. As in the
domain of Confucian scholarship, where
Zhu Xi's curriculum remained influential
throughout the late imperial period but
was always challenged by competing
ones, no single program of cultivation in
-.---c---:-::------ - - - - - - - - - -- - - - - -- - -- - - -
lfA Vol,17-3
medicine ever gained dominance Yi
of the competing visions coni· 0·. et, all
ined ·
various ways the study of canonical t in
with methods of self-developme exts
extended from philological criticis;t th at
cultivation of empathy with one's p to the
f . . d at1ents
rhom bm_emonsanohn an rote learning t~
t e a 111ty to sync es1se a personal st 1
. from d.1verse h.1storical sources.Ye of
pracnce
The Yixue Rumen (The Norms for Stud •
Medicine) from the Ming dynasty Mer:,
Primer (if'=Art 1575), a widely re d
textbook in China,Japan and Korea, provid~
a clear example of how such cultivation was
placed at the centre of medical learning.
In the winter of 1571 Mr Lu Tinghe, Mr He
Mingshan, Mr Li Xing and his nephew
Shisi came together for a meeting [with me]
and asked: Now that the Medical Primer
has been produced, are there any rules for
studying it? I answered: Medicine is [the
art] of managing human life. One should
not lightly think of studying medicine, for
it requires substance and honesty, a quiet
and persevering [attitude], and an interest
in real knowledge and secret virtuousness.
For those who have the desire to establish
[themselves as physicians], however, I can
talk about how to use [the Primer] .
Every morning before breakfast meditate
on rl:,, Pre-Heaven Diagram and
api; rt-; iatively study the Classic of Filial
Pieiy, the Analects and the Elemental
Learning.14 Those with much natural ability
should then study all of the Four Books, the
Yijing in the original unannotated version,
the Book of History, the Great Plan, Against
Luxurious Ease and the Canon of Yao (from
the Zhou Shu). (These do not need to be
memorised by heart but merely understood
in terms of their meaning).15 Medicine is
a branch of scholarly learning. Unless one
studies and understands Ii
[l'.'l1 the principle of everything] one will
remain an uneducated philistine unable to
penetrate the transformations [underlying
the phenomena].
Before lunch you should then recite the
14. 1Hf (xiao xue). In the 1988 edition published
by the Jiangxi Science and Technology Press, this i,~
glossed as "the exegesis of ancient words or texts
(wen zi xun gu zhi xue ::/(~ i)llii'iZ $ )", but may refer
to the text Xiaoxue (the Elemental Learning!],~ ) by
Zhuxi 7'< ~ -
15. The parenthesis here are notes in the original,
brackets are explanations by the translator.
 t "ti:
. character Primer from beginning to
bigd aragraph by paragraph, leaving out
en , pne single character, una·11t· emits
.
not o . . (F "f
from the mouth m um~on. _or I you
to become a specialist m paediatrics
wan t d ..
,ou still need to stu y genera 1med1eme,
) d if you want to become a specialist in
: ternal medicine, you still need to study
internal medicine. Furthermore, there ,viii
be passages that you understand and others
that you do not, hence the text proceeds
from the superficial to the profound
and from the raw to the refined and is
therefore divided into different sections of
study). Once the text has been memorised
by repeated reading, you should then
contemplate silently on it and you ,viii then
completely understand the conceptions
within (in between the words).
Wherever you encounter problems consult
the formularies of famous physicians past
and present in order to broaden your
knowledge. Alrematively, if you can find a
virtuous and illuminated scholar, politely
inquire about the ins and ours [of his arc] .
Tao Jie'an said journey ,videly bur do not
converse with the ignorant. In studying
maceria medica go beyond the Shennong
Ben Cao Jing (Divine Husbandman's
Classic of the Maceria Medica) and in
studying principles beyond the Neijing
and the Nanjing (Classic of Diffi culties) by
reading the works of Zhang [Zhongj ing;
Liu [Wansu], Li [Gaol, and Zhu [Danxi]
Though there are minor formulas and
quick methods, in the end chey are not big
schools of thought; and be careful not to
support their slandering. Once you have
mastered chis Primer in chis way you are
then ready to become a small physician.
[After chat] continue to medicate and study
the Confu cian classics. As you gradually
understand che waxing and waning of yin
and yang apply yourself co examine people.
Gather material fro m near and far and
bring it into your office. Having aligned
yourself with heaven and earth you can
then respond co people's needs.
Individual authors and texts weighed the
importance of various elements on this
journey in different ways. Taking an ideal-
typical approach to classification, we can
distinguish three broad approaches.
The first is represented by those who
believed the ancient canons contained all the
T,.,.,
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tools necessary for also solving the clinical
proble1:1s of the present. Imputing a timeless
and universal quality into the knowledge of Some physicians
the canons, the members of this group differed compared the treatise
co_ns1derably, however, about how these tools
to the writings of
might be extracted from sources that had Confucius, while
c~mplex textual histories and were generally
others linked it to
difficult to understand. Some interpreters of
Buddhism. In the
th e Sha ng Han Lun, for instance, believed the
t~t was best understood by reading it along
early 20th century
With other ancient canons like the Neijing it was read as a
and the Nanjing. Others took precisely the representative of
opposite view. They held that the value of the proto-scientific
treatise stemmed precisely from the fact that empiricism.
it was a unique text in a class entirely of its
own and as such the purest embodiment of
a non-philosophical approach to medicine
in ancient China. Some physicians compared
the treatise to the writings of Confucius, while
others linked it to Buddhism. In the early
20th century it was read as a representative
of proto-scientific empiricism.
The second group of scholar physicians
were more ecumenical in their perceptions of
tradition.They collected available knowledge
into large encyclopaedias and attempted to
create workable syntheses (zhezh6ng ffr93)
from the many competing sources they found
in the medical literature. They produced
some of the most exhaustive compendia
of the Chinese medical tradition, from Li
Shizhen's Bencao Gangmu (Comprehensive
Ma ceria Medica) to the imperially sponsored
Yizang Jinjian (Golden Mirror of the Medical
Tradition). But precisely because they were so
comprehensive they could also be unwieldy,
and because each author produced his own
synthesis they forced the next generation to
do precisely the same yet again.An important
subset of this second group therefore focused
on the process of cultivation itself, mapping
out steps and techniques that would lead one
from being a novice to becoming an expert.
The third group were the innovators of
tradition. Because sooner or later ancient
knowledge was always found wanting, the
question of how co deal with treatment
failure constitutes a recurrent topic in the
literature. In response, some physicians
focused on identifying and correcting errors
in the ancient texts and their interpretations,
while others pushed medical practice into
new (sometimes radically new) directions.
None of these approaches was mutually
Tb, Lantern m
 feature ·· :

''
My brief and
somewhat simplistic
review of how the
exclusive, of course, and different physicians
and authors combined them in different
ways. These approaches endure into the
present: be it in the various jingfang ffl.1f
styles now in vogue whose proponents agree
with each other that the key to successful
Developing such individual authority
demands that we provide students, novices
and experienced practitioners with tools that
allow them to develop the style of practice
most suited to themselves and their contexts
field of medicine has of practice while, simultaneously, enhancing
practice is found in the ancient canons but their connection to the tradition as a whole.
traditionally been
disagree on how what is found there should For just as the tradition nourishes each of
ordered in China and be interpreted and put into practice; be it in us individually, together we are the very life
throughout East Asia the shape of "traditional Chinese medicine': blood of the tradition that vitalises us.
can be condensed "Kam po" or "Korean oriental medicine': all of Having engaged with this problem for
into a simple but which are essentially attempts at synthesising considerable time I have arrived at "meta-
important observation: distinctive national styles of practice from practice" as a path most suited to lead us
16
there is no 'authentic' the many sources of tradition. Furthermore, towards th is end. I define meta-practice as
Chinese medicine out if lineage discourse attempts to order the the husbanding of our tradition's plurality
field of medical practice through imagined without in the process constraining its
there that we must
social relationships of inclusion/exclusion, productive vitality. Put another way, it is a
strive to recover and
cultivation frequently combines the tools of method for sorting what to keep and what
then put into practice. scholarly research and experiential practice to let go and how to align different modes
towards the same end.
of thinking and practising in pmd uctive
ways without insisting on their u1 ·derlying
Meta-practice
sameness or aiming for a total ':,-nrhesis.
My brief and somewhat simplistic review of Meta-practice proceeds from ackno,, 1edging
how the field of medicine has traditionally not only the constitutional plurah . of the
been ordered in China and throughout Chinese medical tradition but a!s» the
East Asia can be condensed into a simple
messiness of the world beyond. It a, l'e pts
but important observation: there is no
that the messiness of the world an,.! our
"authentic" Chinese medicine out there that
limited ability to understand it inva r-·, bly
we must strive to recover and then put into
produces different modes of construe. , .:ly
practice. lnstead, Chinese medicine is forever
engaging with that world. But it also a, -. es
newly created and enacted in the present by
that judgments can be made between b~r;a
physicians, patients and other stake-holders
and worse forms of engagement, and that :ls a
(scholars, the state, industry, universities,
consequence difference is not limitless. Nor,
professional associations). Our task, as
in as much as they all engage with the same
students, novices or masters, is thereby
world, are different modes of engagement
redefined from a quest for authenticity to one
incommensurable with each other.
of constructive discovery. How and with what
For instance, there exists a range of
resources do we construct the best possible
different ways of imagining, mapping and
medicine for our patients in the present?
engaging with the body in the Chinese
There is no right answer to this question,
medical tradition: the body of organ systems;
but there are better and worse ones. To begin
a body inhabited by spirits; a body of flesh
with, we can explicitly define and debate the
and blood; a topographical body of different
values and goals we want to see embodied in
regions and landscapes; a holographic body,
the medicine we practise and the tradition to
and so on. Chinese medicine also employs a
which we belong. I personally, for instance,
range of different logics to understand and
would value a democratic tradition modelled
manipulate these bodies: logics of resonance
on the Greek polis (one that seeks to cultivate
and cosmology that connect microcosms
each of its members as an authoritative voice
and macrocosms at many different levels
in public debate) over one that vests ultimate
of order; logics of contiguity that connect
authority in ancient ancestors whose voices, anatomical body parts; logics of flow that
precisely because they cannot speak to us
directly, need others to speak for them and 16. I use "most suited" in the relative sense of
whose words are therefore always open to delivering my explicit goals based on what I know at
manipulation by those who do the speaking. present. I am open not only to being challenged but
even more so to improvements of the concept.

m Vol:17-3

enlive n th e networked body of conduits and
channels ; logics of co mmuni ca tion between
humans and non-humans th at all ow access
to bodily spirits ; and so on. These di ffe rent
bod ies and the logics through which we
understand them are clearly different, yet
they can be constructively translated into
each other. Meta-practice is the process of
bringing into consciousness these di fferences
rath er th an lumping them together into one
system. Th is allows fo r choices to be made as
well as for consistent im provement.
Let me give a clinical exa mple. I recently
treated several patients wi th one-sided pain
along the course of the foo t lesser yang
Gallbladder channel. The patients d id not
share a co mm on constitu tional d isposition.
None showed typica l signs of a lesser yang
disorder. From a TCM perspective, these
patients had different pathologies tha t (listing
only the most important patterns) ranged
fro m damp-heat toxin to Spleen deficiency
phlegm d ampness, Liver qi de ficie ncy and
blood stasis. Focusing on pathologies of qi
tra nsform atio n, the o nly pathology they
shared was an aspect of stagnation and
stasis. In terms of the perspectives I am
famili ar with, they did no t have a common
constitutional d isposition.
Treating these patients raised conceptual
and practical questions fo r me. Conceptually
I would like to become clea rer about the
precise pathways that lead to constraint
and stagnation in the Gallbladder channel.
Practically, I would like to kn ow how I can
select the most effective trea tments for each
case out of th e too lbox I am fa mil ia r with
or, if this too lbox does no t already contain
them, where I would fi nd th em. I assume that
answeri ng the first question leads directly
to answering the second. I also assume
th at I ca n answer both of these questions
on ly if I consider different perspectives of
understanding and treating this problem.
As to how th ese questions might be
answered , it is clear to me th at these cases
strongly qu estion an interpretation of the
six Jing as equating to the acupuncture
chann els. I also kn ow that this reading has its
historical roo ts in attempts by Song dynasty
interp re ters o f th e Shang Han Lun to align the
tex t with th e acupu ncture body as described
in th e Huangdi Neijing. It was forcefully
challenged by 17th-century physicians who
. · feature
brought new methods of critical scholarship
to the reading of classical sources that led
them to interpret the jing as descriptions of For just as the
bodily topography, regions transversed by the tradition nourishes
acupuncture cond uits but not eq ual to them. each of us individually,
T his interpretation accords more closely together we are the
with my own clinical observations. From here very life blood of
I can begin a journey of discovery that tries
the tradition that
to further explore the difference between
and rela tionships of channels and bodily
vitalises us.
topography. I have also gained clinically in
as mu ch as I now have two different modes
of thinking about Gallbladder channel
constraint presentations without having to
tr y to conflate one with the other.
To give an other example, what changes if I
see the bones as belonging to the Kidneys or
as constituting a distinctive bodily structure
d ifferent from but functionally related to
the muscles and sinews? How are these two
perspectives related' Where and when does
focus ing on that connection stop yielding
results' Clearly we can successfully fix a
broken bone without ever thinking about
the Kidneys, and perhaps thinking about
them will get in the way of doing the fixing.
Yet, knowing about the connection between
essence, the Kidneys and the bones helps us
explain why athletes who train too much
whi le eating too little suffer brittle bones.
We can explore how historical authors have
engaged with these questions and how they
have answered them theoretically and in the
clinic, where they have gone wrong and where
it has yielded results. We can experiment with
different answers in our own practices and
even come up with novel solutions. As is the
case with speaking different languages, being
poly-lingual does not only not diminish one's
proficiency in any single language but on the
contrary enhances it even as it also allows
one to see the same world from somewhat
different perspectives at once.
This adds a dimension to teaching, learning
and cultivation not much emphasised in an
education system (irrespective of whether
university or lineage based) that focuses
on selective content. It also asks much
more of teachers, of course. Teaching meta-
practice skills demands a level of proficiency
in different ways of knowing and doing
Chinese medicine, and of being able to I Part 2 will appear in the
translate between them-or desisting, for January 2021 issue of The
good reasons, from such translation. Lantern.
Th, Lantem m