Historical epistemology and the making of modern Chinese medicine 9781784991906

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Historical epistemology and the making of modern Chinese medicine

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Historical epistemology and the making of modern Chinese medicine Edited by Howard Chiang

Manchester University Press

Copyright © Manchester University Press 2015 While copyright in the volume as a whole is vested in Manchester University Press, copyright in individual chapters belongs to their respective authors, and no chapter may be reproduced wholly or in part without the express permission in writing of both author and publisher. Published by Manchester University Press Altrincham Street, Manchester M1 7JA www.manchesteruniversitypress.co.uk British Library Cataloging-in-Publication Data A catalog record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data applied for ISBN 978 07190 9600 6 hardback First published 2015 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Typeset by Out of House Publishing

For Benjamin Elman and Angela Creager

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Contents

List of figures Notes on contributors

page ix xi

Acknowledgments

xiv

Note on transliteration

xvi

I  Introduction

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1  Historical epistemology and the making of modern Chinese medicine

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Howard Chiang II  Objects

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2  Within the lungs, the stomach, and the mind: convergences and divergences in the medical and natural histories of Ginkgo biloba

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Kuang-chi Hung 3  Bodily knowledge and western learning in late imperial China: the case of Wang Shixiong (1808–68)

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Yi-Li Wu 4  Blood in the history of modern Chinese medicine Bridie Andrews

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Contents

viii III  Authority

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5  The only options? “Experience” and “theory” in debates over forensic knowledge and expertise in early twentiethcentury China

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Daniel Asen 6  State power, governmentality, and the (mis)remembrance of Chinese medicine

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David Luesink 7  Slow medicine: how Chinese medicine became efficacious only for chronic conditions

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Eric I. Karchmer IV  Existence

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8  Metaphysics at the bedside

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Judith Farquhar 9  How to make “acubabies”

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Leon Antonio Rocha Index

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Figures

2.1 Ginkgo’s “breasts.” Okada Kei (岡田啓), Owari meisho zue: kan 7 (尾張名所図会:卷7), in Dai Nihon meisho zue: Dai 1 shū dai 9 hen (大日本名所図会:第1輯第9編), ed. Dai Nihon meisho zue kankōkai (大日本名所図会刊行会) (Tokyo: Dai Nihon meisho zue kankōkai, 1919), 183.

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2.2 A painting of the ginkgo drawn by a local Chinese artist. Albert C. Seward and J. Gowan, “The maidenhair tree (Ginkgo biloba, L.),” Annals of Botany 14.1 (1900), Plate VIII. Image courtesy of Oxford University Press.

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2.3 Wilson’s picture of the ginkgo taken during his expedition to Japan in 1914. Image courtesy of the Eastern Asian Historical Photograph Collections, the Arnold Arboretum, Harvard University, MA.

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2.4 The sequoia and the heart. Willmar Schwabe, Crataegutt Fibel: Crataegus in Klinik und Praxis (Karlsruhe: Willmar Schwabe, 1960), 25. Image courtesy of Dr. Willmar Schwabe GmbH & Co. KG. © Dr. Willmar Schwabe.

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3.1 Wang Qingren’s revisionist diagram of the structure of the stomach, which he based on his observation of corpses. Wang Qingren, Yilin gaicuo (Correcting the Errors of Doctors), 1st edn. (1830). Image reproduced from the Shu ye de ji woodblock reprint of 1847, courtesy of the Needham Research Institute Library.

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4.1 Tang Zonghai used missionary anatomical drawings to give structure to the outer, wei, defensive layer of the body. Tang Zonghai, Zhongxi huitong yijing jing yi (1892). Image courtesy of Harvard-Yenching Library.

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List of figures

4.2 Advertisement for a blood tonic made by a French company. China Medical Journal (1921).

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4.3 Advertisement for Dr. Williams’ “Pink Pills for Pale People.” Guanghua yiyao zazhi (1937). Image courtesy of the Library of Beijing University of Chinese Medicine.

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4.4 Advertisement for “Chilai blood tonic.” Zhong-xi yixue bao 3 (1919).

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4.5 Another advertisement for “Chilai blood tonic.” Liang you (November 1939).

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6.1 “Inaccurate” Chinese view of the body vs. the “accurate” western view of the body. National Medical Journal 1.1 (1915): 52. Courtesy of the New York Academy of Medicine Library.

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Notes on contributors

Bridie Andrews received her Ph.D. from the University of Cambridge, and is currently an associate professor of history at Bentley University in the Boston, MA area. Her book, The Making of Modern Chinese Medicine, 1850–1960, was recently published by the University of British Columbia Press. She is the coeditor of two volumes examining the role of modern medicine in the nonwestern world, and of a volume edited with Mary Brown Bullock on Medical Transitions in Twentieth-Century China. Daniel Asen received his Ph.D. in modern Chinese history at Columbia University and is currently Assistant Professor of History at Rutgers University–Newark. His research interests include the intersection of law, science, and medicine in late imperial and Republican China; the cultural and social politics of expertise; and the history of death and the body. His publications include “Vital spots, mortal wounds, and forensic practice: Finding cause of death in nineteenth-century China,” East Asian Science, Technology and Society 3.4 (2009): 453–74; and “‘Manchu anatomy’: Anatomical knowledge and the Jesuits in seventeenth- and eighteenth-century China,” Social History of Medicine 22.1 (2009): 23–44. Howard Chiang is Assistant Professor of Modern Chinese History at the University of Warwick, UK. He received his Ph.D. and M.A. in the history of science from Princeton University, after completing his M.A. in quantitative methods in the social sciences at Columbia University and his B.S. in biochemistry and B.A. in psychology at the University of Southern California. He is the editor of Transgender China (2012), Queer Sinophone Cultures (2013, with Ari Larissa Heinrich), Psychiatry and Chinese History (2014), and Perverse Taiwan (forthcoming, with Yin Wang). His forthcoming monograph examines the historical and epistemological transformations of sex in twentieth-century China. Judith Farquhar is Max Palevsky Professor of Anthropology and of Social Sciences at the University of Chicago. Her research has focused on

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Notes on contributors

epistemological questions in the modern practice of traditional Chinese medicine as well as on embodiment in everyday life. She is the author of Knowing Practice: The Clinical Encounter of Chinese Medicine (1994) and Appetites: Food and Sex in Post-Socialist China (2002), and the co-editor (with Margaret Lock) of Beyond the Body Proper: Reading the Anthropology of Material Life (2007). More recently she co-authored, with Qicheng Zhang, Ten Thousand Things: Nurturing Life in Contemporary Beijing (2012). Her current work, in collaboration with Lili Lai, examines projects to salvage and sort out minority nationality traditional medicines in China. Kuang-chi Hung is Assistant Professor in the Department of Geography at National Taiwan University. A former student in forestry and forest sciences at the National Taiwan University, Hung received his Ph.D. in the history of science at Harvard University in 2013, specializing in the history of biology, the history of science in East Asia, and the geography of knowledge. Hung has published articles covering topics on the reception of Darwin in Japan, the history of forestry, and nineteenth-century biogeography in the Intellectual History Review, Harvard Papers in Botany, and an edited volume on the environmental history of Japan. He is currently turning his dissertation, under the title “Finding patterns in nature: Asa Gray’s plant geography and collecting networks (1830s–1860s),” into a book manuscript, and completing a study on the Smithsonian’s archaeological expeditions in China during the 1920s and the 1930s. The latter project is based on his research conducted at the Smithsonian Institution Archives as a Smithsonian postdoctoral researcher and at the Needham Research Institute as D. Kim Foundation Postdoctoral Fellow. Eric I. Karchmer is Assistant Professor of Anthropology at Appalachian State University. He is a medical anthropologist (Ph.D., University of North Carolina, 2005) and a practitioner of Chinese medicine. His academic interests include contemporary Chinese society, science studies, the politics of knowledge, colonial and postcolonial societies, and the history of medicine. As part of his dissertation fieldwork, he completed the standard five-year medical degree program at the Beijing University of Chinese Medicine, earning a Bachelor’s of Medicine in the field of Chinese medicine in 2000. He has written about the hybridity of traditional healing practices in contemporary China and currently has a book, Double Truths: Postcolonial Transformations in Chinese Medicine, under review at the University of Pennsylvania Press. He has also been working as a licenced acupuncturist in the State of North Carolina since 2001. David Luesink is Visiting Assistant Professor in the Department of History at the University of Pittsburgh. He is first editor of a collected volume of Chinese and American scholarship, to be called China and the Globalization of Biomedicine, and is revising a manuscript, The Body Politic and the Body

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Anatomic in China based on his 2012 dissertation from the University of British Columbia. Leon Antonio Rocha is Lecturer in Chinese Studies at the Department of History, University of Liverpool. Yi-Li Wu is a research fellow of EASTmedicine, Division of Herbal and East Asian Medicine, Department of Life Sciences, Faculty of Science and Technology at the University of Westminster, and a Center Associate of the Lieberthal-Rogel Center for Chinese Studies at the University of Michigan. Her publications include Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China, which was awarded the 2011 Margaret W. Rossiter Book Prize of the History of Science Society. She holds a Ph.D. in history from Yale University and taught for thirteen years in the history department at Albion College. Her current book project examines the history of trauma medicine in China.

Acknowledgments

The inspiration for this volume materialized under the tutelage of Benjamin Elman and Angela Creager in the years of my graduate study at Princeton University. The breadth of Ben’s and Angela’s erudite knowledge proved to be far more than what my insatiable appetite for theory and intellectual history could absorb. Their mentorship led me to immerse myself deeply in the literature on historical epistemology and to think about its relation to the history of East Asian science and medicine. This is reflected not only in the various response papers that I wrote for their seminars, but also in the dissertation that I eventually completed under their co-supervision. In light of their impact on my intellectual development, it is to them that this book is dedicated. For the reproduction of the cover image (which also appears in Chapter 6), I gratefully acknowledge a contribution from the Wellcome Trust Strategic Award titled “Situating Medicine: New Directions in the History of Medicine,” which is administered by the Centre for the History of Medicine at the University of Warwick. This volume is the brainchild of a major international conference that I co-organized with Carla Nappi and Volker Scheid in 2010. The title of the conference was “The (After)Life of Traditional Knowledge: The Cultural Politics and Historical Epistemology of East Asian Medicine,” and it was hosted by the EASTmedicine (East Asian Sciences and Traditions in Medicine) Research Centre at the School of Life Sciences, the University of Westminster in London, on August 20–1, 2010. I acknowledge the Chiang Ching-Kuo Foundation for International Scholarly Exchange for providing a European Region Conference Grant (CS-007-U-09), and the Arts and Humanities Research Council for a Traditional East Asian Medicines Research Network Grant that made the conference possible. I thank my co-organizers, Carla and Volker, for seeing the project through its different stages, and all of the speakers who shared their groundbreaking research in the summer of 2010. Because of Carla’s and Volker’s expertise, we were able to put together a program that was much more chronologically and geographically diverse than the scope of what is represented in this present volume. Although I invited only those papers that focus

Acknowledgments

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on Chinese medicine in the modern period for inclusion in the anthology, this decision should by no means undervalue those conference papers that have been left out. The choice merely serves the strategic purpose of producing a volume that is concise, focused, and manageable in scope. I hope the dialogues and debates generated by this book will further our thinking on the history of medicine across the whole of East Asia and, indeed, the globe. Howard Chiang

Note on transliteration

East Asian names are given in the customary order, with family name preceding personal name. Names of authors with works in English, however, follow the order given in the publication and the author’s preference for the use of macrons.

I

Introduction

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Historical epistemology and the making of modern Chinese medicine Howard Chiang The history of Chinese medicine is undergoing a sea-change. Scholars have engaged independently and collectively in re-imagining the discipline, contextualizing it in an unprecedented way within a broader context of the translation, transmission, and global circulation of knowledge.1 This is in many ways a new and exciting field, informed by questions that are meant to explore the emergence of different ways of knowing in and beyond modern China, rather than taking the existence of a “tradition” for granted.2 Though much groundbreaking work is resulting from this transformation of the field, no single volume has consolidated, synthesized, and presented this new history to a wide and non-specialist readership. Historical Epistemology and the Making of Modern Chinese Medicine showcases the work of an international and interdisciplinary company of scholars working at the forefront of the new history of Chinese medicine, creating a dialogue with the broader community of historians and philosophers of science. By addressing the questions of historical continuity and rupture, of epistemic heterogenization and hybridization, and of the global and regional transformations of Chinese medical knowledge, this book combines the philosophical concerns of epistemology with the cultural politics of transregional medical formations. It argues that the historical study of Chinese medicine in the modern period must be at once philosophically sensitive and transnational in scope.3 Historians of western science and medicine have produced a flourishing literature around the idea that even the most basic elements of knowledge-making have histories. Under the rubrics of “historical epistemology,” “historical ontology,” “epistemological history,” and “applied metaphysics,” path-breaking scholars such as Lorraine Daston, Arnold Davidson, Ian Hacking, and HansJörg Rheinberger have demonstrated that many of the most timeless-seeming of the ideas that we use to understand the world are in fact contingent, having emerged from and gained grounding in particular historical contexts.4 Among this group, Daston has provided the most explicit definition of historical epistemology: “the history of the categories that structure our thought, pattern our arguments and proofs, and certify our standards for explanation.”5 Their

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work on the construction and transformation of concepts of evidence, scientific objectivity, and personhood has fundamentally reoriented the terrain of the history and philosophy of science and medicine, proving to be an indispensable source of inspiration for a new generation of scholars. Despite this, however, scholars of East Asian science and medicine have not had the chance to come together and direct similarly inspired questions toward reappreciating the foundations of their own intellectual discipline. In doing so, the following chapters advance historical epistemology in fresh ways that de-center its presupposed Euro-American universality. This anthology emerged from an awareness that a growing number of scholars of modern Chinese medicine were independently beginning to raise questions about core concepts that had long characterized work in their field, but had not had the opportunity to share their work in a collaborative setting. Co-organized by Carla Nappi, Volker Scheid, and myself, a resulting international conference was held at the University of Westminster in London in August 2010 that invited historians working at the cutting edge of scholarship on East Asian medicine to engage with the philosophical concerns of epistemology, the thick descriptive modes of critical analysis, and the tools of cultural studies. A selection of the conference papers  – those focusing on Chinese medicine in the modern context  – has been revised considerably in the intermittent years and forms the basis of this collection. The chapters each raise and debate questions, problems, and insights concerning the foundation and evolution of Chinese medical knowledge, such as through parsing out and re-examining critically its most fundamental elements – of “object,” “text,” “tradition,” “disease,” “locality,” “efficacy,” “narrative,” and “the body” – as opposed to taking “Chinese medicine” as a given and coherent category, in order to inspire new questions and directions in the field.6 This book is divided into three sections. The first set of essays explores the role of objects in the modern transformations and global circulation of Chinese medical knowledge. The concept of “object” is invoked here in the sense of material objects but also of the object of knowledge, both of which are understood as interconnected elements in the enumerations of “objectivity” in modern science and medicine.7 The second cluster of essays examines the various kinds of struggle for cultural authority in the development of Chinese forensic and medical sciences since the Republican period (1911–49). The last section of the volume revisits the questions of metaphysics and ontology in a transnational frame for the study of the historical conditions of Chinese medicine’s existence in the post-Mao era. Unfolding in a loose chronological thread, the chapters embody overlapping themes that easily supersede the sectional headings, but they are organized and presented in a way whereby the later essays feature a stronger culmination of the thematic strands emerging from the earlier parts of the book.

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Since landmark studies in historical epistemology rarely navigate outside the intellectual landscape of western science and medicine, this book aims to broaden the theoretical-methodological approach of science studies by exploring the rich cultures of Chinese medicine, thereby adding a new dimension to its history and practices of knowledge-making. Meanwhile, scholarship emerging in recent decades from the growing field of East Asian Science and Technology Studies (EASTS) offers a timely opportunity to bring the history and philosophy of science to bear more closely on one another for inter- and intra-Asian regional inquiries and beyond.8 This volume takes the rich theoretical insight of postcolonial EASTS seriously, pronouncing innovative, robust, and critical perspectives on historical epistemology in a transnational framework through the themes of objects, authority, and existence.9 But before we delve any further into the main themes of the book, we must first consider the meaning and historical context of historical epistemology itself. Historical epistemology in context Historical epistemology emerged in the last two decades or so as a distinct area of scholarly inquiry at the intersections of continental philosophy, analytical philosophy, and the history, anthropology, and social studies of science (including medicine). During the 1990s, an early strand of historical epistemology explored the question of what constitutes evidence across scientific and non-scientific disciplines, from literary criticism to history to biology. The classic reference here is Questions of Evidence: Proof, Practice, and Persuasion across Disciplines (1991), coedited by James Chandler, Arnold Davidson, and Harry Harootunian. Advocates of historical epistemology in science studies subsequently turned their attention to expanding on key concepts such as break, contingency, paradigm, language, episteme, genealogy, objectivity, style, and the concept of concept itself.10 These key terms have served as pivotal building blocks in the development of historical epistemology as a field and an approach. That is to say, these concepts in some form have always played a central role in historical and philosophical inquiries into science and medicine. But it is only within the past two decades that scholars have begun to single them out and make them cohere around this new mode of analysis labeled “historical epistemology.” There are several variations of historical epistemology developed around the question of being (historical ontology), the economy of knowledge production (moral epistemology), the use of images (visual epistemology), the role of things (material epistemology), and the salience of gender (feminist epistemology). Major historical epistemologists whose work has contributed to these alignments and methodological crystallizations include Arnold Davidson, Ian Hacking, Lorraine Daston, Peter Galison, Mary Poovey, Bruno Latour,

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Hans-Jörg Rheinberger, and, we might even add here, Donna Haraway.11 When this group of scholars first used the expression “historical epistemology,” they meant to convey a general concern with broad or organizing concepts that have to do with knowledge, reason, argument, objectivity, rationality, evidence, and even fact and truth. These concepts that sound so basic, grand, and “natural,” like free-standing objects without history, they argue, are in fact highly contingent – the meaningfulness of these ideas having developed and gained grounding only in specific historical contexts. By challenging the seemingly constant and timeless status of these rudimentary but pivotal dimensions of scientific thought and practice, historical epistemologists stress contingency and situatedness – both chronologically and spatially – over ahistorical constancy.12 Henceforth, a crucial feature of historical epistemology, especially as exemplified by the various research projects undertaken by Daston and her collaborators, takes into account the coming into being and passing away of objects of scientific study, which, they have shown, actually change significantly over time.13 Many of Daston’s contemporaries – from Davidson to Haraway – have drawn inspirations from the writings of Michel Foucault, who was deeply influenced by the work of Georges Canguilhem and Gaston Bachelard, among other French philosophers. But before we turn to the 1960s, a crucial decade during which French theory was creolized around the world and helped establish the conceptual foundations of what we call historical epistemology today, let us reach further back in time to understand the earlier intellectual developments in the history and philosophy of science as constituting the epistemic basis for the watershed sixties.14 My goal here is to integrate the various genealogical groundings of historical epistemology. After sketching out the intellectual context from which historical epistemology emerged, I will go on to argue against the sociological framework of “medicalization” and for historical epistemology as the most adequate approach to historicizing the emergence and transformations of Chinese medical objects, authority, and existence. Situated within a deeper historical perspective, the origins of historical epistemology can be traced to the late nineteenth century, when positivism in science invited a mounting measure of criticism. Interestingly, this early “turn” to historicizing epistemology, or ways of knowing, began with critical reflections on the work of scientists by scientists themselves. The Berlin physiologist Emil du Bois-Reymond took the lead in disputing the foundations of the basic concepts with which the nineteenth-century mechanical paradigm of scientific knowledge operated.15 The Austrian physicist Ernst Mach similarly asserted that “The science of mechanics does not comprise the foundations, no, nor even a part of the world, but only an aspect of it.”16 In the late nineteenth and early twentieth centuries, the French philosopher of science Émile Boutroux expanded on the idea of contingency to break up the determinism of classical mechanics;17 the mathematician-physicist-engineer Henri Poincaré, Boutroux’s brother-in-law, espoused a moderate notion of conventionalism

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as a new mode of scientific self-reflection that challenged an all-embracing metaphysical system;18 and the Viennese sociologist Otto Neurath spoke of “the logical structure of [scientific] theories” and the ways in which history of science could help explain “how they may develop.”19 Given the predominant scientific background of these turn-of-the-century authors, it is important to note that the development of historical epistemology has relied on the mutual influences of academic philosophy and the sciences: that is, the maturation of historical epistemology did not simply depend upon the sophistication of a branch of the former discipline alone. Over the course of the twentieth century, the new interest in historicizing epistemology was characterized by a shift from finding out the most adequate method of conducting objective science (and experiments more specifically) to the careful investigation of what scientists did and how that directly shaped the object of their knowledge and practice, which was no longer deemed as historically transcendental or presupposed as an a-priori norm. As Hans-Jörg Rheinberger has noted, “The question now was no longer how knowing subjects might attain an undisguised view of their objects, rather the question was what conditions had to be created for objects to be made into objects of empirical knowledge under historically variable conditions.”20 As the century drew to an end, the term “historical epistemology” had been popularized by a new generation of historians and philosophers of science; quantum theory had long brought the natural sciences out of an ontological positivism that dominated classical physics; and scientists in general had come to acknowledge and readily accept a new scientific multiculturalism – the necessary coexistence of multiple forms and disciplines of the hard and soft sciences.21 Indeed, this was the result of generations of debate about the feasibility of the goal of a unified science that reverberated throughout the century.22 Although the realignment of agency in scientific knowledge production with respect to the subject–object relation can be said to have begun in the fin de siècle, it took a decisive turn after the global shock brought about by World War I. For the first time, popular attitudes toward scientific progress, the general ambivalence toward scientific development as a means of social construction or destruction, and the entangled relationships between science and technology, science and industry, and science and humanism all came under vehement re-evaluation and reached a crescendo after 1918. In the 1920s and 1930s, these large-scale reassessments not only reoriented Marxist “externalist” historians of science to dig deeper into the social, political, and technological conditions for the production of scientific knowledge, as represented by the works of Boris Hessen and Henryk Grossmann;23 the far-reaching repercussions of the Great War also led to an intensification of the “internalist” approach, which came to conceive of scientific development beyond the mere accumulation of facts and knowledge, but ultimately, and most significantly, in terms of revolutionary breaks.

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Key contributions to this “internalist” shift in the interwar period came from the work of the French philosopher of science, Gaston Bachelard, and the Polish immunologist and theorist and sociologist of science, Ludwik Fleck. In his book, The New Scientific Spirit (1934), Bachelard argued for the existence of an “epistemological break” between expert scientific knowledge and everyday common sense, a division for which what he called “epistemological obstacles” played an important role.24 He described scientific development as a process of realization. What mattered most to observation and empirical knowledge, according to Bachelard, was not scientific reality (or what science is), but what science can be. He also picked up on the idea of historical contingency from earlier writers to highlight the “recurrent” feature of scientific discovery: that is, the truths of yesterday always become the errors of today. The appearance and disappearance of the scientific status of truth translate into an eternal change over time, a repetition embedded within what can be conceived more generally as the historicity of science itself.25 This “historicity of science” also undergirded the writings of Fleck, for whom the concepts of “thought style” and “thought collective” formed central components of modern scientific practice. By “thought style,” Fleck meant a style of thinking that prepares the members of the same “thought collective” to be directed toward a uniform perception of scientific fact. Through the mutual exchange of ideas or intellectual interaction within a “thought collective,” scientific fact is no longer the starting point of observation, but historically generated only through a habit of perception shared by the same community of a style of knowing and understanding. Fleck elaborated on these ideas most substantively in his seminal essay, The Genesis and Development of a Scientific Fact (1935).26 The concept of “thought style,” suggesting a nodal point of epistemic convergence, would later be appropriated by Thomas Kuhn in his proposition of “normal science” by recasting “thought style” as the gradual internalization of external signals of resistance.27 Again, both Bachelard and Fleck developed their ideas in the aftermath of the scientific shock that quantum theory brought on to classical physics. After World War I, the series of new findings that centered on the uncertainty principle, following Niels Bohr’s orbital theory of electrons, questioned the relationship between the observer and the observed in scientists’ perception of atomic phenomena like never before. Even the quantum physicist Werner Heisenberg himself conceded, “The scientific method of analyzing, explaining, and classifying has become conscious of its own limitations, which arise out of the fact that by its intervention science alters and refashions the object of investigation.”28 As a result of this challenge to classical physics, one could no longer avoid the existence of theoretical alternatives, even in the hard sciences. In their respective efforts to historicize epistemology, Bachelard and Fleck expounded a theory of knowledge-formation that maintained the established “scientific fact” in a state of permanent provisionality and constant lack of closure.

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After Bachelard’s and Fleck’s revisionism, the development of historical epistemology took another epic turn in the post-World War II period with the publication of Thomas Kuhn’s The Structure of Scientific Revolutions (1962).29 Although the appearance of this landmark study proved to be a watershed episode in the history and philosophy of science, Kuhn, an American physicist, wrote the book at a time when other scientists and influential philosophers across the Atlantic had already touched on issues that would become central to his own thinking.30 For example, one cannot ignore Karl Popper’s critical rationalist philosophy (especially as articulated in his 1935 book, The Logic of Scientific Discovery); Edmund Husserl’s attention to the role of writing in the formation of novel meaning (a theme that would later resurface in the deconstructionist theory of Jacques Derrida); or what Ernst Cassirer called a “cultural object,” whose coming-to-be and going out of existence gave the physical itself new functions and meanings.31 Similarly, one might add here that the connections Martin Heidegger drew between a scientific object and the broader project by which such an object was circumscribed specified a procedural relationship that determined the accessibility and, by extension, intelligibility of why and how certain objects become objects of scientific reasoning.32 Closer to Kuhn’s time, Stephen Toulmin applied the concepts of variation and selection from evolutionary biology to his understanding of science as an ensemble of ideas and techniques with constantly shifting aims and preoccupations.33 The kind of historical philosophy of science that Toulmin envisioned combined the historian’s habit of chronicling with the philosopher’s task of formal theorizing. Even in the radical relativism of Paul Feyerabend’s thinking, logical analysis of science promised only failures, because it could never register a fundamental anti-reasoning across all stages of scientific standardization: “unreasonable, non-sensical, unmethodical foreplay … turns out to be an unavoidable precondition of clarity and of empirical success.”34 Above all, Kuhn’s work cannot be understood in isolation from the notion of revolutionary break developed by the French historian of science Alexander Koyré. For Koyré, there was nothing self-evident about the achievements of Galileo and Descartes, because their accomplishments would have been viewed as completely false or even absurd in antiquity or the Middle Ages. Although his revolutionary break stretched across two centuries, Koyré’s focus on the kind of historic cleavage that characterized the findings that culminated in the Scientific Revolution bespoke the gradual turn in the historiography of science to engage with conditions that the early modern era had left behind – conditions under which modern natural science arose.35 Informed by existing ideas about the recursive formations of cultural objects and revolutionary breaks, Kuhn defined historical periods of scientific breakthrough in terms of what he called paradigms, which he understood to be historically successive and incommensurable with one another. Using the classic example of the Copernican Revolution, Kuhn contended that

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Copernicus’ contemporaries were quite correct and reasonable to dismiss his sun-centered cosmology of the universe, because it lacked credibility then. The “normal science” based on the Ptolemy or geocentric model (earth at the center) would gradually become strained only when Galileo introduced his novel ideas of (planetary) motion based on new astronomical observations, followed by Kepler’s maneuvers to arrive at the law of equal areas concerning orbital movements. Finally, with the three laws of motions, Newton’s unifying attempt championed the paradigm shift that had begun with Copernicus, Galileo, and Kepler.36 Simply put, certain themes in philosophy of science that were developed over the course of the first half of the twentieth century, such as the permanent absence of closure of scientific facts and the conditions that had to be established for an object of knowledge to consolidate its scientific status, now took center stage in Kuhn’s reworking of the conventional understanding of scientific progress, something that Kuhn himself never dismissed entirely but continued to view in terms of an evolutionary model of historical epochs. As such, by the time that debates surrounding structuralism and poststructuralism raged in the 1960s, starting in Paris but eventually reaching most corners of critical studies, a tradition of historical epistemology had already been established within a transatlantic cultural milieu. France stood out in particular, given the influence of Bachelard’s work, dating to the interwar period, but also because his successor in the chair of history and philosophy of the sciences at Sorbonne, Georges Canguilhem, in turn had a far-reaching influence that cannot be underestimated on such French philosophers as Michel Foucault, Jacques Derrida, and Louis Althusser. Unlike Bachelard, who had come to the history of science from physics, chemistry, and mathematics, Canguilhem focused his work on the history of medicine and the life sciences. What distinguished Canguilhem from earlier historians and philosophers of science, quoting Rheinberger, is that his work “represented a form of conceptual history that can also be understood as a history of the displacement of problems which must be reconstructed in their historical context,” viewing history of science, quite elegantly, itself as an “epistemological laboratory.”37 Canguilhem’s historicization of concepts of normality and pathology in medicine also set him apart from his contemporaries in that his approach clearly differentiated the “object” of science from the object of the history of science.38 Both externalists and internalists had fallen short on reflecting on the specificity of their object: while staunch externalists did not provide room for science to stand as an object with a life of its own, internalists tended to proceed without a clear distinction between their own object and the objects of the science they investigated. Therefore, when Foucault delineates four thresholds for the discursive formation of knowledge in The Archaeology of Knowledge, Canguilhem’s fingerprints are readily apparent:

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The moment at which a discursive practice achieves individuality and autonomy, the moment therefore at which a single system for the formation of statements is put into operation, or the moment at which this system is transformed, might be called the threshold of positivity. When in the operation of a discursive formation, a group of statements is articulated, claims to validate (even unsuccessfully) norms of verification and coherence, and when it exercises a dominant function (as a model, a critique, or a verification) over knowledge, we will say that the discursive formation crosses a threshold of epistemologization. When the epistemological figure thus outlined obeys a number of formal criteria, when its statements comply not only with archaeological rules of formation, but also with certain laws for the construction of propositions, we will say that it has crossed the threshold of scientificity. And when this scientific discourse is able, in turn, to define the axioms necessary to it, the elements that it uses, the propositional structures that are legitimate to it, and the transformations that it accepts, when it is thus able, taking itself as a starting-point, to deploy the formal edifice that it constitutes, we will say that it has crossed the threshold of formalization.39

With this clever scheme of different registers of knowledge-formation (though lacking definitional precision to some critics), Foucault allowed himself to associate particular earlier approaches to the history of science with a perspective that focused on certain thresholds. Traditional histories of science, oriented toward the study of the mathematical and physical sciences, tended to operate above the threshold of formalization with its narrowed preoccupation with the normative dimensions of this specific type of discourse. The historical epistemology of Bachelard and Canguilhem was carried out at the threshold defined by scientificity. For Foucault, Bachelard’s notion of “epistemological break” that divided scientific from everyday knowledge is perhaps the most exemplary of this type of history of science, pointing to this very threshold. Finally, Foucault’s own archaeological analysis, or what he described as the “analysis of the episteme,”40 was meant to direct its attention to the thresholds of positivity and epistemologization, the latter being similarly emphasized in Kuhn’s “paradigm” approach, which also gave the threshold of formalization its due. Beyond the social turn of medicalization Placing the boundaries of science and medicine at the center of historical inquiry, the French tradition of historical epistemology since Canguilhem has not only brought to the fore the internal logic of epistemology with a new focus on the medical and human sciences, but has also typified the kind of richly layered and historically grounded analysis that is absent in the sociological study of “medicalization,” an analytical framework that propelled a social turn in

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science studies starting in the 1970s.41 In 1966, Foucault first commented on the medicalization of society in The Birth of the Clinic: The two dreams (i.e., nationalized medical profession and disappearance of disease) are isomorphic; the first expressing in a very positive way the strict, militant, dogmatic medicalization of society, by way of a quasi-religious conversion and the establishment of a therapeutic clergy; the second expressing the same medicalization, but in a triumphant, negative way, that is to say, the volitization of disease in a corrected, organized, and ceaselessly supervised environment, in which medicine itself would finally disappear, together with its object and raison d’être.42

Foucault seems to suggest that inherent in medicalization lies a self-displacing logic – in order to penetrate social experience, medicine itself “would finally disappear,” together with its object and “reason for existence.” This quote clearly spells out an important feature of medicalization: it denotes a process of change over time. Perhaps for this reason, Foucault employs medicalization as an explanatory concept in his historical analysis of the emergence of the modern clinical medical perception with the rise of pathological anatomy in Europe. Since then, however, the rubric of medicalization has been appropriated and deployed more frequently by sociologists of medicine. As evident in the subtitle of the definitive book, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (2007), written by Peter Conrad, one of the first sociologists to popularize the concept, “medicalization” refers to “a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness or disorders.”43 For Conrad, what deserves scholarly attention is not whether any particular problem is really a medical problem, but “the social underpinnings of this expansion of medical jurisdiction and the social implications of this development.”44 In order to serve some analytical purpose, medicalization has a number of distinctive features. Foremost, medicalization deals with definition. To interrogate the historical and social implications for how an entity, a problem, or a type of experience becomes defined in medical terms, described using medical languages, understood through the adoption of a medical framework, or “treated” with a medical intervention, one must disregard its medical status as given and acknowledge that it needs to be defined as such. This appreciation of the defining aspect of medicalization thus also allows for the possibility of demedicalization and re-medicalization. In other words, medical categories can expand, contract, and re-expand. The preconditions for de-medicalization, according to Conrad, entail that a problem must no longer be defined in medical terms and medical treatments no longer deemed as appropriate interventions. Masturbation and homosexuality are stellar examples of categories of experience that have undergone de-medicalization.

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Meanwhile, the shortcomings of the medicalization thesis have been illuminated most clearly in the various projects of Canguilhem and Foucault to historicize the discursive formation of knowledge at the intersections of biology, medicine, and the human sciences. This is because sociological studies of medicalization have tended to neglect the epistemological developments in the history of medicine. Although “medicalization” denotes a process, it rarely questions the epistemological status of what counts as medical. In addition to the social implications of medicine, historians of medicine are equally interested in the changing definitions of health and diseases. For instance, consider Conrad’s discussion of homosexuality as a classic example of de-medicalization. Since the American Psychiatric Association (APA) removed homosexuality from its list of mental disorders in 1973, Conrad interprets the significance of this historical gesture as a decisive moment of de-medicalization. Central to this decision, scholars such as Conrad, Ronald Bayer, and John D’Emilio would argue, was the role of gay social activists, who forged a collective political consciousness in the late 1960s and early 1970s and pressured the psychiatric standards of human sexual expression.45 In this respect, what hinges the entire medicalization and de-medicalization processes of homosexuality – or, to be more precise, what is “medical” about homosexuality – is its official psychiatric status defined by the medical profession. Moreover, the engine of change is understood primarily in terms of social factors. However, the approach of historical epistemology could help us see that such a general explanation of the mental health profession’s changing view of homosexuality by referencing social pressure alone is incomplete, especially given that some psychiatric experts themselves had already begun to modify their clinical understanding of homosexuality by relying on the mid-century scientific findings of the sexologist Alfred Kinsey.46 In fact, even the juxtaposition of liberal-minded psychiatrists against conservative psychoanalysts of this period on the ground of a single epistemic frame of “science” is grossly insufficient. Historian John Forrester has convincingly argued that psychoanalysis differs from other branches of evidence-based medicine and human sciences because statistical evidence does not constitute the leading conceptual architecture of its mode of argumentation.47 Similarly, the normalizing arguments about homosexuality advocated by Kinsey’s research group were constructed within a statistical metric of normalcy that sharply contrasted with a clinical metric of normalcy that underpinned physicians’ long-standing practice of the case-study methodology. So the progressive psychiatrists were not necessarily “more scientific” than the psychoanalysts per se, but their conceptualization of sexual normality simply belonged to a different conceptual scheme with its own set of theoretical and methodological preoccupations that gradually challenged the old. With respect to psychiatrists’ evolving view of homosexuality, what we witness over time is thus a historical shift in the norms of clinical “truth” – from one that found the case-studies method sufficient for

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distinguishing the pathological from the normal to one that became increasingly grounded in the statistical notion of normalcy and socio-populational approaches.48 In the medicalization and de-medicalization of homosexuality, we witness an example of historical epistemology in action. Since the 1980s, a number of philosophers of science whose writings defy the straightforward distinctions of continental philosophy, analytical philosophy, and the history of science have appropriated the concept of “style” from Fleck and turned it into “styles of scientific thinking” (Alistair Crombie), “styles of reasoning” (Arnold Davidson), and “styles of scientific reasoning” (Ian Hacking). Referring to mathematical deduction, taxonomic inquiry, hypothetical modeling, experimental exploration, statistical reasoning, and historic-genetic thinking, Crombie asserts that “We can establish in the classic scientific movement a taxonomy of six styles of scientific thinking, distinguished by their objects and their methods of reasoning.”49 Whereas Crombie’s historical analysis tends to favor continuities over change, both Hacking and Davidson have adopted the opposite approach. Hacking calls moments of discontinuity in the history of each of the scientific styles “crystallization,” while Davidson’s study contrasts two opposing styles of reasoning chronologically and points to the late nineteenth century as the pivotal moment for the emergence of sexuality, a concept that has its own unique space of epistemological articulation and historicity but has tended to be conceived as a universal experience across time.50 Still, taken together, this group of historical epistemologists agrees on the idea that with each style of science, we are not then introduced to a new type of object and a new method of reasoning. Instead, each style is constituted of the method and the type of objects with which it is concerned. These reformulations are intended to delineate different systems of knowledge and emphasize the epistemic ruptures among them, in ways not unlike how I have stressed the differences between the statistical and the clinical conceptual schemes of sexual normality in the mid-twentieth-century United States. The reformulated analytical potential of “style” therefore correlates to not only Bachelard’s “epistemological obstacles,” Kuhn’s “paradigm,” and Foucault’s “episteme,” but also, we might add here, Gerald Holton’s “themata,” Paul Feyerabend’s “incommensurability,” Pierre Bourdieu’s “habitus,” anthropologists’ “culture,” philosophers’ “language,” and the idea of mentalités championed by the Annales School.51 If we return to Foucault’s quote from The Birth of the Clinic, it is evident that what he was referring to is not the kind of medicalization/de-medicalization process understood in Conrad’s sociological terms per se; rather, he is highlighting two notions of productive power – one positive and another negative – that work together to govern the coming into being of a medical condition socially, historically, and, above all, epistemologically: certainly through the formal establishment of medical institutions, but also through the subtle consolidation of new socializable subjectivities that emerged out of a

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rearrangement at the level of epistemic knowledge (savoir), rather than accumulated, defined, adjusted knowledge (connaissances). Distinguishing this (Foucauldian) approach of historical epistemology from sociological studies of medicalization is important, because the history of modern Chinese medicine is replete with examples that can be misread too easily as evidence for the social processes of medicalization. A central goal of this book is to revise that misrecognition by bringing to light the rise of new structures of knowledge around the epistemological transformations of Chinese medicine in the nineteenth and twentieth centuries. Having established the heuristic value of historicizing the emergence and rearrangement of knowledge à la Foucault, Hacking, and Davidson, we have come full circle to the contemporary method of historical epistemology with which we began. The objects of modern Chinese medicine A central premise of this book is that the history of modern Chinese medicine is filled with many worlds of knowledge and cannot be conceptually subsumed within one homogeneous world. As Elisabeth Hsu, Kim Taylor, and others have shown, the concept of “traditional Chinese medicine” (TCM) was invented and nationalized in the early Maoist period (1949–76). As a system of medical theory and practice, TCM was defined in national textbooks mainly as a response to the particular social, political, and economic context of the 1950s and 1960s, which helped determine the selection of politically appropriate fragments from classical sources for the creation and standardization of a medical system that would come to be widely recognized as a coherent field known as TCM.52 The 1990s marked another turning point in the historical development of TCM, echoing the broader trends in China’s political economy in its post-socialist quest for neoliberal global integration.53 Yet, even assuming fundamental historical discontinuity, the historical remaking of Chinese medicine in the modern period nevertheless relies on established theoretical foundations of earlier periods and draws from them to give credence to its newly invented association with the concept of tradition.54 This collection of essays is meant to capture the history of modern Chinese medicine in light of the large-scale transformations it underwent in the nineteenth and twentieth centuries, including the interaction of Chinese medicine with western biomedicine, its invented transformation into TCM, and the history of its globalizing trajectories. These transformations featured decisive epistemological breaks, yet, at the same time, those breaks were undergirded by fundamental continuities that framed the turning points between what came before and after. In short, the old worlds informed the new yet were never identical to them.

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The first part of this volume builds on and extends a long-standing tradition of inquiry within historical epistemology that contextualizes objects of scientific interest. Specifically, this opening section investigates the historical conditions under which certain objects of Chinese medical knowledge, meaning, and practice emerged, transformed, and, in some instances, disappeared. It also adopts a decidedly transnational approach, focusing in particular on the construction of those objects that moved across geo-national boundaries. Kuang-chi Hung’s chapter, which examines Ginkgo biloba as a medical commodity in different places and times, sets the overall tone of this section and volume as a whole. Hung demonstrates that our contemporary popular perception of ginkgo as a mental enhancer is the contingent result of centuries of thinking about the herb that converged and diverged in varying parts of the world (from Ming China to Tokugawa Japan to modern Europe), with these convergences and divergences determined by the plant’s particular relationships to agriculture, horticulture, consumer culture, taxonomy, evolutionary theory, and modern scientific and pharmaceutical enterprises. The observation that ginkgo’s changing nature mirrors fluctuating social relations may have been the only theme that remained constant throughout its history. As Hung notes, this was first articulated during the Song Dynasty (960–1279) by a famed poet and essayist Ouyang Xiu (1007–72) as a response to the sudden drop in the value of ginkgo nuts on account of their increasing availability. Ginkgo nuts’ gradual detachment from their initial status as a rare commodity led Ouyang to confirm an existing belief: that the essence of things (wuxing) reflected the nature of human relations (renqing)  – mercurial and subject to change. Ginkgo later took on a new set of social meanings through its medicalization in Ming China (1368–1644) and de-medicalization in Edo Japan (1603–1868). Li Shizhen (1518–93), who was responsible for integrating ginkgo into Chinese materia medica, specified the therapeutic potential of ginkgo nuts with respect to the “lung” (which in this historical context referred to an organ of the body according to the five-phase theory of Chinese medicine and not the physical organ found in western anatomy). In late imperial China, consumption of ginkgo nuts was considered helpful for improving conditions associated with asthma, coughing, urinary incontinency, and tearing of the eye. On the contrary, in Edo Japan, doctors rarely described ginkgo as a medical commodity; instead, contemporary Japanese writers de-medicalized ginkgo by stressing its mere status as food for consumption that helped the production of saliva and the promotion of digestion. Apart from this difference in the social meanings assigned to ginkgo, early modern Japanese and Chinese writers also diverged in their comments on its cultivation: whereas agricultural attention to ginkgo presented itself as a taboo in the Japanese literature, the Chinese placed ginkgo in sync with rural life, which helped explain the qualification of ginkgo as part of Chinese materia medica as a result of its absorption into a cosmic order shared by human beings. Hung further notes

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a significant difference in the role of ginkgo in Chinese and Japanese societies with respect to the moralities and imperatives that infused the respective social cosmos: Chinese society favored explanations that concerned the broader cosmic circulation of qi, while Japanese society tilted toward understandings of the circulation of money (or qi in the body). In the mid-eighteenth century, ginkgo finally stepped out of East Asia and began to spread over Europe and America. But even here, divergences are notably apparent. Chinese doctors in the Qing Dynasty (1644–1911), following Li’s classification of ginkgo nuts as a fruit, believed that fruits’ malignance corresponded to the social imperative that people should refrain from indulging. In Japan, writers feared that qi might congeal in the body, so they imagined fruits such as ginkgo nuts helped “lubricate” the insides of the human corporeal body. In Europe, commentators perceived the function of fruits as an efficient laxative, which helped to offset their common “fear of excrement” – fear of the body being hijacked by food’s residue. By the time that Dr. Willmar Schwabe, the company that brought the key ingredient of ginkgo that is now believed to improve cognitive function to the world, picked up the function of ginkgo as digestion promoter in the twentieth century, westerners’ enthusiasm for imagining ginkgo as “a link with the limitless past” had already been recycled and projected by Chinese writers themselves. And the emphasis on ginkgo’s status as a “living fossil” eventually found its way into the medicalization of ginkgo as a memory-enhancing herb in the late 1980s. Traditional Chinese views of ginkgo as a remedy for the lung and Japanese descriptions of ginkgo as a form of corporeal lubrication have entirely disappeared from the contemporary global imaginaries of this plant. By providing a sophisticated comparative perspective that moves back and forth between East and West, and by covering a broad range of chronological and geographical diversity, Hung’s historical epistemology goes beyond an approach to the phenomenon of de/medicalization in mere sociological terms; his narrative places the transformations of the social and intellectual status of ginkgo as a medical commodity within a longue durée, thereby showing that these processes of epistemic transmutation cannot be understood without the specificity of historical change over time. Whereas Hung focuses on the medicalization of a plant, Yi-Li Wu places bodily materiality at the center of inquiry. In Wu’s chapter and the subsequent contribution by Bridie Andrews, the “object” of analysis strictly comes from practices of conceptual engagement so that the analyses themselves proceed on the level of historicizing epistemological objects, rather than the tangible culture of medical commodities per se. The object of medical knowledge that Wu’s paper investigates is that of the structures and components of the human body in classical Chinese medicine, a realm of knowledge that has been perceived for hundreds of years by both clinical practitioners and scholars of medicine alike as underdeveloped or flawed.

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Through a close reading of the medical writings left behind by the nineteenth-century physician Wang Shixiong, a scholar doctor best known for his synthesis of the study of Warm Diseases (wenbingxue), Wu challenges a number of the premises upon which the popular narrative of Chinese anatomical ignorance and indifference unfolded. First, the popular narrative is clearly a historical residue of the European Jesuits’ encounter with Chinese medicine in the seventeenth century. In its additional dimensions, it prioritizes dissection over other means to decipher the biology of the human body and applies a false dichotomy between “structure” and “function” to the differences between western and Chinese medicine. That narrative also tends to neglect the substantial flows of knowledge across the supposed boundaries between western and Chinese medicine and characterizes Chinese medicine as “homogeneous” across time and place. By focusing on the period before the establishment of the treaty port system in China, Wu brings to visibility both the therapeutic preoccupations of Wang and the social networks in which he was immersed in order to situate anatomical knowledge in early modern China in its proper historical context. As Wu puts it, “we cannot accurately understand Chinese views of western science, technology and medicine without understanding the epistemological dynamics that historically shaped indigenous Chinese inquiries into the world around them.” At a time when China had not yet experienced maritime pressures from foreign imperial powers, the period before the 1860s gave Wang and his collaborators no unavoidable reason to express elevated interest in western anatomical knowledge, so the fact that they did offers a valuable window onto the epistemological motivations of Chinese doctors for assessing the value of western medicine (and, by extension, the potential limitations of their own training) from the standpoint of a self-confident Chinese medical tradition. Drawing from both Chinese and western sources on human anatomy and physiology, the homosocial network of male medical experts with which Wang was associated valued information gained from the investigations of not just one but multiple corpses (of animals and executed criminals) in order to systematize a consistent pattern of knowledge about the body, verify it within the general parameters of possible variations, and, as demonstrated in Wang’s own work on cholera, make enough empirical connections across the board that ultimately led to the consolidation of the medical doctrine known as Warm Diseases, whose etiological constructions directly implicated regional factors.55 By turning to western medical understandings of the human body, Wang’s network of scholarly physicians highlighted a long-standing concern in Chinese medicine with the interrelation of the form, position, location, and directionality of organs. But just as they were critical of western anatomical knowledge, especially with respect to its limitations in explaining the vital functions of organs and the crucial transformation of food and drink into qi

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in living bodies, Wang and his interlocutors worried about the accuracy and reliability of the kind of bodily knowledge found in existing Chinese medical texts. Here, the body itself operated as a “text” whose truthfulness one could unveil only by verifying the generations of textual (however casual or imprecise) commentary on the organs and structures of the human body against direct observations of the body physical. This renewed interest in the reliability of texts, in other words, echoed the evidential studies (kaozheng) movements, which provided the broader context of the uncompromising approach of Wang’s cohort.56 Rather than representing a subversive group of scholars, Wang and his colleagues, by being more willing to reference and cross-check western medical knowledge, actually carried forward an existing tradition of Chinese scholarly enterprise. Their criticisms of previous Chinese anatomical literature, including the writings of the famous physician Wang Qingren, who had a reputation for attacking traditional Chinese medical understandings of the body and whose revisionist publications predated Wang’s collaborative project by two decades, stemmed from a more general concern about its violation of the epistemological norms of verifiability. Wu’s timely historiographical revisionism thus places a seemingly unusual episode in the history of Chinese medicine within significant continuities from conventional historical accounts of the Chinese scholarly culture of the period. As such, it offers a valuable and necessary ground upon which we can proceed to understanding the efforts among early-twentieth-century Chinese reformers who later relegated Chinese medicine into the realm of anatomical ignorance and indifference – a chapter of Chinese history in which the very commonplace equation of Chinese medicine to a backward appreciation of bodily “function” was constructed, to which we will return in David Luesink’s chapter. Whereas Wu focuses on the materiality of the body to revise a popular misconception of Chinese medical history, Andrews develops a genealogical analysis of one specific component of the medical body – blood – to demonstrate, again, that contemporary perception of its place in Chinese medicine is the historical product of Chinese medicine’s transformation through both encountering modern western medicine in the nineteenth century and its globalization in the twentieth. In classical Chinese medicine, all cases of blood disorders referred to blood being expelled from the body in abnormal ways. Physicians attended to the underlying causes of these blood discharges rather than providing discussions of blood itself as an isolated entity. The volume On the Origins and Symptoms of Ailments (諸病源候總論) edited by Chao Yuanfan (巢元方) captured the basic contours of most discussions of blood pathology throughout Chinese medical history before the Qing.57 Here, bodily illnesses with symptoms of blood are linked to ailments of the internal organs (“inside the body”), identifiable by the manifestation of the blood at the surface of the body. The condition of the blood itself is irrelevant. With minimal variations

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in the history of imperial China, the intellectual foundations of medicine correlated to norms of social relations: the yin and subordinate nature of blood (in comparison to qi), for instance, was notably expressed in traditional Chinese understandings of kinship. The desirability of unimpeded blood flow emerged in the nineteenth century as a quintessential principle of modern approaches to blood disorders in Chinese medicine. As Andrews shows, this was the historical product of a grand titration that involved both native and foreign medical epistemologies of the blood. Departing from earlier theories of blood physiology, the Warm Diseases tradition, which distinguished itself most forcefully in the nineteenth century, posited that diseases worked their way through a normal progression from the surface to the interior of the body, with invasion of the blood sector being the deepest and most serious. When disease entered the blood sector, it would cause the blood to move in an agitated, disordered manner and be used up. Singled out as a site of disease inside the body, blood was now a direct target of treatment by way of cooling and dispersal. Assigning blood an independent epistemological status was also apparent in the writings of the unorthodox anatomist Wang Qingren. Based on his anatomical observations of the human body, Wang discussed separate reservoirs for qi and blood in the body. As mentioned earlier, Wang’s approach to anatomy stirred great controversy in the early nineteenth century due to the moral implications of his style of knowing, which favored direct observations of the internal organs of the body. When Benjamin Hobson (1816–73), the first qualified British medical missionary to visit China, published his Outline of Anatomy and Physiology (全體新論) in 1851, his discussion of “static blood” echoed Wang’s physiological theory of blood stasis as a fatal condition characterized by congealed blood not unlike ones frequently found in the chests of epidemic victims.58 But Hobson went a step further by introducing new chemical terms from the West, juxtaposing red, oxygenated blood against purple, static, or “bad” blood filled with carbon dioxide. In other words, the moral dimensions of this particular form of knowledge production, which was grounded in the medical realism of dissection, provided the very condition of commensurability between foreign and domestic medical discourses in mid-nineteenth-century China. Meanwhile, a new form of syncretism gained footing in the late nineteenth century, as exemplified by the publication of Tang Zonghai’s Treatise on Blood Conditions in 1888.59 In this first Chinese monograph devoted to the topic of blood ailments, Tang accomplished the merging of earlier notions of blood abjection (from the surface of the body) as found in pre-Qing Chinese medical texts with the idea of blood stasis or internal blockage discussed by Wang and Hobson. Tang’s prescriptions for these blood pathologies also drew on the classic Four Ingredients Decoction (四物湯) and White Tiger Decoction (白虎湯) from the Shanghan lun. Moreover, he naturally used western anatomical drawings of the sweat glands, nerve endings, and capillary blood vessels to convey

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traditional Chinese medical concepts of the wei (outer) defensive layers of the body. This implies that for Tang, there was still room in the existing framework of medical knowledge to accommodate a new and foreign medical epistemology. But Tang Zonghai was not exceptional in introducing new conceptions of blood from western missionary medicine. The late Qing reformer Tang Sitong, for instance, delivered a public lecture in Hunan in 1898 that conveyed a modern scientific notion of blood as something that is transformed in each of the major organs through which it runs: the heart, therefore, is no longer the organ that makes blood  – a statement that often appeared in the pages of Chinese medical classics – but is responsible for sending purple carbon-gas blood to the lungs and red oxygenated blood to the rest of the body. Situated within the global context of biomedicine at the time, this new scientific notion of blood increasingly persuaded a ready audience. Through a series of advancements, medical researchers such as Patrick Manson, Charles Laveran, and Ronald Ross identified the cause of what was previously known as “tropical fevers”: parasite-infection in the blood. Coupled with therapies derived from the new bacteriological knowledge and the germ theory of disease transmission in the l890s, these medical developments began to make blood the prime site for both research into disease and therapeutic intervention. Finally, when early-twentieth-century modernizing elites introduced Social Darwinism to China, blood became an indicator of vitality, a caliber of intelligence, and even an index of racial/national fitness. Eugenicists and other contemporary writers alike seized the new cultural valence of blood to demarcate human difference in terms of social categories, draw historically homogenous connections among Han Chinese people across time and place, inject new layers of meaning into popular prenatal advice for women, and transfer westernderived tropes such as degeneracy from science to literature.60 Meanwhile, the burgeoning consumer market surrounding blood medical tonics – situated at the center of a transnational nexus of medical advertisement, entrepreneurship, and pharmaceutical industry – gave credence to the epistemological isolation of blood, which by this point had occupied an ontological stature in the popular imagination similar to the brain and sexual organs, as a crucial constituent of the body for medical treatment. By the time that the Chinese Communist Party gave wide institutional support to the nationalization of TCM, the transposition and reconfiguration of the medical meanings of blood had unfolded over a century’s time. Andrews argues that nineteenth-century Chinese medicine and medicine in twentiethcentury China are not only two entirely different species, denoting a radical epistemic shift, but must be understood as part of the legacy of Chinese medicine’s persistent engagement with the West. The resulting governmentsupported medical system has in turn acquired and entailed new ways of deciphering the body, ways that would appear so foreign to and strangely out of place from the medical classics on which that system is based. As such,

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viewing the gradual medicalization of blood in China from a cross-sectional (sociological) perspective of the consumer culture of pharmaceutical tonics alone can only be partial and insufficient. By treating blood as a moving target of medical knowledge in Chinese history instead, Andrews’ chapter deftly traces the intellectual genealogies of an epistemological object as a correlative inscription on the global political histories of China’s nation formation. The authority of modern Chinese medicine The second part of this volume focuses on the making of the authority of Chinese medicine and its interwoven historicity in the Republican period. Daniel Asen’s chapter opens with an exchange that took place in the late 1920s between the Beijing Bar Association, which requested the Beiping Local Court to reform the existing procedures on forensic inquests, and a high-profile “coroner” (wuzuo), Yu Yuan. As guardians of the few legal areas in which the Republican state maintained older governing norms and practices from the Qing, coroners were yamen functionaries responsible for the examination of dead bodies under the supervision of country magistrates and other local authorities. Such exchanges between the Bar Association and coroners often involved disagreement over the place of the forensic handbook, Washing Away of Wrongs (Xiyuanlu), which dates to the Song but continued to form the basis of coroner’s knowledge and training, in modern forensic practice. Focusing on the debates among supporters and critics of Washing Away of Wrongs, Asen’s chapter carefully unpacks the tensions of the authority of forensic expertise in the 1920s. The controversies surrounding Washing Away of Wrongs were emblematic of the broader intellectual and cultural trends found in existing debates about science itself, especially ones that focused on questions pertaining to the role, priority, meaning, and value of categories central to the norm of scientific knowledge-formation, such as “theory” (xueli) and “experience” (jingyan), and, ultimately, the possible conditions of dissent that breathed life into the heterogeneity of scientific discourse itself. As Asen puts it: the question of whether “experience” or “theory” was more authoritative – an explicit problem in Yu Yuan’s discussion of forensics and an implicit one in most others  – spoke to ambiguities and tensions that were inherent in notions of experimental science itself. Specifically, did the authority of science derive from its empirical foundations (“experience”) or subsequent processes of generalization (“theory”)?

The new field of legal medicine (fayixue) that emerged in the early twentieth century claimed for itself a closer affiliation with scientific theory than with experience. Situating itself under the aegis of scientific medicine, legal

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medicine derived its authority from the analytical concepts and techniques of the modern natural and medical sciences. As such, despite the existence of a long tradition of interaction between medical and forensic knowledge in late imperial China, the discipline was institutionally separate from law. Similar to their competing rhythms of priority in the European and American medical traditions, theory and experience carried meanings and values that were always in flux in the context of Republican China. Because theory provided the kind of abstract explanatory power for the systematic observation of facts, the confirmation of their regularities, and the testing of hypotheses, it was viewed by Chinese legal medical experts (trained in western and Japanese forensic medicine) as empirically and epistemologically superior to experience, a more tacit type of knowledge accrued through direct sensory engagement. Experience, they argued, provided the foundations on which theory was built. Critics of Washing Away of Wrongs posited a more intimate connection between legal medicine and theory on the basis of the latter’s power to explain experiment and generate proof. In contrast, they depicted the coroners who studied the handbook religiously as adherents of an inept kind of forensic expertise that relied solely on experience and imagination. Pushing back, Yu Yuan reworked the categories of theory and experience to contest the usual valorization of theory over experience, arguing that “while one can rely exclusively on experience, abandoning experience and solely relying on theory cannot be done” (see quote on p. 140). By emphasizing the more foundational status of experience (and by extension the less indispensable nature of theory), Yu articulated a perspective according to which Washing Away of Wrongs is equally, if not more, important than legal medicine. Above all, Asen’s historical epistemology accounts for the various kinds of claim laid by different interest groups during a period when the standards of expertise and the authority of certain social actors professing those standards were themselves highly contested. It turns out that trained coroners frequently relied on descriptions of dead bodies recorded in legal cases for information about the structure of the body. This is striking given the growing hegemony of the epistemic authority of western anatomical science since the mid-nineteenth century (as discussed in Wu’s and Andrews’ chapters). So this alternative form of corporeal investigation that stressed the practice of verification and empiricism of direct observation played a pivotal role in the training of coroners with the new aim of testing the text of Washing Away of Wrongs against actual cases. Coroners of the new generation learned that to observe actual situations was itself a procedure of verification. As such, experience proved to be the best form of knowledge on which to rely for verifying or amending existing theories of forensic practice, including the outlines of the centuries-old Washing Away of Wrongs. Under such conditions, supporters of Washing Away of Wrongs were able to expand its scope by bringing modern forms of death not originally documented under its aegis – precisely the kinds

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of death that the Bar Association had in mind when accusing the text of being unscientific and arcane. David Luesink’s chapter explores in greater depth a number of themes that have already been brought to the fore by Wu, Andrews, and Asen, including the evolution of Chinese anatomical knowledge in the context of China’s rapid westernization and modernization and the cognate issue of how the cultural authority of medical expertise acquired a new order of significance in the early Republican period. Luesink’s analysis begins with the corpse of Yuan Shikai, the second President of Republican China, who tried to revive the Chinese monarchy and establish himself as the “Great Emperor of China” in the 1910s, surrounded and scrutinized by a crowd of western-style and Chinese-style physicians. This scene accentuates the peculiarity of the social configurations of medical authority in China, an anomaly on the world stage where the head of state is often left attended only by his trusted medical advisors, rather than being the center of a carnivalesque affair of professional disputes among multiple doctors with diverging medical training and backgrounds. The editors of the National Medical Journal (the main periodical of the National Medical Association, which was formed in China in 1915 by primaries Wu Liande, Yu Fengbin, and Yan Fuqing) seized this opportunity to criticize the lingering existence of Chinese-style medicine. Yuan Shikai’s death in 1916 served as an important touchstone for the beginning of a new chapter in the history of Chinese medicine that lasted till 1930, during which practitioners of western biomedicine sought exclusive authority in the medical field. Starting in the mid-1910s, the displacement of the epistemology of Chinese medicine gained rapid momentum through the orchestrated effort of the Joint Terminology Committee. One of Luesink’s central arguments is that the broader historical transformations of the social and epistemological status of Chinese medicine during this period can actually be seen through the lens of rather mundane activities, such as the standardization of technical terminology and the establishment of linguistic equivalents in medical vocabulary between Chinese and western cultures. The Joint Terminology Committee, led by Tang Erhe (1878–1940), Yu Fengbin (1884–1930), and Yu Yunxiu (1870– 1954), sought both to eliminate Chinese-style medicine and to disseminate “accurate” anatomical knowledge in Chinese. By imbricating the newer, more modern western biomedicine with state power, opponents of Chinese medicine attacked its cultural attachment to the label of “national essence” (guocui). It was within this context that the perception of Chinese medicine as lacking precise anatomical knowledge, blind to the details of the structuration of the human body, and unable to identify the “seat of disease” – Chinese medicine’s supposed “anatomical ignorance” – became most pronounced. However, as Luesink correctly notes, the nationwide petition led by Yu Yunxiu and his colleagues in the Ministry of Health to abolish Chinese medicine in 1929 ultimately failed. This transpired in tandem with the rise of the

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New Culture Movement, for which the journal New Youth, founded by Chen Duxiu, came to epitomize an intellectual revolution brought about by an entire generation of young intellectuals who held all aspects of traditional (often dubbed “Confucian”) Chinese culture responsible for China’s backwardness on the world stage. Tang Erhe’s critique of the highly contentious triple burner (sanjiao) and the Cinnabar field (dantian) appeared in the same issue of New Youth as Lu Xun’s “Diary of the Madman” (1918), which was also where Cai Yuanpei published his plan for university reform and where Qian Xuantong, Li Dazhou, Zhou Zuoren, Hu Shi, and Liu Bannong weighed in on issues of the establishment of a new vernacular Chinese language. Naturally, this cohort of May Fourth writers grouped Chinese medicine with the orthodoxy of the Confucian canon and maintained no place for it in the New Culture of China. By the time that experts reached a consensus on the Chinese terms for translating the important concepts of Arterius (dongmai) and Vena (jingmai), what Luesink calls the logic of governmentality (i.e., scientific standardization) was so entrenched that it remained the operating principle by which both western and Chinese medicine have continued to coexist in China since the 1910s. Thus far, the struggle for cultural authority between Chinese and western medical knowledge has been an important subject throughout the volume. Kuang-chi Hung’s chapter shows that the medical status of Ginkgo biloba varied historically depending on the social norms and the dominant worldviews of a given period and region (China, Japan, or Europe). The cultural authority of medical knowledge both determines and reflects the wider social appeal of medical objects in epistemologically saturated contexts. Both Yi-Li Wu and Bridie Andrews have problematized the long-standing perceived anatomical inferiority of Chinese medicine. They do so by situating the organs and blood of the human body within a historiographical framework that both suspends any unquestioned commitment to the cultural authority of western biomedical knowledge and highlights instead the overlapping links between Chinese and western systems of knowledge that enable a more balanced perspective of their competition and reciprocal influences in the nineteenth and ­twentieth centuries. Daniel Asen’s chapter reveals the underlying tensions between such epistemic categories as “theory” and “experience” in the consolidation of the cultural authority of modern Chinese forensic medicine. Finally, David Luesink’s work on the standardization of medical terminology demonstrates that the struggle for medical authority can never be taken at face value. For example, the failure of Yu Yunxiu’s petition to demolish Chinese medicine cannot be interpreted simply as western biomedicine’s unsuccessful attempt to assert a global hegemony. Rather, the period from 1910 to the present should be more adequately understood in terms of a parallel blueprint of governmentality, entailing a universal metric of scientific standardization, according to which both Chinese medicine and western medicine continue to thrive on the global scene of healthcare delivery.

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In this regard, Eric Karchmer’s essay departs from these studies, because it delineates the ways in which common understandings of the difference between Chinese and western medicine came about, rather than foregrounding their mutating yet consistent tensions over time. Rather than challenging the perceived differences of the two medical systems on a unifying epistemological register per se, Karchmer provides one of these differences – concerning clinical efficacy in particular – a sorely needed historical grounding. For many contemporary observers, the perceived difference in the clinical efficacy of Chinese medicine and western medicine is elegantly captured in the popular saying, “western medicine treats acute diseases; Chinese medicine treats chronic diseases.” However, based on interviews with thirty-nine doctors born and trained in the Republican period, Karchmer was surprised to discover the ahistorical nature of this claim, especially with respect to its irrelevance to the period before 1949. In the first half of the twentieth century, doctors of Chinese medicine claimed to have cured a great variety of acute illnesses, including smallpox, cholera, dengue fever, pneumonia, Cold Damage, dysentery, malaria, meningitis, and scarlet fever. This sits uncomfortably with the popular saying about the differences between Chinese medicine and western medicine. At the center of Karchmer’s inquiry lies the following question: “How could Chinese medical practice change so quickly, shifting from a fast acting medicine indispensable to the care of acute illnesses to a ponderous, impotent bystander in contemporary emergency medicine?” In trying to understand how Chinese medicine “slowed down” in the transition from the Republican to the People’s Republic of China (PRC) era, Karchmer joins the authors of the earlier chapters by adopting the method and approach of historical epistemology. In other words, Karchmer is not concerned with the question of whether Chinese medicine is in reality more suitable for treating acute or chronic diseases, but he is concerned with the question of how the clinical and cultural status of Chinese medicine changed across time from being associated with curing acute illnesses to being widely perceived as most efficacious in treating chronic ailments. What he sets out to examine are the historical conditions that had to be established for the treatment of acute diseases with only Chinese medicine to become inconceivable. Karchmer compares the displacement of the efficacy of Chinese medicine in curing acute illnesses with the kind of paradigmatic or epistemic shifts outlined by Kuhn and Foucault, and he argues that “the slowness of Chinese medicine is part of the broader transformation of this medical system, that includes, among other things, a loss of knowledge and a collective forgetting about how to treat acute conditions.” This collective amnesia was driven by two major factors: Chinese medicine’s encounter with western medicine and the role of the Chinese state in healthcare delivery. Here, Karchmer depicts a world of Republican-era medical culture radically different from the one familiar in dominant historiography,

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to which the chapters by Andrews, Asen, and Luesink play an immense contributing role. One of Karchmer’s most surprising findings is that many of the doctors who came of age in the Republican period were unaware of Chinese medicine’s life-and-death struggle for survival as a result of the 1929 petition led by Yu Yunxiu and his colleagues of the Ministry of Health. Evidently, the influence of these events detailing western biomedicine’s assertion of superiority in China, including the various other episodes outlined in Luesink’s chapter, was highly circumscribed to urban centers (in fact, mostly Shanghai). This can be explained by the fact that, at this time, doctors of Chinese medicine vastly outnumbered doctors of western medicine. Also, the normative locus of clinical care was in the private clinic of Chinese physicians, rather than western medical hospitals, which were few in number and limited to urban areas. And the recollection of his interviewees clearly indicates that most Republican-era doctors had little or no training in western medicine. Despite the rise of a modern, school-based education system in late Qing and Republican China, medical training remained centered on apprenticeships and the classics. What galvanized the shift in Chinese medicine’s perceived efficacy, according to Karchmer, was the PRC state’s commitment to strengthening the institutions of western medicine starting in the 1950s. A clear legacy of these developments can be seen in the recent SARS epidemic that swept across China in 2003, during which the contribution of Chinese medicine doctors to the epidemic control has escaped much of the attention of western media.61 The existence of modern Chinese medicine The last part of the volume aims to push the boundaries of historical epistemology, especially in light of the ways in which this approach can be opened up to address broader philosophical issues of metaphysics and ontology. Much like the ways in which the previous section of the volume builds on the first, the two essays forming this last section extend some of the themes that have been scrutinized in the earlier chapters: most notably, the challenges posed by western imperial expansion and globalization to our assessment of the historical transformation of Chinese medicine in the modern period, the emergence and disappearance of objects of medical knowledge in flux, and the mutually generative relationship of the knowledge-production of modern Chinese medicine and its cultural authority. Judith Farquhar focuses on a moment in the history of Chinese medicine, the 1980s, when metaphysics gave physicians of Chinese medicine an omnipresent solution to rearrange and forward the epistemological foundations of their clinical practice. By metaphysics, Farquhar endorses an Aristotelian, Cartesian, Baconian, and Kantian genealogy that is rooted in classical western intellectual traditions, but she also integrates the more recent perspectives on

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the meaning of things and objects as envisioned by the philosophers of science Lorraine Daston, Bruno Latour, and Peter Weibel, as well as the views of the Chinese philosopher Zhuangzi, who flourished in the fourth century BCE, on qi as the force field of life. With this rich assemblage of thinkers and ideas, Farquhar’s story begins with a bedside scene in a Chinese medicine clinic, the Guangzhou College’s attached hospital, where her friend Xueran was treated for an acute respiratory infection. Xueran’s doctors debated about the proper diagnosis and treatments of his infection, and the arguments are generally divided into two groups – those that considered his illness to ramify through the Six Channels (liu jing) as emphasized by the Cold Damage (shanghan) School, who eventually won out, versus those who understood Xueran’s symptomology as developed, expressed, and transmitted through the Four Aspects (wei qi ying xue) according to the contrasting Warm Illnesses (wenbing) school of thought. In this disquieting clinical setting, circumscribed by the conceptual and material parameters of Chinese medicine, what Farquhar witnessed is the tacit presence of western biomedicine “in all its ontological modernism” and the direct intervention of objectivist metaphysics. Ultimately, Xueran’s main physicians, dedicated to the Cold Damage School, were committed to demonstrating that Chinese medicine was not confined to treating chronic disorders, but could also effectively manage acute illnesses. As we have seen from Karchmer’s ethnographic fieldwork, this conviction has a long history, made readily apparent by the personal anecdotes of almost all of the doctors whom Karchmer interviewed and who matured professionally in the Republican period. But in translating their expertise, which is supposedly rooted in an “ancient” tradition, into a form recognizable according to modern biomedical standards, Xueran’s physician teachers also underscored the value of metaphysical musings and argumentations about the ontology of objects that went beyond the positivist foundations of western natural sciences. As Farquhar notes: Chinese clinicians and writers of the 1980s needed to loosen up, re-examine, and put in motion the metaphysical assumptions of modern science, if Chinese medical things were to be recognized as factual and actual. The elements that needed to be (re)gathered as matters of concern at the bedside could only be assembled in a plausible and practical way if the dynamic of natural forces and processes was more fluid than the causes and masses of Newtonian mechanics and Cartesian biology. (p. 227)

In spite of the ghost of global biomedicine, the very existence of Chinese medicine not only reverses the acute–chronic dichotomy that undergirds the perceived differences between Chinese and western medicine in the late twentieth century, but constitutes the historical and epistemological basis of a metaphysical “cosmos where not even the furniture can be taken for granted” (p. 232).

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Whereas Farquhar’s chapter adds subtle nuance to the theorization of the “thing” of Chinese medicine, Leon Rocha adopts a more patient-centered perspective to examine similarly the correlation between the existence of Chinese medicine and the formation of the objects of medical knowledge. Rocha takes a bold step in his analysis by foregrounding the importance of “narratives” and “plots” with which knowledge about Chinese medicine is produced and by which individuals are convinced to become patients of Chinese medicine. In a subset of popular books on Chinese medicine, the use of Chinese medicine and acupuncture to treat female patients suffering from infertility or to complement these patients’ ongoing in vitro fertilization (IVF) regimens is an increasingly popular topic, and this forms the empirical archive of Rocha’s investigation. Three rhetorical motifs distinguish themselves in this body of writing that add to the contemporary popularity of Chinese medicine: the miraculous function of Chinese herbal and acupuncture treatments, the eternity and timelessness of Chinese wisdom, and a tension between two positions concerning the relationship between Chinese and western medicine (on the one hand, these books criticize western medicine and depict Chinese medicine as a healthier, more “natural” alternative to the more invasive fertility programs that women have to go through. On the other hand, they never discredit the efficacy of western biomedicine, occasionally admitting that Chinese medical treatments function ideally as a complement or adjunct to western fertility programs.) Notably, these lay publications on Chinese medicine are different from other “self-help” books, because they aim to persuade the reader to visit an actual Chinese medical clinic for further assistance. The main targeted readers for these English-language popular manuals on Chinese medicine are none other than Anglo-American women from middle- to upper-class professional backgrounds with a high disposable income, who can afford the money and time to research and experiment with “complementary and alternative medicine.” Taking a cue from the analytical insights of Ian Hacking and other historical epistemologists of science, Rocha identifies the newborn babies of women who seemed to have “successfully” gone through Chinese acupuncture/herbal assisted reproductive treatments as “acubabies.”62 Here, Rocha picks up on a number of themes that have been central to this volume: (1) the object of medical intervention – in this case the mother-patient or her “acubaby” – is neither transhistorically nor transculturally grounded a priori, but emerges and acquires epistemological-ontological significance only in specific historical (oftentimes transnational) contexts; (2) the tension between Chinese and western medicine oscillates with each medical system’s claim to cultural authority, resulting in a century-and-a-half of uneasy coexistence in the forms of complementarity, competition, and, more frequently, some hybridization of both; and (3) the epistemology of Chinese medical knowledge is most powerfully articulated through the constructedness of an auxiliary yet germane variable,

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such as in the arrangement of medical objects, authority, or the very idea of existence. The production of “acubabies” exemplifies the process whereby the existence of Chinese medicine is constituted of the coming into being of the target of its clinical practice and its object of knowledge. Rocha’s analysis concludes with a publicized dispute between professional associations in western fertility medicine and Chinese medicine on the effectiveness of acupuncture and herbal medicine on the treatment of female subfertility by assisted reproductive technologies. As Rocha astutely observes, the dispute “highlight[s] questions concerning standardization and the slipperiness of ‘authenticity’ – whether there could ever be a consensus on a standard protocol or a selection of procedures for all cases of infertility, whether there can be such a thing as an ‘authentic’ acupuncture or ‘Chinese’ medicine” (p. 259). In other words, the history of the production of Chinese medical knowledge in a transnational context, as exemplified by the making of “acubabies,” ultimately calls into question the criteria for determining the authenticity and Chineseness of what we often take for granted to be modern Chinese medicine. In distinguishing historical epistemology from earlier approaches to the history of science, Timothy Lenoir remarks that: in contrast to earlier traditions in the philosophy of science that treated truth as independent of the context of discovery and the history of scientific knowledge as a linear, progressive march in the elimination of error, asymptotically approaching nature, historical epistemology treats knowledge as historically contingent and focuses on uncovering the conditions of possibility and fundamental concepts that organize the knowledge of different historical periods.63

The essays collected in this volume bring us closer to bridging the literature on historical epistemology, which has mainly concerned itself with European and American science, and the historiography of East Asian medicine, which rarely invokes the tenets of the philosophy of science. But rather than pushing for a straightforward, protean application of “western” historical epistemology to the study of “Chinese” medical culture, the history of the objects, authority, and existence of modern Chinese medicine explored in this book connects the broader social forces and challenges of globalization to the internal epistemic formations of East Asian medical knowledge, unraveling the technical contours of key epistemic breaks and shifts in the cultural claims of competing healthcare systems. Taken as a whole, the following chapters show that the social and intellectual status of Chinese medicine cannot be understood as timeless, unchanging, free-standing, and without history, but should instead be conceptualized, with the approach of historical epistemology, as a confluence of multiple contingent worlds of meaning, knowledge, commodity, practice, and reason.

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Acknowledgments I thank Theodore M. Brown, Claudia Stein, and Yi-Li Wu for their invaluable comments on earlier drafts of this chapter. In addition to the two anonymous reviewers, I would like to give my special thanks to Bridie Andrews, Judith Farquhar, Carla Nappi, Volker Scheid, and Marta Hanson, for their support and suggestions, and to Daniel Asen, Eric Karchmer, Kuang-chi Hung, and David Luesink for their intellectual stimulation and persistence in bringing this project to fruition. Notes 1 Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (Berkeley: University of California Press, 2004); Joseph Alter, ed., Asian Medicine and Globalization (Philadelphia: University of Pennsylvania Press, 2005); Elisabeth Hsu, ed., “The globalization of Chinese medicine and meditation practices,” East Asian Science, Technology and Society, special issue, 2.4 (2008): 461–583; Angela Leung, Leprosy in China: A History (New York: Columbia University Press, 2009); Mei Zhan, Other-Worldly: Making Chinese Medicine through Transnational Frames (Durham, NC: Duke University Press, 2009); T. J. Hinrichs and Linda L. Barnes, eds., Chinese Medicine and Healing: An Illustrated History (Cambridge, MA: Harvard University Press, 2013). 2 Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (New York: Zone Books, 1999); Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis (Durham, NC: Duke University Press, 2002); Volker Scheid, Currents of Tradition in Chinese Medicine: 1626– 2006 (Seattle: Eastland Press, 2007); Volker Scheid and Hugh MacPherson, eds., Integrating East Asian Medicine into Contemporary Healthcare (London: Churchill Livingstone Elsevier, 2011); David Luesink, “Dissecting modernity: Anatomy and power in the language of science in China” (Ph.D. dissertation, University of British Columbia, 2012); Bridie Andrews, The Making of Modern Chinese Medicine, 1850– 1960 (Vancouver: University of British Columbia Press, 2014); and Sean HsiangLin Lei, Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity (Chicago: University of Chicago Press, 2014). 3 As is the case with any edited volume, this book does not claim exhaustive coverage. One of the important topics not covered here is the history of barefoot doctors in China, which involved explicit interactions with modern western biomedicine. See Xiaoping Fang, Barefoot Doctors and Western Medicine in China (Rochester, NY: University of Rochester Press, 2012). 4 Lorraine Daston, “Historical epistemology,” in Questions of Evidence: Proof, Practice, and Persuasion across the Disciplines, ed. James Chandler, Arnold Davidson, and Harry Harootunian (Chicago: University of Chicago Press, 1991), 282–9; Arnold I. Davidson, The Emergence of Sexuality: Historical Epistemology and the Formation of Concepts (Cambridge, MA: Harvard University Press, 2001);

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Ian Hacking, Historical Ontology (Cambridge, MA: Harvard University Press, 2002); Patrick Singy, “Experiencing medicine: An epistemological history of medical practice and sex in French-speaking Europe” (Ph.D. dissertation, University of Chicago, 2004); Lorraine Daston, ed., Biographies of Scientific Objects (Chicago: University of Chicago Press, 2000); Hans-Jörg Rheinberger, An Epistemology of the Concrete: Twentieth-Century Histories of Life (Durham, NC: Duke University Press, 2010). 5 Daston, “Historical epistemology,” 282. 6 My editorial decision to focus this anthology on studies of Chinese medicine is not intended to exclude scholars outside the field from entering the critical debates and dialogues that structure the book. On the contrary, this decision was made in the strategic interest of consolidating a tight and cogent empirical basis from which the theoretical and historiographical interventions of this volume can reach out to people working in areas as diverse as possible, from the philosophy of science to EASTS. 7 See, for example, Angela Creager, Elizabeth Lunbeck, and M. Norton Wise, eds., Science without Laws: Model Systems, Cases, and Exemplary Narratives (Durham, NC: Duke University Press, 2007); Lorraine Daston and Peter Galison, Objectivity (New York: Zone Books, 2007). 8 Fa-ti Fan, “The global turn in the history of science,” East Asian Science, Technology and Society 6.2 (2012): 249–58; Warwick Anderson, “Asia as method in science and technology studies,” East Asian Science, Technology and Society 6.4 (2012): 445–51; Volker Scheid and Sean Hsiang-Lin Lei, eds., “Asian medicine and STS,” East Asian Science, Technology and Society, special issue, 8.1 (2014): 1–157. 9 Warwick Anderson, “Where is the postcolonial history of medicine?,” Bulletin of the History of Medicine 72.3 (1998): 522–30; Warwick Anderson, “From subjugated knowledge to conjugated subjects: Science and globalisation, or postcolonial studies of science?,” Postcolonial Studies12.4 (2009): 389–400; Warwick Anderson, “Making global health history: The postcolonial worldliness of biomedicine,” Social History of Medicine 27.2 (2014): 372–84. 10  On “break” and “contingency,” see Gaston Bachelard, The Formation of the Scientific Mind, trans. Mary McAllester Jones (Manchester: Clinamen, 2001 [1938]); Karl Popper, The Logic of Scientific Discovery, 2nd edn. (London: Routledge, 2002 [1959]); Paul Feyerabend, Against Method: Outline of an Anarchistic Theory of Knowledge, 4th edn. (London: Verso, 2010 [1975]). On “paradigm,” see Thomas Kuhn, The Structure of Scientific Revolutions, 4th edn. (Chicago: University of Chicago Press, 2012 [1962]); Gary Gutting, ed., Paradigms and Revolutions: Applications and Appraisals of Thomas Kuhn’s Philosophy of Science (Notre Dame: University of Notre Dame Press, 1980); Daniel Cedarbaum, “Paradigms,” Studies in History and Philosophy of Science 14 (1983): 173–213. On “language,” see Ludwig Wittgenstein, Philosophical Investigations, ed. G. E. M. Anscombe (New York: Macmillan, 1953 [1945]); Michael Lynch, “Extending Wittgenstein: The pivotal move from epistemology to sociology of science,” in Science as Practice and Culture, ed. Andrew Pickering (Chicago: University of Chicago Press, 1992),

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215–65. On “episteme,” see Georges Canguilhem, The Normal and the Pathological, trans. Carolyn R. Fawcett (New York: Zone Books, 1989 [1943/1966]); Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, trans. A. M. Sheridan Smith (New York: Vintage Books, 1994 [1963]). On “genealogy,” see Michel Foucault, The Order of Things: An Archaeology of the Human Sciences (New York: Vintage Books, 1994 [1966]); Michel Foucault, The Archaeology of Knowledge, trans. A.  M. Sheridan Smith (New York: Pantheon Books, 1972 [1969]); Michel Foucault, The History of Sexuality, Vol. 1: Introduction, trans. Robert Hurley (New York: Vintage Books, 1990 [1978]). On “objectivity,” see Daston and Galison, Objectivity. On “style” and “concept,” see Ludwik Fleck, Genesis and Development of a Scientific Fact, trans. Fred Bradley and Thaddeus J. Trenn (Chicago: University of Chicago Press, 1981); Reinhart Koselleck, The Practice of Conceptual History: Timing History, Spacing Concepts (Stanford: Stanford University Press, 2002); Davidson, The Emergence of Sexuality. 11  On historical ontology, see Ian Hacking, The Social Construction of What? (Cambridge, MA: Harvard University Press, 1999); Hacking, Historical Ontology; Ian Hacking, Scientific Reason (Taipei: National Taiwan University Press, 2009); Lorraine Daston and Elizabeth Lunbeck, eds., Histories of Scientific Observation (Chicago: University of Chicago Press, 2011). On moral epistemology, see Robert Merton, The Sociology of Science: Theoretical and Empirical Investigations (Chicago: University of Chicago Press, 1979); Lorraine Daston, “The moral economy of science,” Isis 10 (1995): 3–24; Robert Kohler, “Moral economy, material culture, and community in Drosophila genetics,” in The Science Studies Reader, ed. Mario Biagioli (London: Routledge, 1999), 243–57; Lorraine Daston and Fernando Vidal, eds., The Moral Authority of Nature (Chicago: University of Chicago Press, 2004); Richard C. Keller, Colonial Madness: Psychiatry in French North Africa (Chicago: University of Chicago Press, 2007); Bruno Strasser, “The experimenter’s museum: GenBank, natural history, and the moral economies of biomedicine,” Isis 102 (2011): 60–96. On visual epistemology, see Rudolph Arnheim, Visual Thinking (Berkeley: University of California Press, 1969); Bruno Latour, “Drawing things together,” in Representation in Scientific Practice, ed. Michael Lynch and Steve Woolgar (Cambridge: MIT Press, 1990), 19–67; Brian S. Baigrie, ed., Picturing Knowledge: Historical and Philosophical Problems Concerning the Use of Art in Science (Toronto: University of Toronto Press, 1996); Peter Galison, Image and Logic: A Material Culture of Microphysics (Chicago: University of Chicago Press, 1997); Bernd Hüppauf and Peter Weingart, eds., Science Images and Popular Images of the Sciences (London: Routledge, 2008). On material epistemology, see Andrew Pickering, The Mangle of Practice: Time, Agency, and Science (Chicago: University of Chicago Press, 1995); Davis Baird, Thing Knowledge: A Philosophy of Scientific Instruments (Berkeley: University of California Press, 2004); Hans Radder, ed., The Philosophy of Scientific Instrumentation (Pittsburgh: University of Pittsburgh Press, 2004); Howard Chiang, “The laboratory technology of discrete molecular separation: The historical development of gel electrophoresis and the material epistemology of

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biomolecular science,” Journal of the History of Biology 42.3 (2009): 495–527. On feminist epistemology, see Sandra Harding, The Science Question in Feminism (Ithaca, NY: Cornell University Press, 1986); Donna J. Haraway, Primate Visions: Gender, Race, and Nature in the World of Modern Science (London: Routledge, 1989); Donna J. Haraway, Simians, Cyborgs, and Women: The Reinvention of Nature (London: Routledge, 1991); Sandra Harding, Whose Science? Whose Knowledge?: Thinking from Women’s Lives (Ithaca, NY: Cornell University Press, 1991); Sandra Harding, Sciences from Below: Feminisms, Postcolonialities, and Modernities (Durham, NC: Duke University Press, 2008). 12  On situated knowledge from a feminist standpoint, see, for example, Donna Haraway, “Situated knowledge: The science question in feminism and the privilege of partial perspective,” Feminist Studies 14.3 (1988): 575–99. 13  Daston, Biographies of Scientific Objects; Lorraine Daston, ed., Things that Talk: Object Lessons from Art and Science (New York: Zone Books, 2004); Daston and Galison, Objectivity; Daston and Lunbeck, Histories of Scientific Observation. 14  On the global entanglement of critical theory, see Françoise Lionnet and Shumei Shih, eds., The Creolization of Theory (Durham, NC: Duke University Press, 2011). 15  On Emil du Bois-Reymond, see Hans-Jörg Rheinberger, On Historicizing Epistemology: An Essay, trans. David Fernbach (Stanford: Stanford University Press, 2010), 5–7. My overview of the development of historical epistemology is indebted to Rheinberger’s essay. 16  Ernst Mach, The Science of Mechanics: A Critical and Historical Account of Its Development, 4th edn., trans. Thomas J. McCormack (Chicago: Open Court, 1919 [1893]), 507. 17  Émile Boutroux, The Contingency of the Laws of Nature, trans. Fred Rothwell (Chicago: Open Court, 1916 [1874]). 18  Henri Poincaré, Science and Hypothesis, trans. William John Greenstreet (New York: Dover, 1952 [1902]); Henri Poincaré, The Value of Science, trans. G.  B. Halsted (New York: Dover, 1958). 19  Otto Neurath, “Prinzipielles zur Geschichte der Optik,” Archiv für die Geschichte der Naturwissenschaften und der Technik 5 (1915): 371–89, translated and reprinted as “On the foundations of the history of optics,” in Empiricism and Sociology, trans. Paul Foulkes and Marie Neurath (Dordrecht: D. Reidel, 1973), 101–12 (101). 20  Rheinberger, On Historicizing Epistemology, 3. 21  Sandra Harding, “Is science multicultural? Challenges, resources, opportunities, uncertainties,” Configurations 2.2 (1994): 301–30. 22  An early example of a unifying effort in twentieth-century biology was the modern evolutionary synthesis, also known as the “neo-Darwinian synthesis.” See Julian Huxley, Evolution: The Modern Synthesis (London: Allen and Unwin, 1942). The best secondary treatment of the topic to date remains Vassiliki Betty Smocovitis, Unifying Biology: The Evolutionary Synthesis and Evolutionary Biology (Princeton: Princeton University Press, 1996). On disunity in modern science, see the essays in Peter Galison and David Stump, eds., The Disunity of Science: Boundaries, Contexts, and Power (Stanford: Stanford University Press, 1996).

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23  Gideon Freudenthal and Peter McLaughlin, eds., The Social and Economic Roots of the Scientific Revolution: Texts by Boris Hessen and Henryk Grossmann (New York: Springer, 2009). 24  Gaston Bachelard, The New Scientific Spirit, trans. Arthur Goldhammer (Boston, MA: Beacon, 1984 [1934]). 25  Bachelard, The Formation of the Scientific Mind. 26  Ludwik Fleck, The Genesis and Development of a Scientific Fact, trans. Fred Bradley and Thaddeus J. Trenn (Chicago: University of Chicago Press, 1979 [1935]). 27  I will come back to Kuhn’s contribution to historical epistemology below. 28  Werner Heisenberg, The Physicist’s Conception of Nature (London: Hutchinson, 1958), 28–9. See also Werner Heisenberg, Physics and Philosophy: The Revolution in Modern Science (New York: Harper and Brothers, 1958). 29  Thomas Kuhn, The Structure of Scientific Revolutions (Chicago: University of Chicago Press, 1962). 30  For an erudite study that places Kuhn’s contribution to the human sciences in the context of the postwar “Harvard complex,” see Joel Isaac, Working Knowledge: Making the Human Sciences from Parsons to Kuhn (Cambridge, MA: Harvard University Press, 2012). 31  Karl Popper, The Logic of Scientific Discovery (London: Hutchinson, 1968 [1935]); Edmund Husserl, The Crisis of European Sciences and Transcendental Phenomenology, trans. David Carr (Evanston, IL: North western University Press, 1970 [1936]); Ernst Cassirer, The Logic of the Humanities, trans. Clarence Smith Howe (New Haven: Yale University Press, 1961 [1942]). See also Ernst Cassirer, The Problem of Knowledge: Philosophy, Science, and History since Hegel, trans. William H. Woglom and Charles W. Hendel (New Haven: Yale University Press, 1950); Ernst Cassirer, The Philosophy of Symbolic Forms, Vol. 3: The Phenomenology of Knowledge, trans. Ralph Manheim (Oxford: Oxford University Press, 1957 [1929]). 32  Martin Heidegger, “The age of the world picture,” in The Question Concerning Technology and Other Essays, trans. William Lovitt (New York: Harper and Row, 1977), 115–54. Heidegger’s essay was originally published in 1938. 33  Stephen Toulmin, Foresight and Understanding: An Enquiry into the Aims of Science (Bloomington: Indiana University Press, 1961). 34  Paul Feyerabend, Against Method: Outline of an Anarchistic Theory of Knowledge (London: New Left, 1975), 26. 35  On Alexander Koyré, see Rheinberger, On Historicizing Epistemology, 51–3. 36  Before the publication of The Structure of Scientific Revolutions, Thomas Kuhn presented some of these ideas in The Copernican Revolution: Planetary Astronomy in the Development of Western Thought (Cambridge, MA: Harvard University Press, 1957). In an essay titled “What are scientific revolutions?” (1987), Kuhn explains that the transition from the Ptolemaic view to the Copernican one involved changes not only in the perceived laws of nature, such as the development of Boyle’s gas laws, but also in the criteria by which some terms in the laws attach to nature and the dependency of these criteria upon the theory containing those terms. See Thomas Kuhn, “What are scientific revolutions?,” in The Probabilistic

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Revolution, Vol. 1: Ideas in History, ed. Lorenz Krüger, Lorraine Daston, and Michael Heidelberger (Cambridge, MA: MIT Press, 1987), 7–22, reprinted in Thomas Kuhn, The Road since Structure: Philosophical Essays, 1970–1993, with an Autobiographical Interview, ed. James Conant and John Haugeland (Chicago: University of Chicago Press, 2000), 13–32. 37  Rheinberger, On Historicizing Epistemology, 66. 38  Canguilhem, The Normal and the Pathological. 39  Foucault, The Archaeology of Knowledge, 205–6. 40  Ibid., 191. 41  See, for example, David Bloor, “The strong programme in the sociology of knowledge,” in Knowledge and Social Imagery (Chicago: University of Chicago Press, 1991 [1976]), 3–23; Bruno Latour, “One more turn after the social turn: Easing science studies into the non-modern world,” in The Social Dimensions of Science, ed. Ernan McMullin (Notre Dame: Notre Dame University Press, 1992), 272–92; Donna Haraway, “Situated Knowledge.” 42  Foucault, The Birth of the Clinic, 32. 43  Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (Baltimore: Johns Hopkins University Press, 2007), 4. 44  Ibid. 45  Ronald Bayer, Homosexuality and American Psychiatry: The Politics of Diagnosis (New York: Basic Books, 1981); John D’Emilio, Sexual Politics, Sexual Communities: The Making of a Homosexual Minority in the United States, 1940–1970 (Chicago: University of Chicago Press, 1983). For a more recent and balanced reappraisal of the APA’s 1973 landmark decision, see Jack Drescher and Joseph P. Merlino, eds., American Psychiatry and Homosexuality: An Oral History (New York: Harrington Park Press, 2007). 46  Howard Chiang, “Effecting science, affecting medicine: Homosexuality, the Kinsey Reports, and the contested boundaries of psychopathology in the United States, 1948–1965,” Journal of the History of the Behavioral Sciences 44.4 (2008): 300–18; Howard Chiang, “Liberating sex, knowing desire: Scientia sexualis and epistemic turning points in the history of sexuality,” History of the Human Sciences 23.5 (2010): 42–69. 47  John Forrester, “If p, then what? Thinking in cases,” History of the Human Sciences 9.3 (1996): 1–25. 48  On the liberating impulse of sexual science, see Henry Minton, Departing from Deviance: A History of Homosexual Rights and Emancipatory Science in America (Chicago: University of Chicago Press, 2001). For a more critical treatment of the history of sexological science, see Jennifer Terry, An American Obsession: Science, Medicine, and Homosexuality in Modern Society (Chicago: University of Chicago Press, 1999). See also Vernon Rosario, ed., Science and Homosexualities (New York: Routledge, 1996); Harry Oosterhuis, Stepchildren of Nature: KrafftEbing, Psychiatry, and the Making of Sexual Identity (Chicago: University of Chicago Press, 2000); Lisa Duggan, Sapphic Slashers: Sex, Violence, and American Modernity (Durham, NC: Duke University Press, 2001).

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49  Alistair C. Crombie, Styles of Scientific Thinking in the European Tradition: The History of Argument and Explanation Especially in the Mathematical and Biomedical Sciences and Arts, 3 vols. (London: Duckworth, 1994), Vol. 1, 83. 50  Ian Hacking, “‘Style’ for historians and philosophers,” Studies in History and Philosophy of Science 23 (1992): 1–20; Davidson, The Emergence of Sexuality; Hacking, Scientific Reason. For a more recent reappraisal of “style” in a transnational frame, see Howard Chiang, “Rethinking ‘style’ for historians and philosophers of science: Converging lessons from sexuality, translation, and East Asian studies,” Studies in History and Philosophy of Biological and Biomedical Sciences 40.2 (2009): 109–18. 51  Bachelard, The Formation of the Scientific Mind; Kuhn, The Structure of Scientific Revolutions; Foucault, The Order of Things; Foucault, The Archaeology of Knowledge; Gerald Holton, Thematic Origins of Scientific Thought: Kepler to Einstein, rev. edn. (Cambridge, MA: Harvard University Press, 1988 [1973]); Feyerabend, Against Method; Paul Feyerabend, Farewell to Reason (New York: Verso, 1988); Pierre Bourdieu, The Logic of Practice (Stanford: Stanford University Press, 1980). 52  Kim Taylor, Chinese Medicine in Early Communist China, 1945–63 (London: RoutledgeCurzon, 2005); Judith Farquhar, “Re-writing traditional medicine in post-Maoist China,” in Knowledge and Scholarly Medical Traditions, ed. Don Bates (Cambridge: Cambridge University Press, 1995), 251–76; Andrews, The Making of Modern Chinese Medicine. 53  Elisabeth Hsu, “The history of Chinese medicine in the People’s Republic of China and its globalization,” East Asian Science, Technology and Society 2.4 (2008): 465–84. 54  See, for example, Bridie Andrews, “Tuberculosis and the assimilation of germ theory in China, 1895–1937,” Journal of the History of Medicine and Allied Sciences 52.1 (1997): 114–57; Bridie Andrews, “From case records to case histories: The modernisation of a Chinese medical genre, 1912–49,” in Innovation in Chinese Medicine, ed. Elisabeth Hsu (Cambridge: Cambridge University Press, 2001), 324–36; Sean Hsiang-Lin Lei, “How did Chinese medicine become experiential? The political epistemology of Jingyan,” positions: east asia cultures critique 10.2 (2002): 333–64. 55  Marta Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the Geographical Imagination in Late Imperial China (London: Routledge, 2011). 56  On evidential research and natural studies in late imperial China, see Benjamin Elman, On Their Own Terms: Science in China, 1550–1900 (Cambridge, MA: Harvard University Press, 2005), 225–80. 57  Ding Guangdi (丁光迪), ed., Zhu bing yuanhoulun jiaozhu (諸病源候論校注) (Beijing: Renmin weisheng chubanshe, 2000). 58  Benjamin Hobson, Quanti xinlun (全體新論), 1st edn. (Canton: Huiai yiguan, 1851). 59  Tang Zonghai (唐宗海), Xie zhenglun (血證論) (Taipei: Lixing shuju, 2000). 60  Frank Dikötter, The Discourse of Race in Modern China (Stanford: Stanford University Press, 1992); Frank Dikötter, Imperfect Conceptions: Medical Knowledge,

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Birth Defects, and Eugenics in China (New York: Columbia University Press, 1998). 61  Marta Hanson, “Conceptual blind spots, media blindfolds: The case of SARS and traditional Chinese medicine,” in Health and Hygiene in Chinese East Asia: Publics and Policies in the Long Twentieth Century, ed. Angela Ki Che Leung and Charlotte Furth (Durham, NC: Duke University Press, 2011), 369–410. 62  This is in fact an actor’s category that Rocha has borrowed from Angela Wu. See Rocha’s chapter in this volume. 63  Timothy Lenoir, “Foreword: Epistemology historicized, making epistemic things,” in Rheinberger, An Epistemology of the Concrete, xi–xix (xii).

II

Objects

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Within the lungs, the stomach, and the mind: convergences and divergences in the medical and natural histories of Ginkgo biloba Kuang-chi Hung

This tree’s leaf which from the Orient Is entrusted to my garden Lets us savor a secret meaning As to how it edifies the learned man. Johann Wolfgang von Goethe

Introduction Goethe would never have known that the tree “entrusted to” his garden, Ginkgo biloba, would help to found a global industry.1 According to a survey conducted in 2007, ginkgo and ginseng are among the most popular herbs in the world.2 Particularly in the United States, many people who feel that their memory is fading purchase ginkgo tablets to strengthen their recall abilities. Various catchphrases and summaries describing the products probably enhance this convention, as a brief search of the website Amazon.com, for example, proves: “Extracts of Ginkgo biloba leaves have been used in China for almost 5,000 years as a natural way to support memory and mental sharpness.”3 Professional journals have also been trumpeting the merits of these products. A 1997 essay published in the Journal of the American Medical Association (JAMA) reports that “in a substantial number of cases,” ginkgo products appear to “stabilize and improve the cognitive performance and the social functioning of demented patients for 6  months to 1  year.”4 Partly because of ginkgo’s likely positive effects on the brain, those who suffer from dementia or Alzheimer’s disease frequently embrace ginkgo products when regular treatments prove ineffective. Taken altogether, it seems fair to say that ginkgo is one of the most socially acceptable, commercially successful, and culturally accepted herbs in the contemporary world and constitutes a rather peculiar case in the history of pharmacy.

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Goethe might have been quite startled if he could have learned that the leaves he mused about as being “single and twofold” – a symbol for cultural harmony – would stir fiery debates. Ginkgo first appeared in the pharmaceutical market in West Germany in the 1960s. With its claimed efficacies in treating arterial disease and brain syndromes in the elderly, the so-called GBE (Ginkgo biloba extract) won stellar success in the decades that followed. In the late 1980s, however, when The Lancet reported that in 1988 alone, German doctors wrote 5.24 million prescriptions for GBE, an American doctor responded furiously in an essay entitled “How to waste 200 million dollars a year!” “[T]here is little proof that GBE is effective,” he exclaimed, adding that “the manufacturers have also made every effort to suppress critical evaluation of the drug by threatening legal action against anyone publishing negative information.”5 Regardless, GBE found its way to the United States as a “medical supplement,” and soon its sales surpassed those of its European counterparts. Anxieties thrived among medical professionals.6 In November 2008, an article published in the JAMA claimed that a “randomized controlled trial” would, for the first time, clarify ambiguities surrounding Ginkgo biloba. After six years of surveys that followed thousands of patients who were regularly treated with GBE, it remarked, the results showed that ginkgo products did not help to reduce “either the overall incidence rate of dementia or Alzheimer’s disease (AD) incidence in elderly individuals with normal cognition or those with mild cognitive impairment (MCI).”7 The conclusion proved controversial. For one thing, major media (Time, The New York Times, and the Los Angeles Times, for example) eagerly commented on the discovery, highlighting such assertions as “this study puts a period on the debate … ginkgo does not work in spite of [what] anybody trying to sell it says.”8 For another, the American Botanical Council (ABC), an independent non-profit research organization, cast doubts on the JAMA paper in a press release dated December 28, 2009. The council criticized the research’s methodological shortcomings, limited sample sizes, and utterly obscure results, claiming that “more recent publications [on GBE] have demonstrated an improvement in cognitive performance.”9 It would seem that the JAMA essay is nowhere near a convincing testimony against current applications of ginkgo products. This chapter does not aim at resolving such controversies. Instead, in the view of the history of medicine, the debates on GBE reveal a compelling question: Why have westerners, during the past decades, grown increasingly fond of an herb despite so little expert evidence? Indeed, if we trace ginkgo’s medical history, we will be startled by the inconsistency among different societies’ contemplations of ginkgo’s therapeutic efficacies. For example, when Chinese in the seventeenth century argued that ginkgo could cure disorders of the lungs, their counterparts in Edo Japan (1603–1868) were convinced of ginkgo’s efficacy in promoting digestion. How can an herb affect the body so differently if bodies everywhere are supposedly the same?

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In many ways, ginkgo is a perfect object for such inquiries. As botanists have told us, Ginkgo biloba has been the only surviving species under the division of Ginkgophyta – that is to say, the samples of ginkgo distributed in early modern China, Edo Japan, and modern Euro-America are taxonomically identical. Unlike many popular herbs (for example, ginseng and rhubarb, which cover numerous species), ginkgo has an unusual natural history helping historians to minimize – but not to ignore – biological factors, and to single out what matters in the medicalization of an object. In light of recent studies on “things that talk,” biographies of things, and the material culture of science, this chapter highlights a different way of associating the history of medicine with that of the body.10 We have had provoking studies on how exchanges and consumption of objects generate scientific knowledge.11 In the history of medicine, historians have begun paying close attention to how convergences and divergences – rather than differences and distinctions – take shape chronologically and synchronically.12 This chapter manages to bridge those fertile fields. As we will see, by delving into a botanical’s various movements and into its various representations in agronomic treatises of Ming China (1368–1644), in the folklore of Edo Japan, and in traveling accounts of nineteenth-century western explorers, historians can greatly broaden their examination of notions of the body and the mind, health and illness, mainstream and alternative medicine, and more importantly, humans and the earth where they dwell and coexist with other living beings. A package from the south Sometime in 1053, in Kaifeng (開封), the capital city of Song China (960– 1279), the famed poet and essayist Ouyang Xiu (歐陽修, 1007–72) received a package. It was wrapped up poorly, and weighed so little that it appeared to contain nothing. Opening it, Ouyang found a handful of ginkgo nuts lying inside. He was touched. He knew that the package was from Mei Yaochen (梅 堯臣, 1002–60), his close friend in a distant southern town called Xuancheng (宣城). Inspired, he set out to compose a thank-you letter in the form of a poem. At first glance, he wrote, these tiny, snowy nuts resembled goose feathers, a symbol for lightness and cheapness. But when he came to examine them, Ouyang continued, he could almost see Mei wandering among the ginkgos, selecting and processing the nuts. He assured Mei that if he dared to despise the package for its humbleness, he would hardly deserve Mei as both a friend and a learned person of his day.13 Mei was heartened when reading Ouyang’s reply. He often felt isolated, though Xuancheng, his hometown, was definitely one of China’s most magnificent cities, known for its exuberant intellectual atmosphere in Jiangnan (江南, “the south of the river,” referring to the southern part of the Yangtze

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Plains). The fact was that he had spent most of his adult life in the north, particularly in the capital, Kaifeng, to pursue his dreams and to serve his country. In the late 1040s, when he gradually orbited the zenith of his career, disasters struck. In 1049, he was informed that his father had passed away. With a saddened acknowledgment of absence, he dashed home, away from Kaifeng, away from the learned communities with which he had intimately associated. During his stay in Xuancheng, Mei began sending packages northward. Each package, as did the one Ouyang received, contained ginkgo nuts. “I am now too old to compose a letter,” he told a correspondent. He groaned that he was now literally and figuratively disarticulated with the intellectual center and that he at times considered himself no longer competent as an author – he was one whose works were no longer worthy of his northern friends’ attention. Mei told his friend, however, that an alternative to sending texts had occurred to him: there was a tree – the yajiao (鴨腳, literally “duck foot”) – that could be found only in Jiangnan and whose nuts, when roasted, tasted as delicious as carp. Taste these yajiao nuts, Mei urged his friend: “you will feel as though I were still there.”14 Diligently preparing ginkgo nuts for friends in the north, the isolated Mei was hardly aware that his treasured ginkgo had gradually spread over the vast plain between the Yangtze River and the Yellow River, seeding itself in Kaifeng. Among those who helped the species undertake its great migration was Li Taibo (李太博), the son-in-law of the Emperor. Sometime in the 1040s or the 1050s, Li paid a visit to Jiangnan and was intrigued by the beauty of the socalled yajiao trees. He collected plenty of nuts, spreading them around the capital. A memoir entitled Mozhuang manlu (墨莊漫錄) describes what happened to these new immigrants afterward: in the 1070s, the imperial garden included four grown ginkgos, three of which, despite ripening satisfactorily, had taken root in damp and dark corners, whereas the remaining one, though growing in an open and bright place, had never bloomed.15 Mozhuang manlu then reports a memorable event about the four ginkgos. Having heard of the rarity of the blooming ginkgo, the Emperor decided to pay a visit to the garden. Thirsting for a visual experience, he opted for the aesthetic ginkgo. The Emperor’s visit resulted in frustration, however. Painstakingly gazing through the branches, he hardly glimpsed a sign of a blossom. “What a pity!,” lamented the Emperor, departing in dismay. As though the ginkgo had overheard the Emperor’s lamentation, only a year later the tree not only blossomed but also bore fruit with the “luster of jade.” The Emperor was delighted. A party was then held to celebrate and commemorate the event.16 In addition to grabbing his eye, the ginkgo whetted the Emperor’s appetite. According to a receipt prepared for Emperor Gaozong (高宗, 1107–87), court attendants should serve the Emperor a plate of roasted ginkgo nuts as an appetizer, which was supposed to tease His Highness’ taste buds in preparation

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for subsequent intoxicating dishes.17 From the Emperor’s table, the scent of roasted ginkgo nuts would float onto the streets of Kaifeng. Roughly around the 1100s, people could come to restaurants, relish roasted ginkgo nuts, and imaginatively consider themselves to be as prestigious as the Emperor or as knowledgeable as literati.18 A poet named Yang Wanli (楊萬里, 1127–1206) was among those who grew intrigued by the nuts’ flavor. When their warm, crispy surface brushed against the tongue, he reflected in a poem, a bitter flavor would present itself. He continued that a sense of sweetness would soon flood the mouth, orchestrating a fading bitterness. It would seem that ginkgo nuts awoke in one of the highest senses of gastronomy.19 Aware of the rising demand for ginkgo nuts in the north, nurserymen in the south stored harvested nuts in vaults, so that they could supply their goods constantly and minimize interruptions characteristic of the ginkgo’s growing patterns.20 Nurserymen in the north, too, made every effort to cultivate the ginkgo, in hopes of establishing self-sufficiency of the nuts. An observant resident, Ouyang, beheld the changes. In 1057, he wrote a letter to Mei, outlining what had just happened to Mei’s treasured nuts. When it first appeared in the capital, he recalled, the ginkgo was so rare that several tiny nuts were comparable to grapes and guavas. But the price plunged, he told Mei, and such foodstuffs were now perfectly accessible to common people. How mercurial and subject to change “the nature of things [wuxing, 物性] was!,” he reflected, and how similar such a nature was to “human relations [renqing, 人情]!”21 Mei replied that he definitely agreed with what Ouyang had said about the correspondence between wuxing and renqing. In fact, he related, his current circumstance was just such a case. Given the rising accessibility of the ginkgo nuts in the north, he groaned, now he had no reason to send his packages northward. He had been deprived of one of his most important means of communication. He was now a dispirited and isolated man of letters in the distant south.22 Diverging medicalizations of the ginkgo in Ming China and Edo Japan Even Ouyang could not have foreseen how gradually Chinese society would come to change the ginkgo’s nature. In the decades to come, as ginkgo plantations expanded and associated knowledge exploded, the nut-bearing tree extended its importance to Chinese pharmacopeias. As Li Shizhen (李時珍, 1518–93) described the phenomenon in his classic Bencao gangmu (本草綱 目, Compendium of Materia Medica, 1596), Chinese physicians had not made use of the ginkgo until his day. He stated that, according to his close reading of medical books and the field surveys he had conducted, roasted ginkgo nuts were particularly effective in tunneling the lungs’ conduits (ru feijing, 入肺

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經), replenishing the qi (yi feiqi, 益肺氣), reversing any coughing and difficult breathing (ding chuansou, 定喘嗽), and energizing the lungs that “withered under the evil flame.” Moreover, he added, those who suffered from “urinary incontinence” (suo xiaobian, 縮小便) could take roasted ginkgo nuts to resolve this annoying ailment.23 Li’s juxtapositioning of roasted ginkgo nuts’ diverse functions is curious: could the nuts in truth have such diverse effects on the body? Li’s reasoning makes perfect sense if we place it against the Five Phase Theory, which posited a correspondence among five elements (fire, wood, metal, earth, water) and  – among other things  – organs, colors, and tastes. Li’s reasoning went as follows: First, because ginkgo nuts were white, a corresponding relationship had been inbuilt between the ginkgo and other things belonging to the white category. Second, as the lungs belonged to metal, and a corresponding hue of metal was white, ginkgo nuts were deemed to act upon the lungs. Finally, for the lungs’ correspondence with water, so long as ginkgo nuts could conciliate the restive lungs, the lungs were supposed to resume their function of keeping in check the body’s levels of water, which was why ginkgo nuts served as an effective treatment of urinary incontinence. Li’s reasoning of the ginkgo’s place in Chinese materia medica soon became influential. In the decades that followed the publication of Bencao gangmu, many learned Chinese came to consider roasting an excessively rough – though still common – approach to cooking ginkgo nuts: delicious and therapeutically effective, ginkgo nuts deserved a more elegant preparation. A notable case can be found in Zhoupu (粥譜), a cookbook by Huang Yunhu (黄雲鵠) focusing exclusively on congee. According to Huang, ginkgo nuts were among a few ingredients qualified for yangsheng zhou (養生粥), or life-nourishing congee. To prepare the nuts for this dish, one would carefully extract them from the ginkgo’s juicy fruit, dry them, place them in a pot, add a certain amount of water, and attentively heat the contents: all these steps were crucial for preparing ginkgo congee. If prepared appropriately, Huang stated, ginkgo nuts could warm the lungs, nourish qi, calm the breath, and heal ailments resulting from depletion of vitality.24 A similar view can be found in Bencao qiuyuan (本草求原, An Inquiry into the Origins of the Materia Medica). An herbal book written by Zhao Qiguang (趙其光) and published in the mid-nineteenth century, Bencao qiuyuan includes references to ginkgo nuts for the treatment of a “strange disease” (qibing, 奇病) named roudai weiyao (肉帶圍腰). According to Zhao, those who developed the illness would find a band of sores stretching around the wrist. Though the band per se hardly afflicted the body, patients would gradually lose appetite and eventually “wither” and “dry up” like a diseased plant. Although nowadays roudai weiyao might be diagnosed as “herpes zoster” involving a temporary breakdown of the immune system, in Zhao’s day, the illness was ascribed to an excess of sexual activities.25 As historians

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of medicine point out, in traditional Chinese medicine, indulgence in sexual activities drained vitality, which in turn emptied the body and invited “evil intruders” that sickened the body.26 Adding to and echoing Li’s reasoning of ginkgo’s therapeutic properties, both Huang and Zhao proposed a new range of applicability: retaining and replenishing vitality. Interestingly, we find a different course of medicalization of the ginkgo in Japanese materia medica.27 The book entitled Wago honzō kōmoku (和語本草 綱目, A Japanese Interpretation of Bencao Gangmu, 1698) discusses the subject from the vantage point of the author, Okamoto Ippō (岡本一抱). If you had been a contemporary reader of Wago honzō kōmoku and had aspired to explore Li’s thoughts on the ginkgo by reading Ippō’s “interpretation,” you would have wound up greatly disappointed. First, to locate a single reference to the ginkgo in Wago honzō kōmoku, you would have found it necessary to consult the work’s appendix. Second, as for the format, it seems that Ippō considered the appendix unworthy of thoughtful attention: descriptions in the appendix are short, cramped, and printed in types remarkably smaller than those in the text. Finally, regarding the content, Ippō ruthlessly truncated Li’s reasoning: he neither mentioned ginkgo’s association with the lungs nor expressed concern about ginkgo’s position in the Five Phase Theory. A similar characterization of the ginkgo’s role in Japanese materia medica is evident in the influential work Yamato honzō (大和本草, Materia Medica in Japan, 1709), by Kaibara Ekiken (貝原益軒, 1630–1714). Here, it is worth noting that Ekiken appreciated Li’s Bencao gangmu greatly, and Yamato honzō amply establishes the author’s profound knowledge about the theory fundamental to Li’s Bencao gangmu (i.e., the Five Phase Theory). Still, when finding a place for the ginkgo in Japanese materia medica, Ekiken developed his own notion. Like Ippō, he did not address the ginkgo’s link with the lungs; nor did he aim at unveiling any medical possibilities inbuilt in the ginkgo’s nature. His full attention was occupied by the ginkgo’s morphology and applications in cookery. How do we make sense of the ginkgo’s rather marginal place in Japanese materia medica? According to the criteria Ippō outlined to determine which comments in Li’s Bencao gangmu should be relegated to the appendix, it is very likely that Japanese doctors marginalized the ginkgo because they regarded it as a food-producing plant and thus as a plant beyond the realm of medicine.28 Indeed, a survey of Edo-era cookbooks (e.g., the acclaimed Ryōri monogatari [料理物語, Narrative of Actual Food Preparation, 1643]) reveals the notable ubiquity of the ginkgo. Ginkgo nuts could be cooked with tofu, eggs, fish, and various foodstuffs. Slightly roasted, ginkgo nuts were a perfect appetizer accompanying tea or sake. Many cookbooks also show that ginkgo nuts could be served to people across a wide social scale: from the shogun, the de facto ruler of Edo Japan; to the daimyō, the local rulers; and indeed to ordinary

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folk.29 A hint of the ginkgo’s high visibility and popularity in Japanese cuisine is the society’s emphasis on “stomach vitality.” In his acclaimed Yōjōkun (養生訓, Principles for Nourishing Life, 1713), for example, Ekiken wrote that “stomach vitality is another name for one’s vitality, which neutralizes the elements of illness within one’s body, so that even when they attack in force one can survive the attack.” He then drew his reader’s attention to the importance of saliva in stomach vitality. Coming up into the mouth from the viscera, he asserted, saliva was the “lubricant of the entire body” and the source of “pure blood,” a critical body-nourishing element. Ekiken then suggested that people should never forget taking foodstuffs like flax, sesame, apricot, peach seeds, and ginkgo nuts to get one’s salivary glands to “excrete profusely.”30 The link between the ginkgo and stomach vitality might even have made the ginkgo a symbol for motherhood in Japanese society. In his book entitled Kii no kuni meisho zue (紀伊国名所図絵), for example, Takaichi Shiyū (高市 志友) documents a ceremony centering on ginkgo and women in the village of Awa (Awamura, 粟村). Shiyū notes that villagers there worshiped old ginkgos as the God of Birth. Women came to pray before ginkgos after giving birth, for it had been said that ginkgos blessed new mothers with sufficient breast milk for their babies.31 In her survey article entitled “Ginkgo biloba in Japan,” Mariko Handa records a legend about a ginkgo tree in Sendai, Miyagi Prefecture. The legend goes as follows: Byakkōni was a wet nurse of Emperor Shōmu (reigned 724–49). When she was about to die, her wish was that “a ginkgo be planted on her grave mound.” Handa also observes that “a god is said to be enshrined at the foot of the tree,” and even now, “women who cannot produce their own milk often worship there.”32 The resonances among the ginkgo, nursing, and motherhood probably inspired Miyazawa Kenji (宮沢賢治, 1896–1933) to compose his famous tale “Ginkgo nuts” (Ichō no jitsu,イチョウの実). In it Miya­zawa likens a fruiting ginkgo to a mother joyfully surrounded by numerous children. Similar to humans, Miyazawa relates, the ginkgo mother cannot keep her children forever, and eventually has to let them leave. But when her children are about to leave, the ginkgo mother is so grief-stricken that she loses “almost all her golden hairs.”33 Moreover, to the Japanese, the connection between the ginkgo as a source of nourishing food and the ginkgo as a symbol for motherhood was evident in the tree’s morphology. The ginkgo is a tree with highly developed aerial roots. As it gets old, its aerial roots – to the Japanese eye – would strikingly resemble cows’ teats. Indeed, in Japanese, the ginkgo’s aerial roots are called ichō no chichi (イチョウの乳), literally meaning “ginkgo’s breasts” (Figure 2.1).34 Tasty as a stimulating appetizer, nourishing as breast milk, curious as a tree bearing breasts – despite its minor role in medicine, the ginkgo was infused with multitudes of meanings. To the Chinese in the seventeenth century, however, the connection between the ginkgo and motherhood was utterly absent – though ginkgos thriving in

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2.1  Ginkgo’s “breasts.”

Chinese gardens and fields undoubtedly developed aerial roots as was the case in Edo Japan. Most Chinese simply overlooked the ginkgo’s morphological features, which the Japanese thought wondrous; and those Chinese who took note of them hardly regarded them as being, in any way, analogous to breasts. A tale documented in Kunshan xian zhi (崑山縣志) provides a compelling

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contrast. Gong Yi (龔猗) was a retired officer who had once served on the court of Song. In his later years, he regretfully witnessed the collapse of Song under the attacks of the Jurchens. Desperately, Gong accompanied imperial families during their flight to the south. When they were passing by a place called Zhenyi (真義), he came to a stop at a ginkgo. With profound reluctance, Gong plucked from the tree a branch, inserted it into the ground, and prayed: “If this branch comes to life, I shall take root here.” The branch sprouted, and Gong decided to stay. Decades later, as Gong’s ginkgo and lineages flourished, people in Zhenyi found that numerous lumps appeared on the ginkgo’s branches. Counting those lumps, they were astonished that the total number was equal to the sum of Gong’s “sons and grandchildren.” “What a striking coincidence!,” they whispered; Gong must have met “a magic tree,” or such a correspondence could not have happened.35 Let me draw a short conclusion here before announcing more distinctions between the Chinese and the Japanese manners of associating the ginkgo with the body. On the surface, the two societies were fond of ginkgo nuts, though the fondness brings to light distinctive differences. In early modern China, ginkgo nuts captivated doctors, leading them to contemplate the ginkgo in reference to the most systematic thinking of the day: the Five Phase Theory. In Edo Japan, by contrast, no similar confluence appears to have taken hold. What we witness is rather a de-medicalization: that is to say, despite their familiarities with – among other things – the Five Phase Theory and the ginkgo’s metaphysical connection with the lungs, Japanese doctors distanced themselves from speculations of this sort and consciously confined the ginkgo to cookery. Despite its minor role in medicine, the ginkgo was undeniably crucial to the Japanese, not only for ginkgo nuts’ capability to stimulate saliva, a treasured liquid lubricating the body, but also for the ginkgo’s symbolization of nourishment and motherhood. “A dark and poisonous thing” To understand how such divergences took place, we have to look into the “dark and poisonous” side of the ginkgo; we have to treat it as a tree alternately growing and decaying, prospering and withering, a living being. In his Bencao gangmu, Li Shizhen characterized the ginkgo as “a yin and toxic thing” (yindu zhi wu, 陰毒之物), and ascribed this toxicity to the ginkgo’s flowering pattern: “the ginkgo can only bloom at night, and people rarely witness its happening.” In Li’s view, such a nature both conditioned and constituted various ways in which doctors prescribed ginkgo. Only cooked ginkgo nuts could benefit the human body, and people should never over-consume ginkgo nuts, for a plant featuring yin would swallow qi, enfeeble the body, and cause dizziness and other afflictions.36

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The Japanese during the Edo era would have agreed with Li’s observation. Indeed, what characterized the Japanese people’s attitude toward the ginkgo – besides their appreciation of ginkgo nuts as an indispensable foodstuff – was their anxious reluctance to cultivate the ginkgo in their fields or gardens. This reluctance seems odd at first glance. Why was the ginkgo’s prominence in Edo cuisine unaccompanied by a corresponding enthusiasm for ginkgo cultivation? Hitomi Hitsudai (人見必大, d. 1701), an acclaimed author in both materia medica and cookery, noticed the paradox. In his Honchō shokkan (本朝食鑒, Mirror of Food in Our Country, 1697), he described the ginkgo as an “unwanted tree” and attributed his contemporaries’ anxiety about ginkgo cultivation to a tragedy in 1219, a decisive event after which the Samurai’s control over the government was violently truncated. The tragedy unfolded as follows: One day in 1219, when Minamoto no Sanetomo (源実朝, 1192–1219), the leader of the Kamakura-bakufu, stepped out of the temple of Tsurugaoka, an assassin appeared and stabbed him to death. The assassin’s success relied on a giant ginkgo outside the temple. That ginkgo tree concealed him so perfectly that nobody could have perceived the looming danger. Minamoto no Sanetomo’s tragedy, together with the ginkgo’s infamous role therein, was a tale disseminated widely in the Edo era. In Hitsudai’s opinion, the tragedy bewildered people to the extent that the Japanese had blacklisted the ginkgo, regarding it as a tree exclusively for certain religious sites, but not one that could be planted in fields or gardens.37 Hitsudai’s observation is not the only textual evidence of this ostracism targeting the ginkgo. According to Nihon zokushin jiten (日本俗信辞典, A Dictionary of Popular Beliefs in Japan), people in Gunma and Fukui believed the ginkgo capable of inducing sickness; in Aichi, Nagano, Nara, and Miyazaki, the ginkgo was thought to be detrimental to far more than gardening, for the tree might invite misfortune and death; and to people in Wakayama, Saga, and Nagasaki, cultivating the ginkgo would apparently result in poverty.38 The ginkgo’s allegedly wicked essence sparked other radical speculations, as well. If you were a traveler in Edo Japan, you probably would be advised not to pass by any aged ginkgo at night. Ginkgos’ spirit would appear as a child to stalk you. It would steal the fire from your lantern, and would leave you in the boundless dark. Another warning involved perhaps an even scarier apparition. It was said that if you walked by an old ginkgo, you would spot a woman holding a fan and floating whimsically in the air.39 The famous Buson yōkai emaki (蕪村妖怪絵巻) includes an entry about the ginkgo, disclosing that the ginkgo involved in Minamoto no Sanetomo’s assassination was actually a shape-shifter: if you ran into a wandering monk with a golden bell (kane, 鉦) outside the temple of Tsurugaoka, you should be careful, because the monk would actually be the ginkgo infamously involved in that bloody killing.40 In Niigata-ken densetsu shūsei (新潟県伝說集成, A Collection of the Legends in

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Niigata Prefecture), the author included a tale about a notorious ginkgo in the temple of Seisui. Once upon a time, there was a young lady whose residence neighbored the temple. For a while, she was delighted by a young man’s visits at night. They often chatted until the day dawned, at which point the man would depart, but not before presenting her with a sentimentally symbolic coin (koban, 小判). The lady’s father, aware of his daughter’s romance, sensed danger. He brought the coin to a monk in charge of the temple and sought consultation. While the monk examined the coin against the sutra, the coin abruptly turned into a ginkgo leaf. In truth, this young man was neither young nor human: he was a ginkgo in disguise.41 As noted by Toriyama Sekien (鳥山石燕, 1712–88), all such wandering, naughty, scary, and sometimes annoying spirits were related to yin (which probably explains why ginkgo spirits came to extinguish travelers’ lanterns: the action amounted to a skirmish in the constant struggles between yin and yang).42 Interestingly, although sharing with the Japanese the notion that the ginkgo was an embodiment of yin, the Chinese responded to that nature in a way different from their Japanese counterparts. Nighttime travelers in China were not afraid of being haunted by naughty ginkgo spirits; ladies did not worry that someday their beloved partners would disappear leaving behind nothing except a fan-shaped leaf. Although undoubtedly people in China were bewildered by a myriad of things, the ginkgo rarely featured in their ghost tales. A clue helping to explain the ginkgo’s absence in Chinese ghost tales is that the Chinese had never characterized ginkgo cultivation as taboo. Different from their Japanese counterparts, Chinese people seeded, grafted, planted, and transplanted the ginkgo, expanding its plantings eagerly if not aggressively.43 Here it is worth noting that ginkgo cultivation was by no means an easy undertaking. To the Chinese of Ouyang and Mei’s day, for example, the most insurmountable difficulty was that the ginkgo could not acclimatize itself to the cold temperatures in the north: it grew but bore nothing. In answer to this, nurserymen came up with applicable solutions. A book entitled Quwei jiuwen (曲洧舊聞, literally meaning Old News in Quwei) happens to record one of them. It reported that, in December, nurserymen should remove some soil from the ginkgo’s roots and fill the space with husks. Then, the nurserymen should burn the husks to warm up the ginkgo’s roots, whereupon the ginkgo would ripen regularly. Quwei jiuwen likened the device to moxibustion: doctors’ placing mugworts on patients’ skin and healing ailments by heat.44 Following a similar logic, a book entitled Nongsang cuoyao (農桑撮要) pointed out that nurserymen could transplant the ginkgo whenever they wanted. The trick was “never to let trees know that they are going to be removed.” To achieve this, nurserymen should leave some soil around the roots as they dug the ginkgo out. So long as they could keep the ginkgo “unaware” of the operations, movement should pose no problem.45

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When spatial barriers dissolved, the notion of time would assert itself. Zhou Wenhua (周文華), an agriculturalist roughly contemporaneous with Li Shizhen, nicknamed the ginkgo the gongsun shu (公孫樹, meaning “the grandfather–grandson tree”), revealing how tedious ginkgo cultivation could be. People of course can plant a ginkgo, but only their grandchildren might have a chance to enjoy the yield.46 Bianmin tuzuan (便民圖纂) acknowledged this matter, accordingly offering a solution. The suggestion was that, rather than cultivate the ginkgo from scratch, nurserymen should graft fruiting branches onto grown ginkgo trunks. The branches were supposed to ripen in two or three years, thus allegedly economizing nurserymen’s time and energy.47 A successful cultivation of the ginkgo, as it turned out, should not be left to nature. Rather, it should depend upon the extent to which nurserymen could harness exact agricultural knowledge and relevant techniques. The operations of what might be called the “engineering of time” continued evolving. Well into the seventeenth century, agriculturalists had been able to syncretize the ginkgo’s growing patterns with peasants’ daily lives – the so-called yuelin (月令, or “orders of months”). Late January was the time for seeding and transplanting the ginkgo, February for grafting, August for transplanting, and September for harvesting.48 The era when the ginkgo was increasingly subject to agricultural practices witnessed the growing medicalization of the ginkgo. Li’s Bencao gangmu served as a vantage point. Li catalogued the ginkgo under fruits, a category preceded by vegetables and followed by woods. Such categorization, at first glance, is self-evident  – given that the Chinese knew the ginkgo chiefly through its nuts. Yet Li’s category of fruits is itself problematic. First and foremost, Li’s fruits were defined according to their function instead of morphology. In the beginning of his chapter on fruits, Li wrote that they served to “help” (zhu, 助), which meant that fruits gave zest to food in times of abundance and frugality, and that when plagues and sufferings prevailed, fruits could also serve as medicine. Yet it was noteworthy that fruits’ helpfulness was also defined in terms of the fruit category’s relation to other categories, particularly to grains and vegetables. Following a tradition that could be dated to The Yellow Emperor’s Classic Treatise on Medicine, one of the first systematic accounts of medicine in Chinese history, Li declared that the role of grains was to nourish (yang, 養) and that the role of vegetables was to supplement (chong, 充). Grains were the source of qi, without which the body could not recharge itself to a level of robust vitality. But grains alone were hardly sufficient. Grains’ qi might be obstructed or trapped somewhere in the body, and vegetables’ role was to tunnel through the congealed parts of the body, enabling qi to flow smoothly therein. Fruits were helpful because they offered irreplaceable support for grains’ nourishment and vegetables’ supplemental function. Grains, vegetables, and fruits were three categorical pillars that collaboratively contributed to the health of the body.49

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But we should never conclude that the relationship among fruits, grains, and vegetables constituted a division of labor or something analogous to a role-playing game. Instead, in Li’s scheme, these three categories were hierarchically arranged: grains took the lead, followed by vegetables and then fruits. Metaphorically, the world comprising grains, vegetables, and fruits was not an ecosystem in which every component contributed equally to perpetuating the system. Rather, the world was a bureaucratic organization, in which rank was hailed as a guiding rule. Han feizi (韓非子) included a vivid tale in this respect. “Please help yourself,” Duke Ai of Lu said to Confucius, kindly offering this wandering philosopher peaches and millet. Gratefully, Confucius finished the millet first and then tasted the peaches, each of which entertained other attendants greatly. “The grain is not for eating,” the Duke reminded the philosopher: it was to wipe the peaches clean. “I have known the convention from the beginning,” Confucius replied. What prevented him from doing so was the notion of rank: “The glutinous millet is the head of the five grains. On commemorating the early kings, it is used as the best offering.” By comparison, Confucius continued, “Among six kinds of tree and grass fruits, the peach is the lowest. It cannot even enter the shrine during commemorations of the early kings.” Confucius told the Duke that he had heard only that “gentlemen clean the noble with the humble,” never the reverse. “To clean the lowest among fruits with the highest among cereals” apparently violated the rule of rank. Given that the rule of rank ordered the world, any violation of the rule should be denounced as unrighteousness.50 While acknowledging fruits’ helpfulness, Li then exclaimed that fruits were noxious to the body. In Li’s scheme, fruits induced fever, invited evil intruders, deteriorated viscera, hindered qi, and corroded the body from within – there was virtually no innocent fruit in Li’s view. Li’s anxiety was perfectly illuminated in his comments on the cherry. A fruit previously unbeknownst to the Chinese before the sixteenth century or so, the cherry was wildly appreciated in Li’s day. Li, however, facing contemporaries’ rising interest in the cherry, felt obliged to expose the danger of this red, seemingly innocuous fruit. People might become feverish after over-consuming cherries, Li warned. Etiologically, the ultimate demonstration of cherry-induced fever was its blooming pattern. Li indicated that the cherry ripened only toward the end of March and in April, a timing that enabled it to exhaust pure qi of yang. When suffused with qi of yang, the cherry became “extremely hot and damp.” Li then drew an example to explain how seriously the cherry could hurt the body. Once upon a time, there were two young men born into a prosperous family. Their lavish background afforded them the opportunity to enjoy cherries. Yet, one day after conspicuous consumption of cherries, one of the young men suffered a deterioration of his lungs, and the other young man withered away: the cherry took its toll on these two lives. Morosely yet insistently, Li claimed that no one should accuse the cherry of being solely a tool of death. Fruits were born to

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nourish people, and it was people’s insatiability that turned an innocuous fruit into a lethal poison.51 Beginning as an external object in eleventh-century China, the ginkgo was gradually absorbed into a world centered on agricultural practices and was ordered by precisely outlined relationships among grains, vegetables, and fruits. But this world was not a mere space consisting of objects strewn here and there. Instead, it was a cosmos infused with moralities and imperatives. How a plant was ranked, how a ranked plant was appreciated, how a plantappreciator behaved – all these concerns defined ginkgo’s relationship with the body. Ginkgo was a fruit, which means that it was helpful but noxious. This defined nature explained why ginkgo nuts could calm disturbed lungs on the one hand, but induce various afflictions on the other. But ginkgo’s status as fruit was not that self-evident. To what extent ginkgo had been domesticated – or, put another way – to what extent ginkgo cultivation could be in sync with the temporality and spatiality of qi – was the issue at stake. On the whole, ginkgo’s medicalization in China testifies to an ultimate maxim in traditional Chinese medicine: there is a correspondence between the body and its surroundings. If the traditional Chinese regimen – for example, the so-called internal alchemy – was to postulate ways (for example, certain manners of breathing, physical gestures, and the like) in which the body could absorb qi from surroundings and turn it into something that energized the body, what agriculturalists undertook was virtually the same. It was another sort of alchemy: shifting the essence of plants and making them beneficial to the body. It might be fair to say that to agriculturalists in seventeenth-century China, whether a plant was nourishing had little to do with its physical nature. Instead, what concerned them was the extent to which society could subjugate a plant to a broader, cosmic order. The ginkgo, a plant from the distant south, a tree that produced delicious and yet noxious nuts, could not be qualified as part of materia medica until it had been absorbed into a cosmic order shared by human beings. With respect to the case of China, the ginkgo’s insignificance in Japanese materia medica becomes understandable. Because of Japanese society’s reluctance to engage in ginkgo cultivation, the ginkgo in Edo Japan probably was not as “helpful” as the ginkgo in seventeenth-century China – in terms of what Li defined as fruits’ “helpfulness” to grains and vegetables. Indeed, in Japanese agricultural treatises, the ginkgo was normally catalogued under woods rather than fruits. To the Japanese in the Edo era, ginkgo nuts were essential to domestic life, but the ginkgo as a wood belonged to the wild; to untamed terrain; to a world full of danger, taboos, and unsettling spirits. In the mid-eighteenth century, the ginkgo stepped out of East Asia, and began spreading over the European and American continents. Two centuries or so later, the species would be known both in the West and the East as one of the greatest components in the manufacture of brain boosters.

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The first living ginkgo in Europe appeared in Utrecht sometime between 1727 and 1737, probably owing to the flourishing trade between the Dutch East India Company and Japan. Soon the ginkgo went on an odyssey. It was asexually reproduced (layering) in Britain by James Gordon, a nurseryman in London, and soon found its way into the hands of some of the most prominent botanists and horticulturalists of the day, including Carl Linnaeus in Uppsala, Humphry Sibthorp in Oxford, Joseph Banks at Kew, André Thouin at the Jardin des Plantes, William Hamilton in Philadelphia, David Hosack in New York, and Gardiner Greene in Boston.52 In 1780, a Parisian amateur naturalist named M. Pétigny came to London in pursuit of exotic plants. He ran into a gardener who had five ginkgo seedlings. The gardener informed Pétigny that ginkgos could be found nowhere else in London but in his garden. Though not without hesitation, the gardener said he would sell such precious seedlings – as long as Pétigny could afford the price. Pétigny longed for these ginkgos. Strategically, he made offers to this unctuous gardener over an abundant déjeuner and plenty of wine. The strategy worked well. Pétigny eventually got five ginkgo seedlings in exchange for only twenty-five guineas. Next morning, when the gardener had sobered up, he exclaimed to Pétigny that twenty-five guineas could buy only one ginkgo. Pétigny refused the request, and returned to Paris safely. In his annual Cours d’agriculture pratique, the renowned botanist André Thouin recounted Pétigny’s legendary pursuit. He told the audience that this was why Parisians nicknamed the ginkgo arbre aux quarante écus  – for each ginkgo cost Pétigny only forty crowns.53 Strikingly, even though the ginkgo was present and sometimes prevalent in major gardens in Europe and the Americas over the course of the next century, it remained a wonder to naturalists. On a Saturday in 1885, Lester Ward (1841–1913), an acclaimed American botanist, was passing by a garden in Washington, DC. A tree standing beside a wall attracted his attention. “A ginkgo tree,” Ward noted; but the ginkgo seemed to bear something that made it distinct from any ginkgo he had encountered before. Ward found out the reason. That ginkgo was flowering; its branches were now loaded with staminate aments. As Monday came, Ward immediately informed the garden’s superintendent. He had the superintendent survey the garden, because he was wondering whether there were other flowering ginkgos nearby. The survey turned out to be fruitful. Yes, there was another flowering ginkgo, and it was a female. After inspecting these two ginkgos, Ward concluded that fertilization could not occur naturally; human intervention was necessary. At last, the future President of the American Sociological Association rolled up his sleeves, carrying out artificial fertilization for these separated ginkgos. Afterward, he detailed the process in the journal Science, claiming that “an

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event of considerable interest to botanists has just occurred at Washington in the flowering, for the first time, of two of the ginkgo-trees in the US botanic garden.”54 Botanists’ fascination with flowering ginkgos is a recurring theme in the history of science. In 1796, for example, having heard that ginkgos at Kew had begun blooming, the famed German horticulturalist Carl August sent his assistant to observe the event.55 In 1812, when ginkgos came to bloom in Montpellier, the botanist in charge was so excited that he decided to sacrifice some branches with flowers, and to distribute them to his fellow botanists. He was assured that, as long as his fellow botanists could graft his branches appropriately, ginkgos would soon bloom around France. It was le désir d’être utile à ma patrie that motivated him, he noted afterward.56 Compared to those plants that had once piqued westerners’ curiosity (for example, tulips and roses), the craze for the ginkgo’s flowers took a somewhat different shape: the ginkgo was an object resistant to any facile classification, a planta obscura, and its flowers retained the key to the plant’s deepest secret. In 1771, thanks to the German naturalist and Japanologist Engelbert Kaempfer’s (1651–1716) description of the ginkgo, as well as the British horticulturist Gordon’s seedlings, Linnaeus was able to list the ginkgo in his Mantissa plantarum altera. But besides prioritizing his “authorship” over the name Ginkgo biloba, Linnaeus seems to have encountered difficulties in deciding on the ginkgo’s place in his twenty-four-class framework. His difficulties resulted from conflicts between two taxonomic systems. Kaempfer, reflecting the influence of Caspar Bauhin (1560–1624), compiled his flora with references to fruits, whereas Linnaeus’ system was flower-centric. Thus, in Linnaeus’ view, Kaempfer’s fruit-based descriptions were too vague to classify plants appropriately. Linnaeus ended up relegating the ginkgo to the appendix, under “CRYPTOGAMIA,” a classification that was probably too rough to convey any taxonomic significance.57 Probably the most prominent naturalist of the day, Linnaeus certainly had other sources of information to dispel his confusion with Kaempfer’s account. In 1770, this Swedish naturalist wrote to Carl Thunberg (1743–1828), one of his disciples, who was currently in Amsterdam, pondering whether Thunberg should accept a job offer from the Dutch East India Company. Linnaeus told Thunberg that the voyage to Japan was “not as perilous as some people here would have us believe.” If Thunberg accepted the offer, he emphasized, he would have “the chance to make himself ‘renowned and immortal.’” Thunberg accepted Linnaeus’ advice. In 1771, he embarked on a journey to Japan, a place that he would later call “a foreign most respected Nation.”58 It turned out that the aged Linnaeus was unable to wait for his disciple’s return. And yet, if he could, he probably would have been disappointed as far as the ginkgo’s taxonomic status was concerned – for Thunberg failed to locate any tree referred to as a “ginkgo” during his two-year stay in Japan (even

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though he did notice “ginkgo oil” in Japanese meals).59 In his Flora japonica (1784), Thunberg relegated the ginkgo to the category plantae obscurae; a short note reads: Crescit iuxta Nagasaki in insula Nipon, alibi (“grows near Nagasaki on the island of Japan, and elsewhere”).60 In the following decades, the ginkgo remained obscure despite its increasing popularity. The attempt to penetrate its obscurity was initiated in 1796, when British botanist James Edward Smith (1759–1828) read a paper entitled “Characters of a new genus of plants named Salisburia” before the Linnean Society. Smith was convinced that the ginkgo’s taxonomy was coming of age. He held that confidence, for ginkgos at Kew had begun blooming. In his presentation, he told his audience that he had created a new genus for the ginkgo, and inserted the genus between Linnaeus’ Luereus and Fuglans. More importantly, he announced, he had solved an issue that had long puzzled botanists: the ginkgo’s sexuality. The ginkgo was Monoecia, noted Smith, which meant that the ginkgo bore male and female flowers on the same individual.61 Yet Smith’s paper triggered criticism from the other side of the English Channel. Antoine Gouan (1733–1821), a botanist in Montpellier, was the earliest voice against Smith. In the late 1780s, Gouan became interested in the ginkgo. With the help of his friend, Gouan acquired seedlings from Joseph Banks at Kew. It turned out that the seedlings took twenty-four years to bloom. Gouan recorded the date precisely: April 12, 1812.62 Gouan found that all flowers blooming in his garden were male, which conflicted with Smith’s assertion that the ginkgo was Monoecia. He then came up with a bold conjecture: that the ginkgo was “dioecious,” which meant that botanists should be able to locate a ginkgo bearing solely female flowers, a female ginkgo.63 Gouan’s conjecture, for its stark contrast with Smith’s, stirred up debates between British and French botanists. The debates over the ginkgo’s sexuality were exacerbated by both camps’ disagreement over nomenclature: British botanists preferred Smith’s name for the ginkgo, Salisburia adiantifolia, whereas French botanists, regarding Smith’s neologism as unnecessary, prioritized Linnaeus’ Ginkgo biloba. The key to settling the debate, needless to say, was whether or not a female ginkgo did exist. But where was the right place to begin? To many botanists of the day, a female ginkgo served as the Holy Grail. The first female ginkgo in Europe was discovered in 1814 by the renowned French botanist Augustin Pyramus de Candolle (1778–1841). Located in Bourdigny near Geneva, the ginkgo had been brought there by an amateur naturalist named Paul Gaussen in the 1790s.64 Candolle’s discovery not only settled the controversies over the ginkgo’s sexuality (dioecious) but also opened a new terrain for the ginkgo in Europe: that is, after confirming the existence of the female ginkgo, horticulturalists became capable of making the ginkgo bear nuts. To be sure, in the eyes of many Europeans and Americans, the economic possibilities surrounding the ginkgo’s nuts were as important

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as the its contributions to natural history. In the early nineteenth century, for example, when ginkgos began blooming in Lyon, the Society of Agriculture, Natural History, and Useful Arts reported wistfully that “il serait bien pluś précieux si après nous avoir donné des fleurs, il nous donnait des fruits” (“ it would be much more valuable if after bearing us flowers it bore us fruits”).65 In large measure, Europeans’ and Americans’ expectations for and imagination of the ginkgo’s nuts reflected Engelbert Kaempfer’s vivid description of the ginkgo in his Amoenitatum exoticarum (1712), in which he wrote admirably both of how ginkgo nuts could “promote digestion” as well as “slacken the belly that is blown up because of food,” and of how these nuts, consequently, were “never absent after a sumptuous meal.”66 The Encyclopaedia perthensis notes, “These kernels [of the ginkgo] are said to promote digestion, and to give relief in surfeits; whence they make part of the dessert in great feasts” – apparently a summary of Kaempfer’s description. Also in the early 1810s, when ginkgos began ripening in Paris, two French botanists could not wait to savor what Kaempfer described as the blending of “the sweet of the almond and a bitter taste.” They later reported that roasted ginkgo nuts tasted like “newly roasted maize.” Suspiciously, they questioned Kaempfer’s account, declaring that, after roasting the nuts, there was “nothing in the kernels but a farinaceous matter, without the least appearance of oil.”67 In 1819, partly because Kaempfer had written that ginkgo nuts tasted bitter, an essay entitled “Ueber den Ginkgo” stated that the Japanese esteemed ginkgo nuts more for their “digestive-supporting effects” (verdauungsfördernden Wirkungen) than for their “tastiness” (Schmackhaftigkeit).68 In his The Vegetable Kingdom; or, The Structure, Classification, and Uses of Plants (1847), John Lindley (1799–1865) noted that the ginkgo’s fruits were both “resinous and astringent” and were “thought by the Japanese to promote digestion.”69 In 1877, Charles Sprague Sargent (1841–1927), American botanist and the first director of the Arnold Arboretum at Harvard, opined, “In Japan the kernels have reputed digestive qualities, and are very generally served at dessert … The cultivation of the ‘Ginjko’ [sic] for its nuts is worth consideration,” he remarked.70 Even in the early twentieth century, Ernest Henry Wilson (1876–1930), a plant hunter affiliated with the Arnold Arboretum, reported that in Japan, ginkgo nuts were “eaten at banquets, weddings, and convivial gatherings generally, being supposed to promote digestion and to diminish the effects of wine.”71 The prevalence of Kaempfer’s account of the ginkgo draws us back to 1690, when the German naturalist had just arrived in Dejima, an artificial island in the bay of Nagasaki. Compared to his predecessors, Kaempfer was fortunate to have a Japanese man as a servant. Yet, as unfortunate as his predecessors were, the local administration did not allow him to step outside Dejima, much less travel or conduct natural-history research. Eager to initiate his project on Japan, Kaempfer came up with a bold scheme. Risking being

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executed or expelled, he and his servant “smuggled” books, plants, and artifacts to Dejima.72 Moreover, with specimens and reference books in hand, he deployed every means to reach intelligent Japanese people, in hopes of knowing how the Japanese named their plants and other natural-history objects. Among the texts that helped Kaempfer identify the ginkgo was Kinmōzui (訓蒙図彙, Collected Pictures for Teaching Children) by Nakamura Tekisai (中 村惕斎, 1629–1702). It was Kinmōzui in which Kaempfer found the characters “銀杏,” corresponding to ginkyo in Japanese. Afterward, Kaempfer brought Kinmōzui back to Europe, and had his publisher include the characters in his Amoenitatum exoticarum.73 But Kinmōzui’s description of the ginkgo was rough – after all, Kinmōzui was for children, not for an experienced naturalist. The author Nakamura Tekisai left no comment on the ginkgo’s utilities, let  alone an exposition of ginkgo nuts’ ubiquity in Japanese cuisine. Compared to Kaempfer’s detailed and rich accounts of the ginkgo in the Amoenitatum exoticarum, the aforementioned German naturalist must have consulted other sources to set up his digestion thesis. In this regard, neither flourishing interpretations of Bencao gangmu nor such ginkgo-related Japanese books as Sansai zue (三才図会) and Shokumotsu honzō (食物本草) contemporaneous with Kaempfer’s visit to Japan characterize ginkgo nuts either as a way to help “slacken the belly” or as indispensable after a sumptuous meal. What these works reveal is that most medical texts on the ginkgo’s digestion-related effects warn of ginkgo nuts’ tendency to swell the belly, an absolute warning sign that people should heed. Whether in Edo Japan or in early modern China, a swollen belly spoke of danger. Shennong bencao jing (神農本草經), one of the earliest herbal books in China, declared that whether or not an herb resulted in a swollen belly was an ultimate criterion for sorting out medications. Those herbs that did so were destined to be inferior: that is to say, they were therapeutic, but if taken continuously, the herbs would have a deleterious effect on the body.74 In Edo Japan, too, a swollen belly signaled stagnation of vitality, which, as Gotō Konzan (後藤艮山, 1659–1733) famously put it, gave rise to “a hundred diseases.”75 In this regard, no matter how Kaempfer acquired information upon which he based his account of the ginkgo’s efficacies, his view of the connection between ginkgo nuts and the belly differed fundamentally from that of most Japanese doctors. Ginkgo nuts functioned not to slacken but to swell the belly. A swollen belly was the possible consequence of people’s consumption of ginkgo nuts. It was not the cause of ginkgo’s prominence in Japanese cuisine. Still, Kaempfer undoubtedly got one thing right: that the Japanese regarded ginkgo nuts as a facilitator of digestion. As I have already pointed out, Japanese doctors were convinced that ginkgo nuts promoted digestion by stimulating saliva, a sort of “lubricant” to the body. What remains problematic is how Kaempfer and his contemporaries spoke of digestion in their own terms. Though nowadays, fruits’ promotion of digestion has become part of our

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common sense, people in the past did not necessarily think so. Historians of food have shown that for most of history, fruits were considered noxious, as they purportedly disturbed humors. The great Greek doctor Galen, for example, claimed that fruits caused headaches, gullet distress, bad corruption, fevers, and even premature death. “The merit of raw fruit was but laxative.”76 “We never need them for food, but only as a medication,” he claimed in his On the Properties of Foodstuffs.77 In “Thinning diet,” too, he argued that fruits were all “wet, cold and productive of phlegm, especially those which are eaten raw, such as apples, pears, and cucumbers”: The least harm is done by those which evacuate the gut, for example, blackberries, and next after them plums, and cherries and figs. Fruits which are slow to pass through the system are the worst of all, especially if their bodies are also hard. None of these should be tasted except for those suitable for preservation, which include several kinds of pear, apple, and grape.78

If we juxtapose Kaempfer’s comments on the ginkgo with Galen’s diagnosis of fruits’ impact on humors, a conspicuous parallel surfaces. In the end, what Kaempfer had documented was not the way in which the Japanese in the Edo era regarded the ginkgo. Rather, it was a reflection of dominant thinking about fruits in eighteenth-century Europe. Still, reflecting Kaempfer and his contemporaries’ appreciation of ginkgo’s promised efficacies, it seems that a striking correspondence existed between East Asian and European medicine with regard to fruits. Despite fundamental differences in manners of reasoning, doctors in these two medical traditions agreed that fruits were generally noxious. Cooking functioned alchemically, transforming fruits into something sound for the body. Of note is that different cultures expressed similar levels of anxiety over fruits. To Chinese doctors of the sixteenth century (Li Shizhen, for example), people’s acknowledgment of fruits’ malignance corresponded to the social imperative that people should refrain from indulging. Japanese in the Edo era feared that qi might become congealed in the belly, and therefore, they ultimately credited fruit for lubricating the interior of the body. In Europe, that fruits had a laxative function reflected what Shigehisa Kuriyama terms “the fear of excrement.”79 As Galen himself reflected, “Every superfluous substance [of food] which lingers in the body must obviously putrefy… and thus it becomes pungent, acrid, and burdensome to the organ which contains it.”80 The fear of being hijacked by food’s residue gave rise to the long-enduring popularity of purgation, enemas, laxatives, and bloodletting. Against this backdrop, when botanists aspired to hunt for female ginkgo trees throughout Europe, and when gardeners heartily celebrated the blooming of the ginkgo, what they looked into and looked for was not an exotic wonder from the Far East but something ordinary and comprehensible in contemporary intellectual milieus.

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Kuang-chi Hung The Ginkgo as a celebrity in the twentieth-century world

With the establishment of the Meiji era (1868–1912), a time when Japanese society was immersed in optimism toward western sciences, the folklore and the wonder surrounding the ginkgo lost their sheen. Learned Japanese dissected the ginkgo’s “breasts” with physicians’ acumen. “Merely aerial roots,” they claimed, arguing that these “breasts” were part of the mechanism that enabled the ginkgo to absorb vapor from the air. Some scholars turned a suspicious eye to folklore, targeting those plants associated with magical or spiritual powers. Again, the ginkgo was under specific scrutiny.81 For example, in the Edo era, a giant ginkgo in the city of Edo itself (today’s Tokyo) was said to have been planted by a monk simply inserting his walking stick into the soil. Beholding that this particular ginkgo generated root-like lumps on the trunk, people came to believe that the monk had actually planted the ginkgo upside down, or its peculiar shape would not have presented itself so vividly. To botanists in the Meiji era, however, explanations of this sort reflected people’s obsession with religion. Plant physiology, not religion, should be the ultimate means by which to unveil the ginkgo’s nature. The ginkgo’s bonds with incomprehensible and untamed power were nothing short of a perfect target for Japanese botanists. It was as if the Enlightenment would flourish in Japan as soon as society rejected the “superstitions” hovering over the ginkgo. Such demystification climaxed in the early 1890s, when Hirase Sakugorō (平瀬作五郎, 1856–1925) examined the ginkgo’s flowers under a microscope. Hirase was not a pioneer in this respect. As early as the mid-nineteenth century, Japanese agriculturalists with interest in western natural history had suggested such microscopic analysis and probably had undertaken it. But Hirase differed from his predecessors in his academic sensibilities. During the late nineteenth century, fertilization in gymnosperms was a hot issue in botany. Famed European botanists, in particular Eduard Strasburger (1844–1912) at the University of Bonn, had been delving into the field, and the ginkgo was among the items listed for inspection. As a research assistant working with botanists who had once studied in Germany, Hirase knew how the ginkgo’s fertilization mattered in botany and perhaps in Japanese society. He made full use of his affiliated institution, the University of Tokyo’s Koishikawa Botanical Garden. A male ginkgo had been growing there for centuries and bloomed and ripened satisfactorily. Compared to Strasburger, who had to rely on material packed and delivered from Vienna, Hirase had the advantage of abundant accessible material. Throughout the year 1893, he continuously observed the ginkgo’s flowers under a microscope during the blooming season. Finally he identified a phenomenon that even his prestigious and experienced European colleagues had not noticed: that the ginkgo’s “sperm” or spermatozoids were swimming in a zigzag pattern under the microscope. He was startled, as were his colleagues. An assistant without any significant background in botany had accomplished the most notable discovery in Japanese botany.82

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Hirase’s discovery was first published in Japanese in the Botanical Magazine Tokyo, and was later published as German, French, and English translations. To botanists of the day, his paper was a long-awaited testimony. First, swimming spermatozoids characterize – and indeed are confined to – ferns’ reproductive system. Since the ginkgo shares that very nature, it was beyond doubt that the ginkgo should evolutionarily associate with ferns. Second, however, the ginkgo’s resemblances to flowering plants (conifers, in particular) were undeniable. Thanks to Charles Darwin’s Origin of Species (1859), botanists were able to reconcile the two recognitions by placing the ginkgo, conifers, and ferns in an evolutionary sequence. It turned out that the ginkgo was neither a conifer nor a fern. It was an in-between species that encapsulated the secret of evolution. Later on, botanists featured the ginkgo as a living fossil, a term that was coined by Darwin but that acquired its concrete meaning in the natural history of the ginkgo.83 From a twenty-first-century perspective, in an era when scientists have experimented with cloning a Tyrannosaurus rex from fossilized bones or teeth, the discovery of a living fossil is usually commonplace. Yet, to the public of the late nineteenth and early twentieth centuries, a living fossil was not only a monumental event in science but also an event of varied significance. Besides the ginkgo, a celebrated living fossil that captivated the public was the sequoia, a native genus in the United States. During the early 1870s, an enthusiasm swept over American society to find the “greatest” tree of the nation. The sequoia, for its magnificent size and incomparable height, was the best candidate to many Americans. Yet, in his presidential address to the American Association for the Advancement of Science, Asa Gray (1810–88), arguably the most prominent botanist of the nineteenth-century United States, challenged the sequoia’s candidacy. As the gatekeeper and the strongest supporter of Darwinism in the United States, Gray declared that the sequoia was a “loser” in organisms’ competition for survival. He reminded the audience that, despite this species’ wide distribution over the northern hemisphere, the sequoia had been all but wiped off the face of the earth – except for a confined region along the Sierra Nevada. The case of the sequoia, Gray noted, was comparable to “a more familiar gymnospermous tree, the Ginkgo or Salisburia.” Both of the cases demonstrated that nature was not “an ocean with merely tidal fluctuations.” Rather, it was a river streaming on in a single direction. Both the ginkgo and the sequoia belonged to the irretrievable past and had been left behind in the river of evolution.84 With the past of the ginkgo gradually clarified, botanists came to debate the present status of the species. This time what concerned them was the issue of domestication. To what extent had the ginkgo been domesticated in human civilization? In what sense did humans “prevent” evolution’s natural selection from eliminating the ginkgo? To those who had converted to Darwinism, such issues were highly challenging. The rising concern with the ginkgo’s domestication resulted from a biogeographical fact: that the ginkgo could be found only in China, Korea, and Japan.

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2.2  A painting of the ginkgo drawn by a local Chinese artist.

In the words of Gray, in an age when giant reptiles were roaming the earth’s surface, the ginkgo “inhabited Northern Europe and the whole arctic region round to Alaska, and had even a representative farther south, in our Rocky Mountain district.” Yet, he continued, “for some reason,” the ginkgo’s habitat was now confined to the “shore of East Asia.”85 To figure out the reason for this shift in prevalence, commissioned naturalists wandered through Chinese villages and Japanese temples, trying to identify the slightest traces of people’s interactions with the ginkgo. Some naturalists, like Isabella Bird (1831–1904), insisted that they had run into ginkgos in the wild, whereas others announced that the ginkgo was by all accounts a domesticated tree in East Asia. The socalled wild ginkgo was but a mirage.86 It turned out that the solution to the debate was naturalists’ ability to demonstrate the relationship between the ginkgo and society. Collecting specimens, which was the most worshiped craft of naturalists, did not work out here: a dry plant speaks to botanists but not for society, where it is treasured or despised, domesticated or eradicated. Perhaps this dichotomy explains why Robert Fortune (1812–80), a noted British plant hunter, had a Chinese artist paint a ginkgo for him during his stay in China in the mid-nineteenth century.

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The painting was later reprinted in the Annals of Botany in 1900 as proof of the ginkgo’s domestication in Chinese society (Figure 2.2). American botanists offered the most vivid and systematic account in this respect. Beginning in the late 1890s, the Arnold Arboretum at Harvard launched a series of expeditions to East Asia. The botanist who took the greatest initiative was Charles Sprague Sargent, director of the Arboretum. An expert in economic botany, Sargent was impressed by the ginkgo’s horticultural potentials. In 1897, after a trip to Japan, he reported that the ginkgo, in general, scarcely assumes “its real character until it is more than a century old.” Arguing poetically but also politically against some landscape designers who despised the ginkgo for its foreignness, Sargent declared, “If, on a bright November day, [a landscape designer] had seen the great trees in Kamakura, or in the gardens of Asakura, in Toukyou [sic], he would certainly have recognized the great possibilities of the Ginkgo for picturesque planting.”87 Sargent’s passionate descriptions introduced a new image of the ginkgo to the American public.88 Ernest Henry Wilson, a British plant hunter who joined the expeditions in the early twentieth century, took Sargent’s view even further. In his acclaimed book The Romance of Our Trees (1920), he claimed that “the Ginkgo is the oldest cultivated nut tree” in human history. He added a caption to a series of pictures showcasing giant ginkgos in Japanese temples; Washington, DC; Kew Gardens, and so on, claiming that “the Ginkgo is a link with the limitless past” (Figure 2.3). Amusingly, as if realist pictures had not been sufficient, he included a painting of dinosaurs, noting that “The terrible lizard was an inhabitant of the earth in the age where the Ginkgo belongs.”89 Wilson’s and similar accounts that emphasized the ginkgo’s link with the “limitless past” decisively shaped the ginkgo’s meaning in the twentiethcentury world. The ginkgo was not an exception to the rule “survival of the fittest.” Such a living fossil would have come to extinction without the dedicated nursing provided by both Chinese and Japanese. In a letter sent to The Times in 1936, for example, the famed British botanist Albert Charles Seward (1863–1941) wrote emotionally that “To Ginkgo biloba must be assigned the first place as a link with the past; a sacred tree in the Far East, it should be so regarded by all who desire to safeguard natural monuments; it is the last of a race that, ages before the evolution of man, occupied a position in the floras of the world.”90 Surrounded by many living fossils, the ginkgo had well established its celebrity by the mid-twentieth century. It had even become a measure by which the public imagined the limitless past, the limits of humanity, and intricate entanglements between humanity and nature. In a poem entitled “Ginkgo” (1973), Felix Pollak wrote: Look closely at this leaf: Lao-tzu’s eyes must have rested upon its identical twin, Alexander’s troops

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2.3  Wilson’s picture of the ginkgo taken during his expedition to Japan in 1914. (joking ribald at the sexual smells of their far-away women) must have smelled that fruity stench and eaten those oval pits. Ginkgo biloba: found missing link between flowering plants and ferns: survival is the ultimate virtue.91

The emphasis on the ginkgo’s status as a living fossil eventually found its way into the medicalization of the ginkgo as a memory-enhancing herb. The most apparent link between the ginkgo’s evolutionary history and the ginkgo’s purported medical functions was the tree’s status in the ideology surrounding the “survival of the fittest,” which became a common phrase in conjunction with ginkgo products. No customers would have mistaken the phrase’s implication in medicine: in order to survive, you have to be the fittest; and in order to be the fittest, you should consume something that, itself, has survived from

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2.4  The sequoia and the heart.

the distant past into the present. Figure 2.4 shows an illustration enclosed in a brochure published in West Germany in the 1960s. In it we see a juxtaposition of a human heart and a tree that cannot be misidentified as a sequoia. The caption reads, “Das Altersherz ist die Domäne des Crataegutt,” or “The old heart is the domain of Crataegutt.” To be sure, the illustration does not suggest that Crataegutt is made of the sequoia. Crataegutt is actually manufactured from a common herb in Europe: Crataegus oxyacantha. The sequoia here symbolizes vitality. The heart, by contrast, stands for an aged organ. An aged heart, according to the brochure, is fatigued and dying. Its fibers have lost flexibility, and strength is draining from it. Crataegutt is meant to infuse

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vitality into the aged heart. It will make the heart pump blood robustly as if it were a sequoia: despite having stood on the earth for thousands of years, an aged sequoia remains sufficiently vigorous to draw in water and to nourish its magnificent body. Here, if we compare this message to those treating the sequoia as a “loser” in evolution, we can see that the social meaning of living fossils underwent a radical shift, probably owing to botanists’ active involvement. This symbolic appropriation of the sequoia closely relates to the medicalization of the ginkgo in European and American contexts. The company that marketed Crataegutt in the 1960s was the Dr.  Willmar Schwabe Company (DWSC), the midwife who brought EGb 761 (a ginkgo extract) to the world. Crataegutt was virtually a sister product of EGb 761. Both of them appeared in the 1960s as remedies to circulatory ailments. More importantly, both EGb 761 and Crataegutt relied heavily on the symbolic meaning of a living fossil: the former on the ginkgo’s symbolism, the latter on the sequoia’s  – and not coincidentally were these two living fossils the most renowned around the modern world. Founded in 1866, the DWSC has been, without question, the most crucial agent steering the medicalization of the ginkgo in the West. The DWSC’s first ginkgo product, Tebonin, was marketed in West Germany in 1974, and sold in France the following year with the trademark Tanakan.92 In the United States, for the necessity of clinical tests, the DWSC offered EGb 761 to the Nature’s Way Company (NWC) instead, and the NWC, based in the United States, turned to marketing its ginkgo products as a “supplement” to regular medical treatments.93 Originally a purveyor of homeopathic pharmacopeias, the DWSC is a key figure in the rationalization of folk medicine (Volksmedizin) in Germany. In its well acclaimed Pharmacopoea homoeopathica polyglottica – published in 1873 in three languages (German, French, and English) – the DWSC explained that “the homoeopathic pharmacy has not, like the old school, to deal with complicated formulae and mixtures, but exclusively with the preparation of simple medicinal substances, and this in a way the most simple and direct possible.” With the goal set out, Pharmacopoea homoeopathica polyglottica included references to hundreds of popular herbs, each of which had been chemically examined, with a list of substances that might possess medical applicability.94 In subsequent decades, the DWSC’s major rival in the pharmaceutical market, Dr.  Madaus & Co., undertook a similar project but on a more ambitious scale: the three-volume Textbook of Biological Healing Methods (Lehrbuch der biologischen Heilmittel [1938]), covering thousands of herbs from Europe, Asia, and the Americas. From China’s ginseng to American Indian sweet grass, all of them were described with reference to topological maps, pharmaceutical formulae, chemical analyses, biological features, and the like.95

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Interestingly, neither the DWSC nor Dr. Madaus & Co. included the ginkgo in its groundbreaking works. This absence probably suggests ginkgo’s insignificance in pharmacy between the 1870s and the 1930s. The first attempt to incorporate the ginkgo into homeopathy was made in France in the 1930s. In his book entitled Homoéopathie expérimentale: Le “Ginkgo biloba” (1933), Emmerick-Adrien Maury carried out what homeopathists call the “proving,” in hopes of locating people’s “target regions” and affiliated symptoms likely remedied by the ginkgo. Maury fed his “provers” tinctures derived from ginkgo leaves. The results showed that the ginkgo affected the skin, urinary tract, pharynx, stomach, and head. Maury also noticed that provers attested to sensations of freedom, rapid speech, restlessness, irrational fears, exhaustion, mental excitement, aggression, suppressed anger, hyper-criticism, irrational impressions, confusion, and fatigue. More importantly, he found that provers experienced heaviness in the frontal region and vertigo, which were suggestive of the ginkgo’s association with the head. Maury concluded that, on the whole, tinctures from ginkgo leaves acted primarily upon the left side of the body; cold air, exercise, walking, looking up, and looking to the left would aggravate symptoms induced by the ginkgo tinctures.96 Attempts to examine the ginkgo medically took place in Japan, as well. In 1932, Shu Furukawa, Professor at Tohoku University, reported that he had identified a compound, which he called ginkgolides, and which seemed common in the ginkgo’s leaves, bark, roots, and seeds. Though he was uncertain of the compound’s structure, Furukawa reported that ginkgolides were responsible for many features of the ginkgo: for example, the bitter taste of ginkgo nuts, and the nuts’ beneficial role in digestion. Furukawa’s project was followed by one under the postwar direction of Koji Nakanishi at Columbia University. In 1967, Nakanishi confirmed the chemical structure of ginkgolides, at about the time that the DWSC began marketing EGb 761 in West Germany.97 Despite being a latecomer in ginkgo’s medicalization, the DWSC found its niche in the pharmaceutical market. When trying to identify the regions of the human body that the ginkgo would target, the DWSC neither referred to French homeopathists’ findings, nor drew on the authority of Chinese or Japanese medicine. Instead, the DWSC adopted a conviction that had endured in Europe and the Americas: that ginkgo nuts helped with digestion. Worthy of note is the fact that, when the DWSC had begun identifying ginkgo’s therapeutic efficacies in the 1960s, theories concerning how digestion functioned in the body had undergone revolutionary changes. For the most part, physiologists had established important relationships between digestion and circulation. The relationships that had been emphasized in Galenic medicine – for example, corruptive food residue, purgation, disturbance of humors  – were later considered obsolete against the discoveries of how blood circulated nutrients throughout the body and of the stomach’s pivotal function. In his book entitled Practical Dietetics, with Special Reference to Diet in Disease (1895),

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William Gilman Thompson (1856–1927) asserted that “vigorous active circulation accompanies good digestion and maintains a normal local reaction and temperature, and feeble, sluggish circulation produces local congestion of the viscera and interferes with gland secretion and absorption.” The new physiological basis gave the DWSC a chance to transform an old conviction into a new commitment: that ginkgo promoted digestion because it helped with circulation. So long as clinical tests could prove that ginkgo facilitated circulation, a new array of possibilities would open wide: from varicose veins to angina to blood clots to Alzheimer’s Disease, all of these ailments were, and to some extent are, diagnosed as circulatory ailments.98 There is an expression in Chinese, jinshang tianhua (錦上添花), literally meaning to embroider the brocade with flowers, or to perfect the perfect. The ginkgo in the 1980s seamlessly matched the expression. Inspired by Nakanishi’s research at Columbia University and driven by a market value presumed to be worth $500  million per year, chemist Elias J. Corey (1928–) and his team at Harvard were devoted to the synthesis of ginkgolides. In the late 1980s, the world was introduced to the first synthesized ginkgolides. The New York Times celebrated Corey’s achievement with an article entitled “Ancient tree yields secrets of potent healing substance.” “For at least 5,000 years,” it reported, “an extract of the ginkgo leaf has been recommended in Chinese medicine as being good for the heart and lungs,” helping treat such ailments as “coughs, asthma, and acute allergic inflammations.” Such an ancient tree, together with its promised efficacies, had recently won success in the pharmaceutical market. Corey’s achievement in synthesizing ginkgolides meant that there could now be a rich supply of that potent substance for mass production and market expansion, as well as for easing the sufferings attributable to circulatory ailments.99 In 1990, Corey won a Nobel Prize for his contributions in organic synthesis. Though synthesized ginkgolides never found a highly successful niche in the marketplace because the public still preferred the substances extracted from living ginkgos to the substances synthesized in the laboratory, Corey’s achievement had an immediate impact. Pharmaceutical companies soon marketed EGb 761 with a new trademark, “Ginkgold,” implicitly referring to Corey’s award-wining ginkgolides.100 In 1997, an essay in the JAMA reported that “EGb 761 appears capable of stabilizing and, in a substantial number of cases, improving the cognitive performance and the social functioning of demented patients for 6 months to 1 year.”101 A treasured living fossil, a laurel wreath bestowed by the Nobel Prize committee, a symbol for Chinese civilization, a magic bullet for circulatory ailments: this is Ginkgo biloba, the world’s first and foremost brain booster. Conclusion This chapter has explored the intersections among various separate fields: food and medicine, body and mind, the traditional and the modern, the East

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and the West. The target of my approach has been a highly esteemed – yet controversial – herb in modern times: Ginkgo biloba. As the only species of its kind, the ginkgo is an ideal object for comparative studies. Given that the ginkgo cultivated in early modern China, Edo Japan, and the Europe and the Americas of today is, taxonomically, one and the same, studies on ginkgo’s medicalization should shed fresh light on how respective societies medicalize a botanical in their own manner. One of my motivations came from current clinical studies on ginkgo products. Over and over again, we are told that because ginkgo has been prescribed in Chinese or Japanese medicine for thousands of years, we moderns have no reason to avoid this ancient tradition – as long as biochemists can get the extract right. In light of the prevalence of such discourses, this chapter has analyzed the ginkgo in early modern China, Edo Japan, and the Europe and the Americas of today in their own right. Rather than portray a linear route marching progressively from traditional medicine to modern biomedicine, the chapter emphasizes divergences and convergences. By provincializing  – not by privileging  – societies involved in ginkgo’s medical history, it addresses how respective cultures condition people’s perceptions of a botanical and its therapeutic efficacies. There is nothing wrong with the view that human bodies respond to the same botanical similarly. But these very similarities can generate distinct contemplations, which in turn give shape to the divergent medicalizations of a unique object. To Chinese doctors, ginkgo’s correspondence with the lungs was conspicuous. The nuts’ color, the ginkgo’s blooming pattern, even the bodily discomforts in question, all of them helped explain to Chinese doctors why cooked ginkgo nuts could remedy asthma, coughing, and urinary incontinence. But a modern reader should not take such prescriptions literally. According to the Five Phase Theory, the lungs are not only relevant to respiratory illnesses, but also responsible for symptoms ranging from incontinence of the bladder to the eyes’ secretion of sticky tears. In contrast, doctors in Edo Japan – despite their familiarity with Chinese doctors’ speculations  – rarely followed suit. Japanese doctors characterized ginkgo nuts as being “digestive” aids because the nuts seemed to stimulate the production of saliva, the lubricant that could hydrate and nourish the body. With hindsight, the Japanese version of ginkgo’s efficacies brought about the most dramatic transitions in the plant’s medical history. Thanks to Kaempfer’s effort to render the ginkgo understandable and useful to his readers, Europeans throughout the eighteenth and early nineteenth centuries were convinced that ginkgo nuts promoted digestion – though what they meant by “digestion” reflected the Galenic sense of the term: that is to say, ginkgo nuts were a laxative to purge the body. That peculiar way of thinking, when coupled with the physiology of digestion in the early twentieth century, situated ginkgo in a new terrain of pharmaceutical applicability: circulation. Ginkgo promoted digestion because it helped with circulation.

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Taken as a whole, the current recognition or negation of ginkgo as a memory-enhancing herb owes much of its existence to the past of western medicine, not to the past of Japanese or Chinese medicine. For that matter, people who take ginkgo tablets hoping that the Chinese herb might be as effective as acupuncture or qigong are actually acting on beliefs consistent with those underlying bloodletting, enemas, and other remedies that, once popular in western medicine, are considered anathema in contemporary biomedicine. Likewise, people who reject ginkgo’s pharmaceutical applications because of its connections to herbal or alternative medicine are, in fact, rejecting a significant aspect of western medicine’s past. The case of the ginkgo shows that, regardless of whether the setting is early modern China, Edo Japan, or the Europe and the Americas of today, ginkgo’s medicalization has ultimately been dependent on how the respective society cultivates, tastes, uses, and appreciates the ginkgo. The worldview that guides respective societies’ prescription of ginkgo emerges when we piece together clues scattered throughout agricultural treatises, folklore, and scientific observations. The Chinese people’s belief that ginkgo remedies lung ailments speaks of a world centered on agricultural activities and layered with grains, vegetables, and fruits – a world bestowed with hierarchical and moral ethos. In Edo Japan, the ginkgo was categorized as a tree (i.e., belonging to the “woods”) and reflected dualities: nourishment and motherhood on the one hand, misfortune and danger on the other. Such distinctions are essential for explaining why the ginkgo underwent peculiar medicalizations in China and Japan, respectively. By the same token, when tracing the making of ginkgo as a brain-booster, it is insufficient – if not misleading – to constrain our view to the pharmaceutical market, drug industries, medical research, and the like. Rather, we have to trace how the ginkgo was treasured, debated, demonstrated, and showcased in society, against the backdrop of the ever-thriving Darwinism, the birth of modern botany, and so on. A study on the development of certain pharmaceuticals, in this regard, should not confine itself to mapping out a history of pharmaceuticals-as-commodities. As anthropologists of material culture have made clear, historians should learn to venture through a multitude of facets that shape the life history of a thing, or what they call the “cultural biography of things.”102 Goethe probably foresaw the general emergence of this approach in the history of science. His verse on ginkgo leaves states not only that the leaf “divides itself into itself ” but indeed concisely exemplifies studies that hinge on how divergences and convergences take place throughout histories and places. Indeed, Goethe attached an actual pair of ginkgo leaves to the piece of paper on which he recorded the poem.103 The presence of these preserved leaves on the page of poetry suggests that, perhaps more than the poem’s words, the accompanying ginkgo leaves promote the idea that empirical observation is key to the poem’s core meaning. We can almost hear the poet whispering, “Think with the object!”:

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Is it one living being? That divides itself into itself Are there two who have chosen each other, So that they are known as one?104

Acknowledgments I would like to thank Howard Chiang for inviting me to contribute this essay to the volume and for his heroic effort in making the volume possible. In the course of preparing this essay, I received tremendous help from many scholars in various fields, particularly from Shigehisa Kuriyama, Janet Browne, Henrietta Harrison, Peter Del Tredici, He Bian, Carla Nappi, Daniel Trambaiolo, Wolfgang Michel, Cor Kwant, and Yan Liu. Notes I want to emphasize two points before entering the text. First, in this chapter, I use the term “fruit” to refer to the ginkgo’s fleshy “seeds,” because people in the past mostly thought in this manner. Second, what I offer here is a cultural history and a medicinal history of the ginkgo; for those who are interested in the history of the ginkgo from a scientific point of view, see, among others, Peter R. Crane’s remarkable Ginkgo: The Tree That Time Forgot (New Haven: Yale University Press, 2013); and Peter Del Tredici, “The evolution, ecology, and cultivation of Ginkgo biloba,” in Ginkgo biloba, ed. Teris A. van Beek (Amsterdam: Harwood Academic, 2000), 7–23. 1 For a remarkable analysis on Goethe and the ginkgo, see Siegfried Unseld, Goethe and the Ginkgo, trans. Kenneth J. Northcott (Chicago: University of Chicago Press, 2003). 2 “Chinese extract market: Ginkgo, ginseng focus,” Nutrition Business Journal 12.11 (2007): 7–9. 3 See www.amazon.com/Ginkgo-Biloba-Extract-24-Caps/dp/B00068UASI (accessed October 31, 2014). 4 Pierre L. Le Bars, Martin M. Katz, Nancy Berman, Turan M. Itil, Alfred M. Freedman, and Alan F. Schatzberg, “A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo Biloba for dementia,” JAMA 278.16 (1997): 1327–32 (1327). 5 “West Germany Ginkgo biloba extract: Over 5  million prescriptions a year,” The Lancet 334.8678 (1989): 1513–14; “How to waste 200  million dollars a year!,” Pediatrics 86.1 (1990): 38. 6 See, for example, Brendan I. Koerner, “Ginkgo biloba? Forget about it: A history of the top-selling brain enhancer” (2007), at www.slate.com/id/2165042/; Paul E. Gold, Larry Cahill, and Gary L. Wenk, “The lowdown on Ginkgo biloba,” Scientific American 288.4 (2009): 87–91. 7 Steven T. DeKosky, Jeff D. Williamson, Annette L. Fitzpatrick, et al., “Ginkgo biloba for prevention of dementia: A randomized controlled trial,” JAMA 300.19 (2008): 2253–62.

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8 Alice Park, “Ginkgo biloba does not prevent Alzheimer’s,” Time, November 18, 2008, www.time.com/time/health/article/0,8599,1860453,00.html. Also see Karen Kaplan, “Ginkgo biloba fails to ward off dementia in trial,” Los Angeles Times, November 19, 2008, http://articles.latimes.com/2008/nov/19/science/ sci-ginkgo19; Roni Caryn Rabin, “Ginkgo biloba ineffective against dementia, researchers find,” The New York Times, November 19, 2008, www.nytimes. com/2008/11/19/health/research/18ginkgo.html. 9 American Botanical Council, “Herbal science organization clarifies new ginkgo study,” The New York Times, December 28, 2009, http://cms.herbalgram.org/ press/2009/JAMAGinkgoResponse.html. 10 See, for example, Lorraine Daston, ed., Things That Talk: Object Lessons from Art and Science (New York: Zone Books, 2004); Arjun Appadurai, ed., The Social Life of Things: Commodities in Cultural Perspective (Cambridge: Cambridge University Press, 1986). 11 For example, Harold Cook, Matters of Exchange: Commerce, Medicine, and Science in the Dutch Golden Age (New Haven: Yale University Press, 2007); Linda Barnes, Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848 (Cambridge, MA: Harvard University Press, 2005). 12 Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (New York: Zone Books, 1999). Also see Alain Touwaide, “Indigenous vs. foreign: Early-modern materia medica in comparative perspective,” Early Science and Medicine 14.6 (2009): 677–9; Waltraud Ernst, “Beyond East and West: From the history of colonial medicine to a social history of medicine(s) in South Asia,” Social History of Medicine 20.3 (2007), 505–24. 13 Ouyang Xiu, Ouyang Xiu quanji: juan wu (歐陽修全集: 卷五) (Beijing: Zhonghua shuju, 2001), 88. 14 Mei Yaochen, Wanling xiansheng wenji (宛陵先生文集) (Changsha: Shangwu yinshuguan, 1940). The poem is entitled “Daishu ji yajiaozi yu duxia qinyou” (代書寄鴨腳子於都下親友). 15 Zhang Bangji (張邦基), Mozhuang manlu (墨莊漫錄) (Shanghai: Shanghai guji chubanshe, 1992), 48. 16 Ibid., 48. 17 The recipe is included in Wulin jiushi (武林舊事), which was written by Zhou Mi (周密) and can be found in Meng Yuanlao (孟元老), Dongjing meng hua lu (東京夢華錄) (Beijing: Zhonghua shuju, 1962), 443. 18 Meng, Dongjing meng hua lu, 17. 19 Yang Wanli (楊萬里), Yang Wanli shiwenji (楊萬里詩文集) (Nanchang: Jiangxi renmin chubanshe, 2006), 250. 20 The description is from Meng liang lu (夢梁錄), which was written by Wu Zimu (吳自牧) and can be found in Meng, Dongjing meng hua lu, 277. 21 Ouyang Xiu, Ouyang Xiu quanji: juan qi (歐陽修全集: 卷七) (Beijing: Zhonghua shuju, 2001), 106. 22 Mei, Wanling xiansheng wenji; the poem is part of Yongshu nei han yi Li Taibo jia xiansheng yajiao (永叔內翰遺李太博家新生鴨腳).

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23 Li Shizhen, Li Shizhen quanji (李時珍全集) (Wuhan: Hubei jiaoyu chubanshe, 2004), 2342–4. Regarding Li and his Bencao gangmu, thus far the most comprehensive account in English is Carla Nappi, The Monkey and the Inkpot: Natural History and Its Transformations in Early Modern China (Cambridge, MA: Harvard University Press, 2009). For a cultural history of materia medica in late imperial China, see He Bian, “Assembling the cure: Materia medica and the culture of healing in late imperial China” (Ph.D. dissertation, Harvard University, 2014). 24 Huang Yunhu, Zhoupu (Shanghai: Shanghai guji chubanshe: 1995–99), 500. 25 Zhao’s Bencao qiuyuan can be found in Zhu Xiaoguang (朱晓光), ed., Lingnan bencao guji sanzhong (岭南本草古籍三种) (Beijing: Zhongguo yiyao keji chubanshe, 1999). The paragraph about the ginkgo is on p. 498. 26 See, for example, Kuriyama, The Expressiveness of the Body, Chapter 6. 27 Regarding the history of Japan’s materia medica (or honzōgaku), a comprehensive and insightful account in English can be found in Federico Marcon, “The names of nature: The development of natural history in Japan, 1600–1900” (Ph.D. dissertation, Columbia University, 2007); also see Federico Marcon, “Inventorying nature: Tokugawa Yoshimune and the sponsorship of honzōgaku in eighteenthcentury Japan,” in Japan at Nature’s Horizons, ed. B. Walker, J. Thomas, and I. Miller (University of Hawai’i Press, 2013), 189–206. I also found inspiration and useful reference in Maki Fukuoka, The Premise of Fidelity: Science, Visuality, and Representing the Real in Nineteenth-Century Japan (Stanford: Stanford University Press, 2012). 28 Okamoto Ippō, Wago honzō kōmoku (Tokyo: Meicho shuppan, 1979), 10. 29 Ryōri monogatari can be found in the first volume of Edo Jidai Ryōribon Kenkyūkai (江戶時代料理本研究会), ed., Honkoku Edo jidai ryōribon shūsei (翻刻江戶時代料理本集成) (Kyoto: Rinsen shoten, 1978–81), 3–37. The paragraph about the ginkgo is on p. 29. For a good summary of the ginkgo’s role in Japanese cuisine, see Shihomi Hori and Terumitsu Hori, “A cultural history of Ginkgo biloba in Japan and the generic name ginkgo,” in Ginkgo biloba, a Global Treasure: From Biology to Medicine, ed. T. Hori, R. W. Ridge, W. Tulecke, P. Del Tredici, J. Trémouillaux-Guiller, and H. Tobe (Tokyo: Springer, 1997), 385–411. 30 Ekiken Kaibara, Yōjōkun: The Japanese Secret to Good Health, trans. Masao Kunihiro (Tokyo: Tokuma shoten, 1974), 34–6. 31 Takaichi Shiyū, Kii no Kuni meisho zue (Tokyo: Nihon meisho zue kankōkai, 1921–2), 431. 32 Mariko Handa, “Ginkgo biloba in Japan,” Arnoldia 60.4 (2000) 26–34 (31); also see Mariko Handa, Yasuo Iizuka, and Nobuo Fujiwara, “Ginkgo landscapes,” in Hori et al., Ginkgo biloba, 259–83 (277). 33 The whole text of Ichō no jitsu can be found at: www.aozora.gr.jp/cards/000081/ files/4423_7299.html. 34 Arioka Toshiyuki (有岡利幸), Shiryō Nihon shokubutsu bunkashi (資料日本植物 文化誌) (Tokyo: Yasaka shobō, 2005), 92–4. 35 Zhou Shichang (周世昌), Kunshan xian zhi (Taipei: Taiwan xuesheng shuju, 1987), 637.

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36 Li, Li Shizhen quanji, 2343–4. 37 Hitomi Hitsudai, Honchō shokkan (Tokyo: Heibonsha, 1976–81). 38 Suzuki Tōzō (鈴木棠三), Nihon zokushin jiten (Tokyo: Kadokawa shoten, 1982), 380–1, 386–7. 39 My narrative here is based on the novel Hanshichi torimonochō: Bake ichō (半七捕 物帳: 化け銀杏) by Okamoto Kidō (岡本綺堂, 1872–1939). The whole text can be found at: www.aozora.gr.jp/cards/000082/files/960_15004.html. 40 Yosa Buson (与謝蕪村), Buson yōkai emaki (Osaka: Kitada shisui bunko zōhan, 1928). 41 Koyama Naotsugu (小山直嗣), Niigata-ken densetsu shūsei (Tokyo: Kōbunsha, 1995), 214. 42 Quoted from Murakami Kenji (村上健司), Nihon yōkai daijiten 日本妖怪大事典 (Tokyo: Kadokawa shoten, 2005), 270–1. 43 Hui-Lin Li, “A horticultural and botanical history of ginkgo,” Morris Arboretum Bulletin 7.1 (1956), 3–12. 44 Zhu Bian (朱弁), Quwei jiuwen (Beijing: Zhonghua shuju, 2002), 129. 45 This volume can be found in Yimen guangdu (夷門廣牘) (Shanghai: Shanghai guji chubanshe, 1995–99). 46 Zhou Wenhua, Runan pu shi (汝南圃史) (Shanghai: Shanghai guji chubanshe, 1995–99), 52. 47 Kuang Fan (鄺璠), Bianmin tuzuan (Shanghai: Shanghai guji chubanshe, 1995–99). 48 Zhou, Runan pu shi, 5, 7–8, 12. 49 Li, Li Shizhen quanji, 2248–9. 50 The paragraph can be found at http://chinese.dsturgeon.net/text.pl?node=2378& if=gb#n2381. It is part of Waichushui zuoxia (外儲說左下). 51 Li, Li Shizhen quanji, 2340–1. 52 Regarding the globalization of the ginkgo, the most comprehensive work belongs to Crane’s Ginkgo; relevant information can also be found in the following works: Ernest Henry Wilson, The Romance of Our Trees (Garden City: Page, 1920), 49– 73; Cyril Dean Darlington, “The Oxford botanical gardens: 1621 to 1971,” Nature 233.5320 (1971), 455–6; Peter Del Tredici, “The ginkgo in America,” Arnoldia 41.4 (1981), 150–61. 53 John Claudius Loudon, Arboretum et fruticetum britannicum; or, The Trees and Shrubs of Britain, Native and Foreign, Hardy and Half-Hardy, Pictorially and Botanically Delineated, and Scientifically and Popularly Described; with Their Propagation, Culture, Management, and Uses in the Arts, in Useful and Ornamental Plantations, and in Landscape-Gardening; Preceded by a Historical and Geographical Outline of the Trees and Shrubs of Temperate Climates throughout the World, 2nd edn. (London: Henry G. Bohn, 1854), 2096. 54 Lester F. Ward, “The ginkgo-tree,” Science 19.124 (1885): 495–7. 55 Erasmus Hultzsch, “Goethe und die Ginkgobäume seiner Zeit,” in Ginkgo: Ur-Baum und Arzneipflanze; Mythos, Dichtung und Kunst, ed. Maria Schmid and Helga Schmoll (Stuttgart: Wissenschaftliche Verlagsgesellschaft, 1994), 49–54 (50).

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56 Antoine Gouan, Description du “Ginkgo biloba,” dit noyer du Japon (Montpellier: Chez Delmas, 1812), 11. 57 Linnaeus’ description of the ginkgo can be found in Ōba Hideaki (大場秀章), Edo no shokubutsugaku (江戸の植物学) (Tokyo: Tokyo daigaku shuppankai, 1997), 51. Wolfgang Muntschick, “The plants that carry his name: Kaempfer’s study of the Japanese flora,” in The Furthest Goal: Engelbert Kaempfer’s Encounter with Tokugawa Japan, ed. Beatrice M. Bodart-Bailey and Derek Massarella (Sandgate: Japan Library, 1995), 71–95. 58 For a succinct account of Thunberg’s life and career, see Timon Screech, “Editor’s introduction,” in Carl Thunberg, Japan Extolled and Decried, ed. Screech (New York: RoutledgeCurzon, 2005), 4–20. 59 Ibid., 211. 60 Carl Peter Thunberg, Flora japonica (Lipsiae: In bibliopolio I. G. Mülleriano, 1784), 358–9. 61 James Edward Smith, “XXVII. Characters of a new Genus of Plants named SALISBURIA,” Transactions of the Linnean Society of London 3.1 (1797): 330–2. 62 Gouan, Description, 3. 63 Ibid., 6–9. 64 For a notable essay on this and other relevant topics, see René Sigrist and Patrick Bungener, “The first botanical gardens in Geneva (c. 1750–1830): Private initiative leading science,” Studies in the History of Gardens and Designed Landscapes, 28.3–4 (2008): 333–50. 65 Société d’agriculture, histoire naturelle et arts utiles de Lyon, Compte-rendu des travaux (Lyon: Imprimerie de Ballanche, 1814), 24–5. 66 Wolfgang Caesar, “Engelbert Kaempfer, Entdecker des Ginkgobaums,” in Schmid and Schmoll, Ginkgo, 46. 67 Encyclopaedia Perthensis, or, Universal Dictionary of the Arts, Sciences, Literature, &c., Intended to Supersede the Use of Other Books of Reference, 2nd Edition, Vol. XIV (Edinburgh: Printed by John Brown, 1816), 86. Alire Raffeneau-Delile, “Première récolte de fruits du Ginkgo du Japon en France (1833).” Delile was the director of the Jardin du Roi. I found this useful reference at Harvard’s Gray Herbarium, with a remark “Extrait du Bulletin de la Société d’Agriculture du Dépt. de L’Hérault, no. de 9 bre et 10 bre 1833.” 68 Joseph Franz von Jacquin, “Ueber den Ginkgo” (Wien: Carl Gerold, 1819). 69 John Lindley, The Vegetable Kingdom; or, The Structure, Classification, and Uses of Plants, Illustrated upon the Natural System, 2nd edn. (London: Bradbury and Evans, Whitefriars, 1847), 231. 70 Quoted from Del Tredici, “The ginkgo in America,” 160–1. 71 Wilson, The Romance, 72. 72 See Engelbert Kaempfer, Kaempfer’s Japan: Tokugawa Culture Observed, ed., trans., and annot. Beatrice M. Bodart-Bailey (Honolulu: University of Hawai’i Press, 1999), 28. Also see Paul van der Velde, “The interpreter interpreted: Kaempher’s Japanese collaborator Imamura Genemon Eisei,” in Bodard-Bailey and Massarella, The Furthest Goal, 44–58, (44).

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73 For Kaempfer’s botanical studies, see Wolfgang Michel, “On the background of Engelbert Kaempfer’s studies of Japanese herbs and drugs,” Journal of the Japan Society of Medical History 48.4 (2002): 692–720; for a detailed examination of given literal evidence in the making of the generic name “Ginkgo,” see Hori and Hori, “A cultural history,” 398–401; Wolfgang Michel, “On Engelbert Kaempfer’s ‘ginkgo,’” at http://wolfgangmichel.web.fc2.com/serv/ek/amoenitates/ginkgo/ ginkgo.html. 74 Yamada Keiji (山田慶児), Kikiwake tabewake miwake – honzō kara hakubutsu­ gaku he, in Mono no imēji: Honzō to hakubutsugaku e no shōtai (物のイメージ: 本 草と博物学への招待), ed. Yamada Keiji (Tokyo: Asahi shinbunsha, 1994), 4–8. 75 Quoted from Shigehisa Kuriyama, “The historical origins of KATAKORI,” Japan Review 9 (1997): 131. My analysis here benefited from this katakori essay, as well. 76 Adam Leith Gollner’s account directs me to this aspect of fruit-consuming; see Adam Leith Gollner, The Fruit Hunters: A Story of Nature, Adventure, Commerce, and Obsession (Toronto: Anchor Canada, 2009). 77 Galen, On the Properties of Foodstuffs, trans. with commentary by Owen Powell (Cambridge: Cambridge University Press, 2003), 91. 78 Galen, Selected Works, trans. with notes by P. N. Singer (Oxford: Oxford University Press, 1997), 317–18. 79 Shigehisa Kuriyama, “The forgotten fear of excrement,” Journal of Medieval and Early Modern Studies 38.3 (2008), 413–42. 80 Quoted ibid., 430. 81 See, for example, Shirai Mitsutarō (白井光太郎), Shokubutsu yōi kō (植物妖異考) (Tokyo: Ariake shobō, 1967). 82 Toshiyuki Nagata, “Scientific contributions of Sakugoro Hirase,” in Hori et  al., Ginkgo biloba, 413–16. 83 Albert C. Seward and J. Gowan, “The maidenhair tree (Ginkgo biloba, L.),” Annals of Botany, 14.1 (1900): 109–54 (110–11). 84 Asa Gray, “Sequoia and its history,” in Scientific Papers of Asa Gray, Vol. 2: Essays; Biographical Sketches, 1841–1886, ed. Charles Sprague Sargent (Boston, MA: Houghton, Mifflin, and Co., 1889), 142–73. Regarding Gray’s account of sequoias as “evolutionary losers,” see Philip J. Pauly, Fruits and Plains: The Horticultural Transformation of America (Cambridge, MA: Harvard University Press, 2007), 87–8. 85 Gray, “Sequoia and its history,” 161. 86 Isabella L. Bird, Unbeaten Tracks in Japan: An Account of Travels in the Interior Including Visits to the Aborigines of Yezo and the Shrine of Nikkō, 3rd edn. (London: J. Murray, 1888), 313. 87 Charles Sprague Sargent, “Notes on cultivated conifers – (I),” Garden and Forest 10.502 (1897): 390–1. 88 Charles Sprague Sargent, Forest Flora of Japan: Notes on the Forest Flora of Japan (Boston, MA: Houghton, Mifflin, and Co., 1894). 89 Wilson, The Romance, 67.

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90 Quoted from Pierre François Michel and David Hosford, “Ginkgo biloba: From ‘living fossil’ to modern therapeutic agent,” in Ginkgolides: Chemistry, Biology, Pharmacology and Clinical Perspectives, ed. P. Braquet (Barcelona: J. R. Prous Science, 1988), 7–8. 91 Felix Pollak, Ginkgo (New Rochelle: Elizabeth Press, 1973), 14. 92 Katy Drieu and Hermann Jaggy, “History, development and constituents of EGb 761,” in Ginkgo biloba, ed. Teris A. van Beek (Amsterdam: Harwood Academic, 2000), 267–77. 93 Koerner, “Ginkgo biloba?” 94 Willmar Schwabe, Pharmacopoea homoeopathica polyglottica (Leipzig: W. Schwabe; New York: Boericke and Tafel, 1872), xix–xx. 95 Carsten Timmermann, “Rationalizing ‘folk medicine’ in interwar Germany: Faith, business, and science at ‘Dr. Madaus & Co.,’” Social History of Medicine 14.3 (2001): 459–82. 96 My account here is based on Frans M. van den Dungen, “Homeopathic uses of Ginkgo biloba,” in van Beek, Ginkgo biloba, 467–73 (469–71). 97 Koji Nakanishi, “A personal account of the early ginkgolide structural studies,” in van Beek, Ginkgo biloba, 143–50. 98 William Gilman Thompson, Practical Dietetics, with Special Reference to Diet in Disease (New York: Appleton, 1900  [1895]), 308. A noteworthy analysis is Michael H. Shank’s analysis of Galen and William Harvey: “From Galen’s ureters to Harvey’s veins,” Journal of the History of Biology 18.3 (1985): 331–55. 99 John Noble Wilford, “Ancient tree yields secrets of potent healing substance,” The New York Times, March 1, 1998, www.nytimes.com/1988/03/01/science/ancienttree-yields-secrets-of-potent-healing-substance.html?pagewanted=1. 100 This point is based on Koerner, “Ginkgo biloba?” 101 Le Bars et al., “A placebo-controlled,” 1327. 102 Igor Kopytoff, “The cultural biography of things: Commoditization as process,” in Appadurai, The Social Life of Things, 65–91. 103 The image can be found in Cor Kwant’s remarkable website on the ginkgo: www. xs4all.nl/~kwanten/goethe.htm. 104 Unseld, Goethe and the Ginkgo, 43.

3

Bodily knowledge and western learning in late imperial China: the case of Wang Shixiong (1808–68) Yi-Li Wu Introduction What phenomena do seekers of knowledge believe to exist and choose to investigate? How do they judge whether they have achieved the knowing of these phenomena? And how are the terms of their inquiries shaped by time and place? These are central questions in the study of what scholars have variously called “historical ontology” and “historical epistemology.”1 This chapter directs these questions at a realm of knowledge that has conventionally been portrayed as deeply flawed: classical Chinese medical understandings of the structure of the human body. For centuries, Chinese texts on healing included written descriptions and visual images of the body’s material components – internal organs and circulation vessels, skin and flesh, sinews and bones – and they depicted such knowledge as therapeutically relevant.2 Beginning in the seventeenth century, however, as European observers began to learn about Chinese medicine, they pronounced it ignorant of and indifferent to “anatomy.”3 This narrative of anatomical ignorance was notably articulated by the seventeenth-century Jesuits and nineteenth-century Protestant medical missionaries who sought to introduce Chinese doctors to western anatomical science. Beginning in the late nineteenth century, Chinese reformers and modernizers also took up this narrative of anatomical ignorance, using it to attack Chinese medicine as superstitious and unscientific. In response, defenders of Chinese medicine sought an epistemological safe space that would protect it from the criticisms of biomedicine. They found it in the work of Tang Zonghai 唐宗海 (1851–1908), who famously argued that while western medicine was superior in anatomy, Chinese medicine had a superior grasp of qi transformation, namely bodily function. Tang’s original intent was to identify the relative strengths of Chinese and western medicine that would allow the two systems to be integrated together. Later doctors, however, used Tang’s formulation to

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argue for an epistemological incompatibility between the two systems. They denied that Chinese medicine was making claims about the actual material structures of the body and instead characterized it as concerned with functional dynamics that were beyond the ken of western science.4 This “function, not structure” characterization continues to dominate modern iterations of “traditional Chinese medicine” (TCM).5 It is true that there were only a few episodes of human dissection in China prior to the twentieth century, and that Chinese thinkers did not pursue the detailed knowledge of bodily structure so dear to European anatomists. Nevertheless, the narrative of Chinese anatomical ignorance and indifference is a historical construct that rests on problematic premises. First, it treats European modes of bodily knowledge as the norm against which other cultures ought to be measured, and it assumes that the desire to dissect is an inevitable outcome of the desire to understand the body’s structures. It also assumes that “Chinese medicine” was largely homogeneous across time and place. More broadly, this narrative is problematic because its primary aim is to explain what Chinese medical thinkers did not do (pursue European-style, dissection-based anatomy) rather than what they did do (depict, debate, and discuss the body’s components and their relation to illness and healing). The importance of looking at what Chinese doctors did do, furthermore, is underscored by recent scholarship that documents significant historical changes in Chinese medical views of the body. Leslie de Vries, for example, reveals how Zhao Xianke (趙獻可, sixteenth–seventeenth century), an influential interpreter of the “supplementing through warming” medical current (wenbu, 溫補), created a new model of the body in which the Gate of Life (mingmen, 命門) replaced the heart as the body’s true ruler.6 Volker Scheid shows that late imperial physicians seeking a better understanding of the therapeutic applications of the Treatise on Cold Damage (Shanghan lun, 傷寒論, second–third century) moved away from the bureaucratic body of the medical classics, one primarily defined in terms of networks of circulation channels and collaterals and treated via regulation of the bodily system. Instead, physicians like Fang Youzhi (方有執, 1522–99), Yu Chang (喻昌, 1585–1664), and Ke Qin (柯琴, fl. early seventeenth century) elaborated a territorial model of the body that was divided into different physical regions, each encompassing different anatomical components, where pathogens could invade. The doctor was now likened to a military strategist who required detailed knowledge of the bodily terrain in order to expel pathogens from a given region.7 Such reformulations were derived from intellectual resources indigenous to China, but western works on science and medicine later became another source upon which Chinese medical thinkers could draw. Pi Guoli’s detailed study of Tang Zonghai shows how he adapted western anatomical information to address long-standing uncertainties about the body’s structures and functions.8 Nor did foreign ideas necessarily discredit indigenous ones. As Sean H.-L. Lei demonstrates, Tang’s

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innovative explanation of the way in which bodily fire and water came together to produce qi was inspired by the steam engine.9 This chapter will thus ask: What role did the materiality of the body and its component structures play in the development of Chinese medical thought and therapeutic practice? What aspects of bodily materiality did Chinese doctors seek to know, and what criteria did they use to evaluate existing and new knowledge about this material body? I will investigate these themes with a case study of the famous Hangzhou doctor Wang Shixiong (王士雄, 1808–68), best known to medical historians as an important synthesizer of teachings on Warm Diseases (wenbing, 溫病), a category of febrile and epidemic illnesses.10 Wang engaged intensively with contemporary debates over the meaning and therapeutic applications of the Chinese medical classics, and he wrote and published heuristic medical works as a way of disseminating his ideas and establishing his medical authority and reputation. Wang was also well read and deeply interested in western anatomical texts. My aim is to understand how questions of bodily structure and western medicine fit into the worldview of this classically trained Chinese male doctor. The case of Wang Shixiong is particularly useful, furthermore, because his medical perspectives developed during the first half of the nineteenth century, well before the great triumphs of western germ theory and antiseptic surgery, and before the seemingly inexorable expansion of foreign imperialism led Chinese reformers to question the basis of their own culture. To analyze the writings of Wang Shixiong and his associates, therefore, is to examine how Chinese thinkers evaluated western medicine from the standpoint of a self-confident Chinese medical tradition. I will pursue these inquiries by analyzing three of Wang’s medical works: the Jottings from the Hall of Repeated Felicitations (Chongqing tang suibi, 重慶堂隨筆), published in 1855, and two versions of his Treatise on “Huoluan” [Sudden Turmoil Disease] (Huoluan lun, 霍亂論): namely, the original edition published in 1839 and a revised version published in 1863.11 The first section of this chapter discusses the essays on body structure that Wang and his friends wrote for the Jottings. Not only were they were keenly interested in matters of body structure, but the interpersonal relationships among doctors, scholars, and officials fostered exchanges of such information. The second section focuses on the way in which Wang and his friends critically evaluated descriptions of the body contained in a range of Chinese and western sources. Inspired by the ideals of evidential scholarship (kaozheng, 考證), they were skeptical of received textual wisdom and emphasized the need to verify information by means of rigorously assessed facts. Finally, the third section analyzes how Wang drew on anatomical information from Chinese and western authors to refine his understanding of huoluan, an indigenous disease concept that he used to explain epidemic cholera.

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A socio-medical history of bodily views in the Jottings The textual production of Jottings from the Hall of Repeated Celebrations was intimately intertwined with the filial dynamics of the Wang family and the scholarly pursuits of Wang Shixiong and his male associates. The core of the book was a collection of essays by Shixiong’s great-grandfather, the physician Wang Xuequan (王學權), who began writing it in 1808, the year Shixiong was born.12 Shixiong was the fourth son born to his parents, but the three boys before him had all died in childhood. According to the Chinese system of enumerating years in terms of the “ten heavenly stems and twelve earthly branches,” Shixiong’s birth year fell in the same place in the sexagenary cycle as that of his grandfather Guoxiang. Great-grandfather Xuequan, then nearing eighty, declared this to be a sign that Shixiong, unlike his older brothers, would enjoy a long life. Perhaps feeling his own mortality, Xuequan also began to compose a book recounting his perspectives on medical topics ranging from seasonal ailments to pulse diagnostics. Unfortunately, he died a few years later with the work incomplete. Xuequan’s son Wang Guoxiang (王國祥, Shixiong’s grandfather) tried to complete the work, but a few years later he died of illness. Xuequan’s grandson Wang Sheng (王升, Shixiong’s father) then took responsibility for completing the text. Sadly, however, he too died several years later, aged forty-nine, leaving Wang Shixiong fatherless at age fourteen. Noting that his great-grandfather had composed a medical work on the occasion of his birth, young Shixiong vowed to become a doctor. Ultimately, he would also complete the text started by his great-grandfather and expanded by his grandfather and father, publishing it in 1855 under the title Jottings from the Hall of Repeated Celebrations.13 By that time, Wang Shixiong was a prominent figure in medical circles, with three published collections of medical cases to his name. He was also recognised as the author of two influential works on the nosology and etiology of epidemic diseases: the Treatise on “Huoluan” and the Warp and Weft of Warm and Heat Disease (Wenre jingwei, 溫熱經緯, 1852). Wang Shixiong’s success as a doctor came not only from his own native talents, but also from his ability to build an extensive network of scholars and officials who became patrons, collaborators, and friends after he cured them or a family member. Wang Shixiong’s medical career thus exemplifies a welldocumented dynamic in late imperial China: a man’s ability to build strong male homosocial networks was a key determinant of his professional success or failure.14 Wang’s friends and supporters paid for his medical writings to be published, and their names and words appear in his medical works, whether as preface writers, editors, annotators, or contributors. An early patron was Zhou Heng (周鑅), secretary in a government salt monopoly office, who had contracted a sudden, acute attack of debilitating chills. Wang Shixiong was only sixteen at the time, but he confidently challenged the diagnosis of the

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attending physician and cured Zhou Heng himself. This launched a fruitful association between the two men, and Zhou Heng would eventually compile and edit Wang’s first published collection of medical cases, A Record of Cures (Huichun lu, 回春錄), completed in 1843.15 Wang’s most important supporter was arguably the scholar-official Yang Zhaoli (楊照藜, courtesy name Suyuan [素園]), a native of Dingzhou County (Zhili Province), who obtained the highest examination degree of jinshi (“presented scholar”) in 1845. From his boyhood, Yang Zhaoli had been impassioned by medical studies. Once he entered government life, Yang could afford to collect medical texts, including Wang Shixiong’s Treatise on “Huoluan,” which he admired for its medical acumen. In 1849, when Yang Zhaoli was serving as the magistrate of Yihuang County (Jiangxi Province), his wife fell ill with a painful internal accumulation. Upon learning that Wang Shixiong was visiting nearby, Yang asked him to treat her.16 After Wang cured Yang’s wife, the two men became close friends and collaborators. Subsequently, Yang Zhaoli financed the publication or republication of Wang’s three medical case collections as well as his work on huoluan. He wrote prefaces to several of Wang Shixiong’s medical texts and contributed annotations to yet others. The two men thus constructed a mutually beneficial relationship: in Yang, Wang Shixiong found a steadfast patron from the world of scholar-officials, while through Wang, Yang Zhaoli obtained an entrée into a community of medical authors. The contributors to the Jottings The completion of the Jottings was an act of filial dedication, sustained over four decades. At the same time, Wang Shixiong greatly expanded his ancestors’ text by adding commentaries and new material of his own. This included discussions of western anatomical works and the structure of the body. While comments on these topics are scattered throughout the Jottings, I will focus on a series of essays that appear in the second half of the book, in a section devoted to diagnostic techniques (see Table 3.1).17 The first essay was written by great-grandfather Wang Xuequan, and it is followed by a commentary by Wang Shixiong’s father Wang Sheng. The vast majority of this section, however, consists of writings by Wang Shixiong and three of his friends: Hu Kun (胡琨), Li Zhirui (李志銳), and Xu Ranshi (徐然石). Hu Kun (courtesy name Meizhong [美中], sobriquet Ciyao [次瑤]) was a native of Hangzhou (specifically, from Renhe County) and Wang Shixiong described him as a close friend.18 In the second section of this chapter, we will discuss the influence of evidential scholarship in Wang’s medical works. In addition to the fact that Wang’s hometown of Hangzhou was a leading center of evidential scholarship, we can assume that he enjoyed connections to these

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Table 3.1  Essays in the Jottings dedicated to anatomy Author

Title/topic

Wang Xuequan

No title. Compares Chinese and western anatomical knowledge; cites Jesuit texts. No title. Compares Chinese and western anatomical knowledge. No title. Compares Chinese and western accounts of human bones; cites Jesuit texts and Benjamin Hobson. Titled “Written after reading [the Jesuit text] Illustrated Discussion of the Human Body.” Titled “Written after reading [Wang Qingren’s] Correcting the Errors of Doctors.” Titled “Written after reading Correcting the Errors of Doctors.” Titled “Written after reading [Benjamin Hobson’s] New Discourses on the Entirety of the Body.”

Wang Sheng Wang Shixiong Hu Kun Li Zhirui Xu Ranshi Hu Kun

scholarly circles through his relationship with Hu Kun. Kun was the son of Hu Jing (胡敬, 1769–1845; jinshi of 1805) a scholar-official, poet, and noted expert in painting and calligraphy. After various positions at court, latterly as an expositor in the Hanlin Academy, Hu Jing returned to Hangzhou and became the director of the Chongwen Academy (Chongwen xueyuan, 崇文學院), an important center of evidential scholarship. Hu Kun himself received a juren degree in 1844 and variously held positions as instructor at a district school and an archivist in the Court of Imperial Sacrifices. He was also an accomplished mathematician and student of trigonometry. Not only was mathematics a key area of study in evidential studies, but Hu Kun’s friends included the mathematicians and known evidential scholars Xiang Mingda (項明達) and Dai Xu (戴喣). The study of trigonometry (so essential to astronomical calculations) necessarily meant the study of European mathematical texts, and the two essays that Hu Kun wrote for the Jottings show that his interest in western learning extended to medicine as well.19 Li Zhirui (courtesy name Jinheng [晉恆]) was a native of Liaocheng County in Shandong. We know that Li came from a scholar-official family, for during the early nineteenth century, his father served as Prefect of Lin’an Prefecture in Yunnan. Li Zhirui accompanied his father to the post, presumably serving as some kind of administrative assistant. Like many other men of his social class, Li Zhirui was interested in medicine, and he read widely in the classical and heuristic literature. He was skeptical, however, of the existing descriptions of the viscera. In 1816, during his father’s tenure in Lin’an, a local uprising broke out that gave Li Zhirui the opportunity to make his own anatomical observations. Li Zhirui recalled that he was initially too horrified to watch the executions of captured rebels, but he gradually overcame his fear and started

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to study the viscera of unclaimed corpses. “I told the executioner to gather and wash [the corpses’] organs, and I inspected them in great detail,” Li explained. “After I inspected several tens of people, I knew that the diagrams and explanations of organs in the books throughout history were all wrong.”20 I have been able to find little information on Xu Ranshi (courtesy name Yazhi 亞枝), also a native of Hangzhou (Renhe County). He does not appear to have obtained any kind of examination degree, and he was most probably a lower-level literatus who had become a doctor, or who was at least intensely involved in medical studies. Xu Ranshi’s literacy, medical expertise, and close integration into Wang Shixiong’s personal and professional networks are all apparent in the fact that he helped to edit two of Wang’s medical case collections, while also contributing annotations to Wang’s treatise on diseases of warmth and heat.21 The essays that Wang and his friends wrote for the Jottings critically discussed a range of medical issues, including the form of internal organs, the number and shape of bones in the human body, the relative roles that the brain and heart play in cognition and memory, and the nature of the circulatory vessels and tubes through which qi and blood flow. Some of these also expanded on comments on anatomy and western medicine that Wang Shixiong had made in an earlier text published a few years previously.22 Notably, Wang Shixiong had previously rejected the idea that westerners and Chinese had differently shaped organs, a topic subsequently taken up by Hu Kun in the Jottings. This suggests that Hu Kun, Li Zhirui, Xu Ranshi, and Wang Shixiong had been discussing such issues among themselves for some time. Magistrate Yang Zhaoli was also part of this conversation, and his prefatory essay to the Jottings echoed themes from the other writers’ essays, praising anatomical texts as invaluable resources for the doctor while noting some of their shortcomings. In effect, Wang Shixiong used his friends’ writings to elaborate ideas that he considered important while simultaneously implying that these views were shared by a wider network of literate men. Furthermore, by adding these essays into his family’s text, Wang presented his ancestors’ perspectives as important reference points for the medical issues that concerned his contemporaries. Western sources of bodily knowledge

As an ensemble, the writers in the Jottings discussed all of the western medical texts that would have been available to them at the time: two by Jesuit missionaries and one by a Protestant medical missionary.23 The earliest of these was A Summary Discussion of Western Teachings on the Human Body (Taixi renshen shuogai, 泰西人身說概), which originated as a draft manuscript composed around 1625 by the Swiss Jesuit and physician Johann Schreck (1576– 1630). Schreck’s draft was expanded after his death by the Chinese scholar

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Bi Gongchen (畢拱辰, jinshi of 1616), who published the resultant volume in 1643. The second text, composed during the 1630s, was the Illustrated Discussion of the Human Body (Renshen tushuo, 人身圖說), a translation of a work by the celebrated French surgeon Ambroise Paré (1510–90). Illustrated Discussion was primarily the work of Italian Jesuit Giacomo Rho (1593?–1638), who worked on it in collaboration with Jesuit Nicolò Longobardo (1559–1654) and Schreck. Finally, the Jottings discussed the Quanti xinlun (全體新論) first published in 1851 by Benjamin Hobson. It was the first of four Chineselanguage works that Hobson would produce, in collaboration with Chinese literati assistants, in order to promote western medicine in China.24 Hobson gave it the English title of An Outline of Anatomy and Physiology, which would signal to English speakers the fact that he was introducing the Chinese to a new scientific corpus. However, the Chinese title meant New Discourses on the Entirety of the Body, which allowed Wang and his friends to situate it in the context of existing Chinese discussions of the body. To replicate their perspectives, I will also refer to this work as New Discourses. It appears that an interest in western texts had long been a feature of the Wang family medical culture. Wang Shixiong’s great-grandfather Xuequan was familiar with both the Summary Discussion and the Illustrated Discussion, which he discussed in the Jottings. We also know that the Wang family owned a copy of the Summary Discussion, as Wang Shixiong lent it to his friend Hu Kun.25 Wang Shixiong also seems to have actively sought out such works. By 1852 or so, he had already read and compared two editions of Hobson’s New Discourses: one produced by Hobson himself (almost certainly the first edition of 1851, published by Hobson’s hospital in Guangzhou) and a version of Hobson’s work reprinted in 1852 by the Cantonese official and bibliophile Pan Shicheng (潘仕成, jinshi 1832) as part of his Collected Books from the Lodge of the Immortal of the Oceans and Mountains (Haishan xianguan congshu, 海 山仙館叢書).26 Especially noteworthy is the fact that Wang Shixiong was able to see these two editions within a year of their being published in Guangdong. Hobson produced 1,200 copies of the first edition of New Discourses, and he sold a few to Chinese buyers and sent numerous copies to missionary colleagues in Shanghai, Ningbo, and Guangzhou.27 While I have not determined how Wang obtained Hobson’s text, his quick access to it suggests he was connected to a wider network of Chinese men interested in western medical learning. Chinese sources of bodily knowledge

When assessing western accounts of the body, the Jottings authors continually compared them to existing descriptions in Chinese works. These included ancient texts – The Yellow Emperor’s Inner Classic (Huangdi neijing,

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黃帝內經) and the Classic of Difficult Issues (Nanjing, 難經, first century CE)  – as well as the Golden Mirror of the Medical Lineage (Yizong jinjian, 醫宗金鑑), the normative textbook compiled by the Qing Imperial Medical Academy and published in 1742.28 Wang Shixiong and his friends also took a keen interest in the revisionist work of Chinese physician Wang Qingren (王清任, 1768–1831; no relation to Wang Shixiong) who said that the classical descriptions of the body were all incorrect. A physician from Yutian County (Zhili Province), Wang Qingren had long been dissatisfied with the existing depictions of internal bodily structures. Beginning in 1797, he undertook his own investigations, initially examining the exposed corpses of children who had died during an epidemic.29 Buried in shallow graves, their abdomens had been ripped open by birds or dogs. Wang Qingren also attended some executions to observe the organs of dead criminals. Frustrated in his attempts to see an intact diaphragm in situ, he finally obtained details on its structure and position in 1829 from one Heng Jing, the Provinical Administration Commissioner in charge of Jiangning Prefecture, who had observed the bodies of many executed people while on a previous military posting in Hami. With this information in hand, Wang Qingren felt that he could finally publish his findings, which he did in 1830 under the title Correcting the Errors of Doctors (Yilin gai cuo, 醫林改錯). The text was reprinted frequently thereafter. Yang Zhaoli was among its admirers, and he introduced Correcting the Errors to Wang Shixiong, who in turn introduced it to Hu Kun.30 This sort of book-sharing, so typical of scholarly culture, facilitated these men’s access to and discussions of new anatomical information. Their essays also suggest that they perceived Wang Qingren’s new findings to be of a piece with the anatomical teachings of westerners. Finally, the Jottings also incorporated information from forensic medicine. In 1247, the judicial official Song Ci completed a systematic treatise on death investigation titled Collected Writings on the Washing Away of Wrongs (Xiyuan jilu, 洗冤集錄), which subsequently became the model for forensic examinations in China. During the late seventeenth and early eighteenth centuries, the Qing Ministry of Justice compiled an expanded, revised version of this text, formally known as Records on the Washing Away of Wrongs, Edited by the Codification Office (Lüliguan jiaozheng xiyuan lu), to serve as the official standard for the empire.31 During Wang Shixiong’s time, this work would have been widely known: all magistrates and judicial personnel were required to use it, their forensic inquests were carried out in public before the families of victims and alleged perpetrators, and numerous commentaries on the manual circulated as well.32 Wang Shixiong referenced the Washing Away of Wrongs in his essay on bones, as well as observations of bones made by Yang Zhaoli. We may assume that Yang’s observations also came from forensic investigations: although direct inspection of corpses was carried out by a special sub-bureaucratic functionary known as the wu zuo (sometimes translated as “ostensor”),

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magistrates like Yang presided over such inquests and were expected to guarantee their accuracy. Structure and function in classical medicine

Wang Shixiong and his friends believed that accurate knowledge of the body’s components was needed to understand properly the dynamics of illness and cure. “When a clock is damaged,” Li Zhirui said, “one must find a clock-smith to repair it, because he has the ability to understand the functions within it. Medicine is also like this.”33 This belief was hardly new or unique to them. Wang Qingren had made this very argument to explain his anatomical investigations, asking “If one treats illness without a clear understanding of the organs, then how is this any different from a blind man walking in the dark?”34 Far from being distinct issues, bodily structure and function were two facets of an integral whole. One way to appreciate this relationship is to draw an analogy between medicine and fengshui. Fengshui is concerned with the flow of qi through the objects in and features of given terrain. By definition, then, patterns of qi flow and the physical contours of the terrain are inextricably connected. Similarly, the generation and flow of qi in the human body were conditioned on the form and arrangement of internal structures. Xu Ranshi made this reasoning explicit in his essay for the Jottings, where he likened the physical components of the body’s interior to the yin–yang structure of the cosmos, and the functions of the organs to the patterns of cosmic qi exchange that generated the myriad things: The Classic of Changes says, “Heaven and Earth establish positions [dingwei,定 位], Mountain and Lake reciprocally circulate qi [tongqi, 通氣].” The things that are inside a person’s physical shell constitute the establishment of positions. The transformation of drink and food into essence, liquids, blood, stool, and urine, constitutes the reciprocal circulation of qi.35

The doctrine of yin and yang, which described correspondences between cosmological phenomena, also focused attention on the location and directionality of bodily structures and flows. As is well known, yin and yang were associated with specific positions and directions in the body: yang being associated with the upper half of the body, the dorsal and lateral (facing away from the body’s midline) planes, and the right side; and yin being the lower, ventral, medial (facing toward the midline), and left. The yin conduits of the hand ran along the medial (inner) surface of the arm to connect with the chest, while the yang conduits of the hand ran along the lateral (outer) surface of the arm to connect with the head. Furthermore, when yin or yang qi was transported from organ to organ, it had to move in specific directions for the body to work properly. Qi that flowed contrarily or recklessly in the wrong direction was both a sign and a cause of illness.

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Such concerns inform many of the textual and visual representations of bodily structure in the historical medical literature. In the Classic of Difficult Issues, for example, the thirty-second “difficult issue” asked why the heart and lung were located above the diaphragm, while the other organs were located below.36 The answer was that the heart and the lung were the most important organs, in charge of the flow of blood and qi throughout the body, and thus also had to be physically elevated. Other questions addressed in this classic included why the liver had two lobes and why the kidney was made up of two objects. Subsequent commentaries to the Difficult Issues show that doctors continued to wrestle with such questions, and specific teachings from the Difficult Issues also became fodder for ongoing debates about bodily structure. In particular, there were three internal entities whose form and location were frequently contested: the so-called Triple Burner (san jiao, 三焦), the pericardium, and the Gate of Life (mingmen). Zhang Jiebin (張介賓, 1563–1640), famous for his commentaries on the Inner Classic, was one of the prominent writers who tackled these problems. Among other things, he claimed that the Difficult Issues had erred when it said that the left kidney performed the functions of the kidney, while the right one was the Gate of Life. Following a process of meticulous textual analysis, Zhang concluded that the Gate of Life had to be the “child palace,” (zigong, 子宮). In women, this corresponded to the womb, while in men it corresponded to an amorphous yet clearly discernible reservoir of reproductive vitality. To underscore his point, Zhang also produced a new image of the internal organs, one that “corrected” older charts by inserting a new organ (the womb-cum-Gate of Life) and reconfiguring the pathway along which seminal essence flowed.37 The medical author Li Zhongzi (李中梓) subsequently incorporated Zhang Jiebin’s new image into his widely circulating compendium Required Readings for Doctors (Yizong bidu, 醫宗必讀, 1637), where he presented knowledge of the organs as one of the fundamental things that doctors needed to know.38 Zhang Jiebin’s desire to correct existing texts, as well as Li Zhongzi’s decision to pick Zhang’s version over older, well-established diagrams, show that doctors took these images seriously as vehicles for medical knowledge and that they worried about the accuracy of the information that these images portrayed. “Localistic thinking” in diagnosis and therapy

In addition to understanding the constituent features of the body and how they functioned together, the effective diagnostician had to be able to identify the physical location of the dysfunction. As Li Zhirui pointed out, faulty knowledge of the organs condemned Chinese doctors to mediocrity and guesswork. Unable to identify the position of the illness, they would succeed in curing only if they guessed correctly:

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The people of today who make medicine their occupation do not know the true form of the organs or the pathways and roads of qi and blood. When they encounter an illness, they are at a loss to determine its location. They make estimates and conjectures, and administer treatment on the basis of general approximations, using the illness to test the medicine, and using medicine to feel out the illness. If by chance [a therapy] hits the target, then they turn it into a set method. Over the course of time, there are instances when it works and instances when it does not, and they themselves do not know the reasons behind it.39

This attention to disease location is what Paul Unschuld has termed “localistic thinking,” and it appears throughout the medical literature, notably in works on acupuncture, where the clinician needed to determine which conduits (and associated organs) were afflicted.40 Recall also that Xu Ranshi emphasized the importance of dingwei, the “fixing of positions.” The idea that qi flow was patterned according to structures located in specific positions is also echoed in the commonly used medical term buwei (部位), which referred to sectors of or positions on the body. Thus, doctors spoke of the buwei of different circulation channels, and the wrist was also divided into buwei where the pulses of different organs could be read.41 Teachings on smallpox similarly divided the face into sectors associated with the organs. The spot on the face where the pox first erupted would indicate which organ it had struck, and this would allow the doctor to know how life-threatening the outbreak was likely to be.42 The Golden Mirror similarly taught that each of the five yin organs was associated with a different sector of the body. Perturbed movement of qi in a given sector thus denoted a disorder of the associated organ.43 In short, doctors saw bodily location as an important factor in understanding disease, even if they presented different localistic schema.44 As the eminent eighteenthcentury physician Xu Dachun(徐大椿) pointed out, “whenever there is illness, there must be a cause, and the place that this illness is received will be associated with a section [buwei] of the body.”45 Xu explained the sectors in which pathogenic influence could lodge: the skin and flesh, bones and tendons, depot and palace organs, and channels and vessels. Correctly identifying the illness’s location, he said, was the prerequisite for effective therapy. And yet, there were persistent ambiguities about bodily components that remained to be satisfactorily addressed. In their attempts to resolve these, doctors might very well refer to anatomical observations made from corpses. In a famous example, Sun Yikui (孫一奎, fl. late sixteenth century) quoted the writings of He Yiyang, a former army doctor who had investigated the organs of executed rebels but failed to find anything corresponding to textual descriptions of the Triple Burner as a hand-sized membrane.46 The question of whether the Triple Burner even had a physical form continued to occupy doctors like Tang Zonghai through the end of the imperial age and beyond. In such cases, medical texts from the West could provide useful points of reference.

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The writers in the Jottings warned that one could not simply believe the bodily descriptions found in the ancient Chinese medical classics, because the received versions of these texts had been corrupted over time. The only reliable descriptions were those based on direct inspection of the body’s structures. Thus great-grandfather Wang Xuequan opened his essay in the Jottings by quoting Bi Gongchen’s praise for European anatomists, whose excellent skills allowed them to produce valid knowledge about the human body: “They peel away their skin layer by layer, and cut out pieces bit by bit. They are able to ‘strike in the hollows and guide through the spaces’ and there is not the slightest thing that they do not investigate. Therefore their texts and discussions are detailed and comprehensive in the extreme.”47 The phrase “strike in the hollows and guide through the spaces” came from Zhuangzi’s parable of Cook Ding, whose butcher’s knife never got dull, thanks to his superior knowledge of the animal body. Cook Ding explained that he knew how to insert the blade into the empty spaces between the animal’s joints, “until – flop! the whole thing comes apart like a clod of earth crumbling to the ground.”48 So too, the internal structures of the human body were laid bare by the unparalleled skill of European dissectors. To be sure, Chinese history included episodes of dissection, and Wang Xuequan cited well-known examples of prisoners and criminals who had been anatomized and then studied by medical men: During the Xin Dynasty of Mang [9–23 CE], they apprehended Wang Sunqing, and ordered a doctor from the imperial medical office and a skilled butcher to jointly flay and cut him up, measuring and weighing his five viscera, and guiding slivers of bamboo into his pulse vessels to determine where they began and ended. These also can [be used to] treat illness. Also during the Qingli reign of the Song Dynasty [1041–48], the governor Du Ji apprehended the Hunan bandits Ou Xifan and several tens of tribal leaders, and executed them in the market, so that all could have their bellies cut open and their kidneys and intestines extracted. They had the doctors and artists come to study them one by one, and to make drawings of them.49

But while these Chinese episodes were analogous to western dissections, Xuequan said, they did not achieve the same level of excellence. The reason, he implied, lay in the superior way that westerners handled their observations: “When it comes to thinking about and researching these things in fine detail, without creating one unsubstantiated saying, then the West is unique” (emphasis mine). In other words, western writers described only those bodily structures that they had actually seen. Wang Shixiong’s father Wang Sheng similarly suggested that existing Chinese descriptions of internal anatomy were based on inference, not on direct observation. Although the anatomization of Wang Sunqing and Ou Xifan’s

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followers did produce useful knowledge, “the later people who discussed the inner landscape [of the body] also did not inquire among the butchers and executioners.”50 In other words, even if Chinese descriptions had originally been based on observation, the received textual descriptions had not been subsequently reconfirmed in later eras by people who were directly knowledgeable about internal body structures. Li Zhirui likewise complained that the descriptions of bodily organs and channels that appeared in Chinese texts throughout the centuries were all unclear. This was because Chinese authors “did not see things with their own eyes and had nothing that they could study and investigate.”51 Furthermore, he said, received editions of the ancient medical classics had been corrupted over the centuries and could not be trusted: Since antiquity there has been no orthodox transmission [of knowledge]. If we just consider works like the Divine Pivot and Basic Questions, these are rooted in the canons and classics of the sages. However, after the first Qin Emperor’s burning of the books, they were not complete works, and many were threaded together and assembled by people of later times. Within them, there are original sayings, but they also consist of the erroneous exegeses of later generations. For the past several thousands of years, they have transmitted error upon error, and no one realises this.52

With their concerns about rectifying corrupt texts and their emphasis on the need to verify received wisdom with empirical data, the writers in the Jottings echoed the epistemological methodology of the evidential scholarship movement. As Benjamin Elman relates, after the fall of the Ming Dynasty (1368–1644), scholars became disillusioned with the Neo-Confucian cosmological speculation of the late Ming, and they turned away from the pursuit of moral sagehood that had occupied generations of their predecessors. Instead, Qing literati devoted their energies to expanding and refining concrete knowledge, espousing a methodology termed kaozheng, literally “examining evidence.” Casting a critical eye on transmitted texts and teachings, these scholars “stressed exacting research, rigorous analysis, and the collection of impartial evidence drawn from ancient artifacts and historical documents and texts.”53 This critical approach also permeates the Jottings’ essays on anatomical writings. Furthermore, the remarks about verification in the Jottings essentially portray the human body itself as a kind of text whose original meaning had been obscured by generations of imprecise commentary. In such situations, direct observation of the material body was the only reliable way to confirm what was or was not true. Hu Kun’s discussion of Hobson’s New Discourses makes this point by directly contrasting Chinese medicine’s textual mishmash with the accurate western anatomical knowledge derived from first-hand investigations: Verbose discussions of the Divine Pivot appear in numerous books, but most of these are counterfeits and not the original text. Therefore in the thousands of hundreds of years from Bian Que until the present time, the flow of water

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Yi-Li Wu from the upper stream has been constantly muddied. In the discussions that this treatise of Europe [Hobson’s text] sets forth, is there anything confused and disorderly? Each thing in it was directly observed, dredging out [confusion] to enter into the bones and sinews.54

Pattern and variation

It was not enough to examine a single body, however, for physical dimensions and structural forms could vary from person to person. This was why Li Zhirui (and Wang Qingren before him) needed to look at dozens of bodies before he could be sure that his observations were correct. Indeed, one could not understand the true form of the body unless one also understood the parameters of what was normal and what was exceptional. Again, direct observation could provide clarity when textual accounts were ambiguous. Such perspectives underlie Hu Kun’s criticisms of a famous essay by the scholar-official Yu Zhengxie (俞正燮, 1744–1840), in which Yu argued that there were numerous, significant differences between the internal organs of westerners and Chinese.55 Yu Zhengxie’s opinions were based on his reading of Jesuit texts, whose bodily descriptions he apparently found both alien and alienating. But Hu Kun rejected Yu Zhengxie’s claim that western and Chinese organs were different, and he refuted Yu’s arguments with a two-pronged attack: he charged that Yu failed to read the Jesuits’ Summary Discussions carefully or critically enough, and he claimed that Yu could have avoided these misinterpretations if only he had had access to Illustrated Discussion and Wang Qingren’s Correcting the Errors.56 Evidence obtained from direct observation of bodies, in other words, would have corrected Yu’s over-reliance on text-based reasoning. To rebut Yu Zhengxie, therefore, Hu Kun cited anatomical observations from both the Illustrated Discussion and Wang Qingren’s Correcting the Errors that showed that the actual form of human organs could differ from the canonical model. On this basis, Hu argued, any structural variations that might exist were person-specific, and not race-specific: Master Yu [Zhengxie] also says, the lungs of Chinese people have six lobes, [while the people] of other countries have four lobes. Note: Master Wang [Qingren] verified with his own eyes [the presence of] four lobes in Chinese people’s lungs. Thus, China does not only have [people with] six lobes. The Illustrated Discussion says that the lung has four lobes, and some have five lobes, with a small lobe erupting from between the two lobes. So likewise, other countries do not only have [people with] four lobes.57

A concern with variation also animates Wang Shixiong’s own anatomical essay in the Jottings, where he discusses the number and type of bones in the human body.58 Wang seeks to reconcile divergent western and Chinese

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descriptions of bones from a wide range of works: the Inner Classic, the forensic manual The Washing Away of Wrongs, the government medical textbook Golden Mirror, Schreck and Bi Gongchen’s Summary Discussion, and Hobson’s New Discourses. One of his aims is clearly to understand the extent to which the usual morphology of the body can vary across individuals. Thus Wang cites examples of people whose ribs, backbones, teeth, and other bones were unusual in form or number. He also portrays direct observation as a useful way to verify knowledge about these variations. For example, Wang Shixiong cited Yang Zhaoli’s personal observations of human bones, which revealed that the skull did not necessarily split into separate plates after death. Yang also told Wang that in his experience, it was not true that women’s bones were black, while men’s were white, a common belief enshrined in the Washing Away of Wrongs.59 It is worth noting that Wang’s essay on bones echoed broader epistemological concerns of the time. As Pierre-Étienne Will has discussed, the government forensic manuals of the Qing were widely acknowledged to contain errors and discrepancies. Some officials and legal experts thus produced privately authored manuals to provide more accurate guidance to their peers, and one of the important topics was how correctly to identify bones and assess skeletal remains.60 Yang Zhaoli’s comments on bone color show that he shared the concerns of others who were critically evaluating received information. Wang Shixiong’s reference to Yang also highlights the fact that male networks facilitated the circulation of bodily knowledge among different realms of practice: scholarly study, therapeutic practice, and legal medicine. Furthermore, male scholars and officials routinely traveled throughout the empire, whether for professional or personal reasons, and this circulation of personnel also promoted information exchange. We saw above that Wang Qingren supplemented his own observations with information from the official Heng Jing. Similarly, in 1830, Li Zhirui happened to meet Wang Qingren when both men were in Beijing. Li took the opportunity to discuss his observations of executed rebels with Wang Qingren and noted with satisfaction that Wang’s findings “accorded with what I had seen, without the smallest discrepancy.”61 The limits of anatomical study

While they believed in the value of direct observation, Wang and his friends recognized that there were limits to what a dead body could reveal: no matter how acute one’s vision, it was impossible to verify how an organ observed in a corpse would actually function in a living person. Thus while Wang and his co-authors considered certain aspects of western bodily knowledge to be superior to Chinese learning, they approached western texts with the same spirit of critical skepticism that they used to assess the ancient Chinese

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classics. Wang Xuequan, for example, diluted his praise of western dissectors by pointing out that they were still unable to locate qi in a dead body, for “the dead material that has form can be discerned, but its function [gong yong] that is formless cannot be discerned.”62 The only way to verify these formless functions, Xuequan said, was to observe the inside of a living human body, but such things were possible only in fantastic, fictional tales like Journey to the West (Xi you ji). Thus, in the absence of direct observation, western teachings on bodily function could never transcend the level of speculation: It does not go beyond “striking in the hollows and guiding through the spaces,” and then making inferences about the actual state of things. Therefore, although the books that [westerners] write, such as A Summary Discussion of the Human Body and An Illustrated Discussion of the Human Body, do develop new insights that are able to supplement the shortcomings of Chinese people’s [ideas], they fail to avoid the harm of forcing interpretations onto things. We should believe that which is trustworthy, and discard that which is doubtful.63

In a similar vein, Xu Ranshi explained that he could not accept all of Wang Qingren’s claims because they were derived from the observation of dead bodies devoid of qi: Living people have qi and therefore reciprocal circulation [between the parts of the body], while the dead have no qi and lack circulation. What this gentleman saw were things without qi. Therefore, I believe that the gentleman clearly understands the “establishment of positions” [i.e., the form and location of internal bodily components] and so I uphold it, but I have my doubts about the gentleman’s inability to explain the circulation of qi and so I will supplement it.64

These objections were hardly unreasonable, given that Wang Qingren did misconstrue some of the things he observed. For example, he did not know that the arteries of dead bodies are often emptied of blood, and he thus concluded that the arteries were channels for qi circulation.65 Even Li Zhirui, who had conducted his own investigations into the organs of dead rebels, said that there were serious limits to what could be discovered in this way. Significantly, Li noted that while the Jesuits and Wang Qingren had created improved images of the stomach and spleen, they were unable to explain how these organs performed their crucial function of transforming food and drink into qi. This was a major lacuna, for a central tenet of late imperial medicine was that the entire body’s wellbeing depended on the smooth generation of qi through digestion by the spleen and stomach. But western medicine had no satisfactory explanation for this most vital dynamic. Thus, Li said, one could only rely on the descriptions from the Chinese medical classics.66 In sum, while the writers in the Jottings valued anatomical descriptions, they were also skeptical of claims that seemed to overstate the available evidence. In cases of uncertainty, furthermore, the best way to ascertain the truth was by

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comparing textual descriptions and empirical evidence from a wide range of sources. It was in this context that Wang Shixiong and his friends assessed the anatomical claims of Wang Qingren and western authors, employing them as useful, additional reference points. To the extent that this new knowledge shed light on existing therapeutic problems, doctors like Wang Shixiong could also incorporate it into their own understandings of disease. Body structure and cholera Epidemic diseases were historically among the most pressing medical problems in China, and the desire to prevent and manage such outbreaks inspired important medical innovations.67 By the Qing, doctors could draw on an array of competing medical explanations for epidemics, which revolved around three central issues. First, were these ailments due to pathological cold or pathological heat? Second, were they caused by abnormal and unseasonable climatic patterns, or by noxious miasmas and pestilential vapors particular to a specific place? Finally, what were the physical pathways by which the pathogenic influences entered and spread through the body? The calculus became even more complex after 1820, when cholera arrived in China.68 Now, in addition to older questions about etiology, doctors debated whether cholera was an entirely new disease or rather a new variation of an old disease. Cholera’s devastating spread through China coincided with Wang Shixiong’s maturation as a doctor, and epidemic disease became an important focus of his medical work. In his search for answers, Wang championed the medical doctrine known as Warm Disease. As Marta Hanson shows, southern Chinese physicians became dissatisfied with the doctrine of Cold Damage (shanghan), originally elaborated by the Han Dynasty physician Zhang Ji, which had long been the dominant explanatory framework for epidemic disorders.69 These southern thinkers rejected the older idea that Warm Disease was a variant form of Cold Damage, and they instead argued that it was an independent category of illnesses with a distinct etiology. Over the course of the eighteenth and nineteenth centuries, Warm Disease evolved into an important doctrinal current. As for cholera, Wang Shixiong argued that it was not a new disease, but a particularly virulent form of huoluan (霍亂), literally “sudden turmoil” or “sudden chaos.” Known since antiquity, huoluan was characterized by the sudden onset of violent vomiting, diarrhea, and muscle cramping. Wang elaborated his arguments in his Treatise on “Huoluan,” completed in 1838 and published the following year. During the devastating civil war known as the Taiping Rebellion (1851–64), the printing blocks of this text were lost. Eventually, Wang produced a second, expanded version, titled Re-Edited “Treatise on ‘Huoluan’” from the Residence of Frequent Sighs (Suixi ju chongding Huoluan lun, 隨息居重訂霍亂論), completed in 1862 and published in 1863.70

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By the time he composed the second edition, Wang Shixiong had read the works of Wang Qingren and Benjamin Hobson, and he incorporated information from them into the Re-Edited “Treatise.” Significantly, Wang used their observations of bodily structures to refine his understanding of two important issues in the study of huoluan: the nature of the blockages that the epidemic pathogen created in the stomach and lungs, and the role that pathogenic warmth played in the generation of toxic blood (du xue, 毒血). Gates of the stomach and toxic blood

From the beginning, questions of bodily structure were important in the etiology of Warm Disease. Doctors explained that heteropathic qi entered through the nose and mouth during inhalation, and then penetrated ever more deeply into the body as the disease progressed. However, different writers presented varying explanations of the pathogen’s itinerary. Yu Chang, for example, argued that the toxin of Warm Disease penetrated downwards via the Triple Burner, going from the lung into the stomach and then to the intestine.71 Another influential model was proposed by Ye Gui, who envisioned the body as divided into four sectors that proceeded from the exterior to the interior and that could be successively struck by pathogenic qi: defensive qi, constructive qi, yang qi, and yin qi (blood). Wang Shixiong’s original description of huoluan published in 1839 explained that the pathogenic agent enters through the mouth and nose and then penetrates the lung and stomach, forming an obstruction in the center of the chest. This obstruction would then prevent the normal upward and downward circulation of qi, producing the classic symptoms of “sudden turmoil,” namely vomiting and diarrhea: Huoluan is caused by a heteropathy (xie, 邪) that is without form. It enters the mouth and nose upon inhalation and goes into the circulation channels of the lungs and stomach. Then it obstructs the circulation within their pathways of qi. Therefore it is an illness of blockage and obstruction. If the clear [qi] cannot ascend, then it becomes diarrhea … the turbid cannot rise, and there is pain in the belly with vomiting.72

In this early text, Wang Shixiong provides only a general description of the blockage’s location: the circulation channels (luo, 絡) of the lung and stomach. When he produced his Re-Edited “Treatise” of 1863, however, Wang identified a specific anatomical location where the blockage occurred: the so-called fluid gate (jin men, 津門) of the stomach. This anatomical detail came from Wang Qingren’s Correcting the Errors. Chinese medical texts conventionally described the stomach as having two “gates” or apertures: an upper one connected to the esophagus and a lower one connected to the small intestine.

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3.1  Wang Qingren’s revisionist diagram of the structure of the stomach, which he based on his observation of corpses.

Wang Qingren claimed, however, that there was a third aperture, which he dubbed the “fluid gate” (see Figure  3.1). (If we compare his descriptions to modern anatomical sources, it appears he based this on his observation of the bile duct.) Wang Qingren reported that he had witnessed an epidemic outbreak of huoluan in northern China in 1821, and he argued that the symptoms of vomiting and diarrhea were caused by a pathological blockage in this very fluid gate.73 Thus, in addition to naming this new aperture of the stomach, Wang Qingren presented it as a crucial node in the body’s circulatory system. When Wang Shixiong revised and expanded his treatise on huoluan, he incorporated Wang Qingren’s model of stomach blockage: The noxious qi of the epidemic enters through the mouth and nose and goes into the qi tube [trachea] and arrives at the blood tubes. It makes the qi and blood congeal and knot, blocking up the fluid gate (note: Correcting the Errors of Doctors says, “about a cun to the left of the hidden gate, there is another gate, which is called the fluid gate. Above the fluid gate there is a tube, which is called

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the fluid tube. This is the pathway by which refined juices and liquids leave the stomach.) The water is not able to leave, so above there is vomiting and below there is diarrhea.74

Besides provoking internal blockages, the pathogenic qi of huoluan could spread throughout the body and engender “toxic blood,” itself a pathogenic substance. Wang Shixiong’s 1839 text on huoluan presented two methods for eliminating toxic blood, both borrowed from Guo Zhisui’s A Jade Scale for Treating “Sha” Illnesses (Sha zhang yu heng, 痧脹玉衡), completed in 1675. The term sha encompassed a diverse group of ailments, all attributed to noxious qi and miasmas.75 Their distinctive symptoms ranged from granular sand-like rashes to “twisting intestine” afflictions that resembled forms of huoluan, and some practitioners even believed that cholera was a form of sha. While Wang Shixiong rejected the idea that cholera was sha, he incorporated therapies for sha into his treatise on huoluan.76 One method was to scrape and rub the skin in order to draw the toxins out from the interior. The other was to use a needle to pierce the so-called “sha sinews” (sha jin, 痧筋) where toxic blood accumulated. This would allow the corrupted blood to flow out and the patient to recover. These sha sinews were identifiable by their distinctive and abnormal color, described variously as “blue-green” (qing, 青), dark green, purple, or deep red. They appeared in two main places: above and below the crook of the elbow, and above and below the back of the knee. In his first text on huoluan, Wang described them thus: Look above and below the bend of the person’s leg. If there are thin sinews of a deep green color, or of a purple color, or of a deep red color (in people whose flesh and skin are white and tender, these will be purplish-red in color), then these are the sha sinews. If you pierce them, then there will be purplish-black toxic blood.77

A modern reader might wonder whether these sha sinews correspond to veins. However, the association between the sha sinews and the body’s circulatory networks is much more ambiguous in Chinese medical texts. Sha sinews are described as specific places on the body where toxic blood will collect, suggesting that they are connected to normal circulatory channels. However, medical texts imply that sha sinews are not seen in a healthy person, appearing only in cases of disease. Their appearance, furthermore, is a sign that the toxin has penetrated deep into the body. In such cases, Wang Shixiong counseled, the only way to assure a successful cure was to “use a needle or a lancing stone to eliminate the toxic blood.” But how did blood become toxic? According to Wang Qingren, the culprit was heat. In his description of the 1821 epidemic which he observed, Wang Qingren argued that the role of heat could be confirmed by observing the color of the blood that flowed out of huoluan victims who had been cured

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by piercing. “That which flows completely out is blackish-purple blood,” he said. “How is this anything but the toxin of a Warm Disease that is burning and smelting [the blood]?”78 Wang Qingren’s views about the color of heated blood presumably came from his familiarity with food products made with animal blood, a traditional feature of many cuisines, including China’s. For a sick person’s blood to be the same color as cooked blood was thus incontrovertible proof that she had been stricken by heat, not cold. Furthermore, Wang Qingren highlighted the epistemological power of visual evidence: to see (the color of blood) was to know (the cause of the illness). Wang Shixiong agreed, and his Re-Edited “Treatise” incorporated Wang Qingren’s explanation that heat was responsible for the toxic blood of huoluan. Furthermore, Wang Shixiong said, this explanation was trustworthy precisely because it was based on direct observation: “Master Wang [Qingren] saw the organs with his own eyes and he is good at needling methods. The things he said are all detailed and reliable, and it is not something that guesswork and empty suppositions can compare with.”79 Blocked lungs and “charcoal qi”

Wang Shixiong cited Wang Qingren to explain how huoluan formed blockages in the stomach and to confirm the role of heat. In similar fashion, his revised treatise on huoluan cited Benjamin Hobson to elucidate how huoluan produced blockages in the lungs and to provide further details on the nature of its hot, toxic qi. The reference to Hobson appears in Wang Shixiong’s discussion of “inducing sneezing” (qu ti, 取嚏) as a therapy for huoluan. Wang counseled that in cases where the pathogenic qi engendered a blockage in the respiratory system, the force of a sneeze could clear this blockage and allow pathogenic qi to drain out on its own. This was not a new idea, and since at least the fourteenth century, doctors had taught that inducing sneezing was one way to treat “seasonal qi” (shi qi, 時氣) or “seasonal toxins” (shi du, 時毒).80 These diseases were so named because they were attributed to pathogenic climatic influences that arose in different seasons, and they were potentially fatal. Conceptually, they overlapped with Warm Disease and huoluan. An important explanation of the sneezing cure for seasonal toxin appears in the influential writings of Xue Ji (薛己, 1487–1559), who explained that the symptoms of disease first arose in the nose; spread to the ears, neck, and throat; and eventually produced a noxious accumulation in the airways. But if the accumulation could be expelled from the body through the nose, then the patient would be cured.81 Wang Shixiong’s discussion of therapeutic sneezing followed these Chinese understandings. But he expanded on indigenous views by equating the noxious qi of huoluan with the “western” concept of “charcoal qi” (tan qi, 炭氣),

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which he understood as a hot, suffocating, and potentially fatal force that would block up the lungs and impair breathing: Huoluan and all forms of sha all arise because orthopathic qi is obstructed by heteropathic qi. Therefore the turbid qi cannot be exhaled out, and the clear qi cannot be inhaled in. Qi becomes chaotic in the center, and this then becomes a syndrome of things being closed up and blocked. The turbid qi is extremely hot, and westerners call this charcoal qi (tan qi). If the charcoal qi cannot come out, then the person faints, feels suffocated, and dies. Now the lung is master of exhalation, and the opening aperture of the lung is the nose … Once sneezing is provoked, then the pathway of qi will be cleared of obstruction. Then the heteropathic qi will drain out to the exterior, the turbid qi can leave, and the illness will ease up on its own.82

Although Wang does not identify the “westerners” by name, earlier comments that he made in the Jottings show that he learned about “charcoal qi” from the description of respiratory gas exchange in Benjamin Hobson’s New Discourses.83 Hobson used the Chinese characters tan qi, literally “charcoal qi,” to translate the English term “carbonic acid gas,” then the term for what is now conceptualised as CO2 (carbon dioxide).84 (In order to reproduce the flavor of Hobson’s text as Wang would have read it, I will continue to translate tan qi as “charcoal qi” below.) Hobson’s text portrays charcoal qi as a suffocating, poisonous substance that can accumulate in the blood and cause death – in short, as something that bears many striking resemblances to the hot, obstructive, noxious qi of huoluan. First, the very name of “charcoal qi” signaled this substance’s harmful nature. As New Discourses explained, “its nature is toxic [du], in the same way that charcoal is, thus it is called charcoal qi.”85 This reference to charcoal as toxic echoed Chinese medical descriptions of people being struck by “coal toxin” (meidu, 煤毒) or “coal and charcoal toxin” (煤炭毒, meitan du) while they slept in poorly ventilated rooms, descriptions that clearly indicate carbon monoxide poisoning from the use of coal or charcoal for indoor heating.86 Hobson explained that his charcoal qi was a bodily waste product that is transformed into a gas and expelled with each exhalation.87 He also emphasized that it was a poisonous substance that “can kill people” (neng sha ren, 能殺 人) if it accumulated in their blood when normal respiration was impaired. As evidence, Hobson recounted the story of the infamous Black Hole of Calcutta, where 146 prisoners were locked up together in a tiny cell with only two small windows. By the next morning, 123 of them were dead. They died, Hobson explained, because they could not breathe, and the charcoal qi thus poisoned their bodies. Furthermore, Hobson emphasized, an autopsy of the dead prisoners would have revealed that “inside the lungs and in the left chamber of the heart, the blood was all purple in color,” thus proving that the blood was indeed imbued with charcoal qi.88

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Wang Qingren had cited the dark color of blood to prove the presence of pathogenic heat. In similar fashion, Hobson cited the dark color of blood to demonstrate the presence of charcoal qi. These similarities became significant because of the obvious conceptual link between heat and charcoal, namely that charcoal was produced by heat. We can see Wang Shixiong drawing this link in a passage in the Jottings, where he reworked one of Hobson’s descriptions to reconfigure charcoal qi as the direct product of body heat. Hobson’s original sentence said, in part, that “during exhalation, charcoal qi is expelled.” Wang modified this sentence to read: “because people’s bodies are fundamentally hot, during exhalation, charcoal qi is expelled” (emphasis mine).89 In other words, while Hobson’s longer discussion had originally defined charcoal qi as something derived from bodily waste products, Wang’s quotation presented it as the product of bodily heat. Finally, Hobson described blood saturated with charcoal qi in terms that made it resemble Chinese medical concepts of blood struck by heat, in that both could be understood as the corrupted form of a normally nourishing fluid. Hobson explained that when “living qi” (sheng qi, 生氣, i.e. oxygen) enters the blood, the blood turns red, and this is the “proper blood” (zheng xue, 正血). But when charcoal qi enters the blood, the blood turns purple, and this is the “bad blood” (nao xue, 孬血).90 In Chinese medicine, zheng is used to describe the proper qi that protects the living body and guarantees its healthy functioning. The opposite of zheng is xie (邪), which refers to pathogenic, corrupted, improper forms of qi that will cause disease. By describing red blood as something that is zheng and imbued with “living” qi, Hobson’s text implies that purple blood is in fact xie, a harmful thing that should be eliminated from the body. Conceptually and linguistically, therefore, Hobson’s descriptions of “bad blood” imbued with carbon dioxide resonated with Chinese understandings of toxic blood corrupted by heat. These convergences ultimately allowed Wang Shixiong to conclude that the heteropathic hot qi of huoluan was in fact the same as what the westerners called charcoal qi. Hobson’s “new discourses” thus enabled Wang Shixiong to refine his approach to an old problem, that of understanding epidemic disease. Conclusion The rhetoric of “civilization” requires the construction of a traditional “Other” that embodies all the ideas that are seen as impediments to progress. Previous generations of scholars claimed that Chinese elites were too culturally arrogant, conservative, or insular to recognize the benefits of western science. Even when faced with the threat of western imperialist expansion after the mid-nineteenth century, China “failed” to modernize while its neighbor Japan succeeded.91 In recent years, however, Benjamin Elman and others have discredited this

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failure narrative by demonstrating that Chinese thinkers actively engaged with western scientific learning, which they adapted to Chinese needs on Chinese terms.92 Similarly, this chapter has sought to problematize the Chinese medical Other that supposedly had no interest in bodily structure. The case of Wang Shixiong shows that Chinese doctors valued anatomical information gained from the investigation of dead bodies, even if they did not practice dissection themselves. Furthermore, many European doctors of that time would have agreed with the Chinese criticism that bodily functions could not be verified by investigating corpses. Indeed, the very limitations of cadaver study motivated some European anatomists to conduct their investigations via the controversial practice of animal vivisection. Of course, there were profound differences between European and Chinese approaches to the body. Chinese doctors’ interest in bodily structure was predicated on its relevance for diagnosis and therapy. By contrast, European culture contained numerous incentives to pursue anatomical knowledge as an end in itself, even when this knowledge had no direct utility for medical practice. As historians of Europe have shown, anatomical study was seen as a way to understand God’s divine creation or to gain greater insight into the soul. Knowledge of anatomy also allowed artists to depict the human body with greater realism, something esteemed in European (but not Chinese) art. Furthermore, the ability to obtain and dissect cadavers embodied a form of social power and constituted a display of epistemological virtuosity that could generate immense professional capital for the European anatomist.93 To understand why dissection was prevalent in Europe but scarcely present in China, therefore, we need to examine the factors that actively drove anatomical study, rather than simply those that supposedly inhibited it. This point is also worth considering because medical historians have tended to depict Wang Qingren’s Correcting the Errors as culturally anomalous, the lone example of western-style (read: enlightened) approaches to anatomy in China prior to the rise of modern medicine. It has also been suggested that Wang Qingren’s critics were appalled by the immorality of examining dead bodies and offended by his attacks on the classical canon.94 However, the case of Wang Shixiong suggests an alternative set of interpretations. Interest in bodily structure was in fact an intrinsic feature of Chinese medical thought that could demand more or less explicit attention depending on circumstance. Men such as Wang Shixiong’s friend Li Zhirui were examining dead bodies, even if they did not do so as extensively or as systematically as did Wang Qingren. Their interest in anatomy thus cautions us against assuming that Chinese cultural norms were inevitably hostile to the study of corpses. In fact, in the course of meting out justice, the good Confucian official might very well have to examine corpses or order the mutilation of the bodies of people executed for heinous crimes.95 Indeed, it was their connections to government service that had enabled Yang Zhaoli and Li Zhirui to examine human internal

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organs and bones. Finally, Wang Qingren’s attack on the received medical classics did not perturb Wang Shixiong and his friends, for the norms of evidential scholarship encouraged such skepticism. When they criticized Wang Qingren, it was not because he offended their moral sensibilities, but because he violated their epistemological ideals, making claims about the body that could not be empirically verified. In conclusion, the case of Wang Shixiong allows us to recover important aspects of the history of the material body in China. While the “function, not structure” narrative came to dominate Chinese doctors’ selfperceptions after the early twentieth century, this rhetoric would have sounded odd to Wang Shixiong and his colleagues, who believed that physicians needed accurate knowledge of the body’s physical components in order to understand its functions. Acknowledgments I would like to thank the Hewlett-Mellon Fund for Faculty Development at Albion College for funding the research for this chapter. Earlier versions of the chapter were presented at conferences and seminars sponsored by the University of Westminster, National Chengchi University, Université de Paris, University of Hong Kong, New York University, and the University of Michigan. I thank the organizers and participants for providing me with these valuable opportunities to receive feedback on my work. Notes 1 Ian Hacking, Historical Ontology (Cambridge, MA: Harvard University Press, 2002), especially Chapter 1. 2 See, for example, Li Jianmin, Si sheng zhi yu: Zhou Qin Han maixue zhi yuanliu (The Boundary between Life and Death: The Origins of Channel Theory in the Zhou, Qin, and Han Dynasties) (Taipei: Institute of History and Philology, Academia Sinica, 2000); and Saburo Miyasita, “A link in the westward transmission of Chinese anatomy in the later Middle Ages,” Isis 58.4 (1967): 486–90. For images of the body, see Huang Longxiang, ed., Zhongguo zhenjiu shi tu jian (An Illustrated History of Chinese Acupuncture and Moxibustion) (Qingdao: Qingdao chuban she, 2003); Catherine Despeux, Taoïsme et corps humain: Le Xiuzhen tu (Paris: Guy Trédaniel, 1994); and Wang Shumin and Vivienne Lo, eds., Xingxiang Zhongyi: Zhongyi lishi tuxiang yanjiu (The Form and Appearance of Chinese Medicine: Studies of Diagrams and Illustrations in the History of Chinese Medicine) (Beijing: Renmin weisheng chubanshe, 2007). 3 Linda Barnes contextualizes these perspectives in the larger history of European– Chinese medical exchanges in her Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848 (Cambridge, MA: Harvard University Press, 2005).

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4 Pi Guoli, Jindai zhongyi de shenti guan yu sixiang zhuan xing: Tang Zonghai yu zhong xi yi huitong shidai (Changing Models of Thought and Views of the Body in Recent Chinese History: Tang Zonghai and the Age of “Chinese–Western Medical Convergence and Assimilation”) (Beijing: Sanlian shudian, 2008). On Tang and the origins of the “anatomy vs. qi” narrative, see Sean H.-L. Lei, “Qi-transformation and the steam engine: The incorporation of western anatomy and re-conceptualisation of the body in nineteenth-century Chinese medicine,” Asian Medicine 7.2 (2012): 319–57. 5 Prominent examples from western commentators include Manfred Porkert, The Theoretical Foundations of Chinese Medicine: Systems of Correspondence (Cambridge, MA: MIT Press, 1974); and Ted Kaptchuk, The Web that Has No Weaver: Understanding Chinese Medicine (New York: Congdon and Weed, 1983). 6 Leslie de Vries, “The Gate of Life: Before heaven and curative medicine in Zhao Xianke’s Yiguan” (Ph.D. dissertation, Universiteit Gent, 2012). 7 Volker Scheid, “Transmitting Chinese medicine: Changing perceptions of body, pathology, and treatment in late imperial China,” forthcoming in Asian Medicine 8.2 (2014). 8 Pi, Jindai zhongyi. 9 Lei, “Qi-transformation.” 10 For details, see Marta E. Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China (Abingdon: Routledge, 2011). 11 Unless otherwise noted, all page citations from the Chongqing tang suibi come from the widely available reprint edition published as part of Wang Mengying yixue quanshu (The Complete Collection of Wang Mengying’s Medical Books) (Beijing: Zhongguo zhongyiyao chubanshe, 1999). I have also relied on the edition of Chongqing tang suibi published in Cao Bingzhang, ed., Qianzhai yixue congshu shisi zhong (A Collection of Fourteen Medical Books by Qianzhai) (Shanghai: Jigu ge, 1918). My citations from Wang’s works on huoluan are taken from Huoluan lun (Treatise on Sudden Turmoil Disease) (author’s preface dated 1838, first edn. 1839; woodblock edition published by Hanxiang shuju, 1851); and Suixi ju chongding Huoluan lun (re-edited Treatise on Sudden Turmoil Disease from the Residence of Frequent Sighs) (author’s preface dated 1862, first edn. 1863; modern critical edition of Siming Lin Yanchun woodblock edition of 1887, reprinted in Wang, Wang Mengying yixue quanshu). 12 My account of these events comes from a preface dated 1830 by Wang Shixiong’s maternal uncle, Yu Shigui. Wang, Chongqing tang, 615–16. 13 The title refers to a name that the Wang family adopted in the year that Wang Sheng’s oldest son was born (which I estimate to be 1798). The other celebrations that year were Wang Xuequan’s seventieth birthday and Wang Guoxiang’s fiftieth birthday; Yu Shigui, preface dated 1830, in ibid., 615–16. I assume that Wang Shixiong had essentially completed the text by 1852, because he signs the penultimate essay in the text with that date. However, the very last entry in the book is an essay by Wang Shixiong, dated the first month of 1855, and Yang Zhaoli’s preface to the entire work is dated a few months later; ibid., 618, 675–6. Thus it appears that the text was not published until 1855.

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14 Susan Mann, “The male bond in Chinese history and culture,” American Historical Review 105.5 (2000):1600–14. 15 The Huichun lu also circulated under the title Wangshi yi’an (Medical Cases from Master Wang). For the case of Zhou Heng’s illness, see Wangshi yi’an (modern critical edition of 1918; lithographed version published by Ji gu ge in Wang Mengying yixue quanshu), 257. 16 These events are related in Yang Zhaoli, preface dated 1850, Wang Shi yi’an. 17 Wang, Chongqing tang, 666–71. 18 For Wang Shixiong’s descriptions of Hu Kun see Wang, Suixi ju, 3:172 and Wang Shixiong, Gui yan lu (Records of Returning to the Inkstone) (author’s first preface dated 1857, reprinted with author’s new preface dated 1862; critical edition of 1918; lithographic edition reprinted by Ji gu ge in Wang Mengying yixue quanshu), 436. The biographical information on Hu Kun and Hu Jing discussed here also comes from Chen Qiong, et al., comps., Min’guo Hangzhou fu zhi (Gazetteer of Hangzhou Prefecture from the Republican Period) (1922; fascimile reprint Shanghai: Shanghai shudian, 1993), 31:222b–223a and 145:42a–b. 19 For Xiang Mingda, Dai Xu, evidential scholarship, and the study of European mathematics, see Benjamin Elman, On Their Own Terms: Science in China, 1550– 1900 (Cambridge, MA: Harvard University Press, 2005), 246. For the Chongwen Academy and kaozheng, see Benjamin Elman, From Philosophy to Philology: Intellectual and Social Aspects of Change in Late Imperial China (Cambridge, MA: Harvard University Press, 1984), 109, 124. 20 Wang, Chongqing tang, 669. 21 See the following works attributed to Wang Shixiong, all reprinted in Wang Mengying yixue quanshu: Wangshi yi’an xubian (A Second Collection of Medical Cases by Master Wang) (prefaces dated 1850; modern critical edition of 1918, Ji gu ge lithographed version), 8:347; Wangshi yi’an sanbian (A Third Collection of Medical Cases by Master Wang) (comp. Xu Ranshi et al., prefaces dated 1854; modern critical edition of 1918, Ji gu ge lithographed version),1:363; Wenre jingwei (The Warp and Woof of Warm and Heat Diseases [1852]), 2:23 and 2:33. 22 The remarks appear in Shen Yaofeng’s Nüke jiyao (Edited Essentials of Medicine for Women), which Wang Shixiong edited and published. I have used the reprint in Nüke jiyao, taichan xinfa (The “Edited Essentials of Medicine for Women” and “Essential Teachings on Producing Children”) (Beijing: Renmin weisheng chubanshe, 1988). Wang also added his own commentary to the text, and his remarks on anatomy and western medicine appear on pp. 64 and 73–6. All modern bibliographical accounts state that Wang Shixiong published Nüke jiyao in 1850, which is the date of his preface. However, Wang’s annotations to this text include a long summary of material from Benjamin Hobson’s work, which was not published until 1851. I thus assume that the original version of Nüke jiyao was completed around 1850, but not published until a couple of years later. 23 There was a third anatomy text produced by the Jesuits, known as the The Manchu Anatomy, but the few existing copies of this work were reportedly kept within the imperial household and were unavailable outside the court. For the history of Jesuit medical texts in China, see Nicolas Standaert, ed., Handbook of Christianity in China, Vol. 1: 635–1800 (Leiden: Brill, 2011); Marta E. Hanson, “Jesuits and

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Medicine in the Kangxi Court (1622–1722),” keynote lecture for symposium on “Medicine and culture: Chinese–western medical exchange (1644–ca. 1950),” Pacific Rim Report 43 (2007): 1–12; Marta E. Hanson, “The significance of Manchu medical sources in the Qing,” in Stephen Wadley, Carsten Naeher and Keith Dede, eds., Proceedings of the First North American Conference on Manchu Studies, Vol. 1: Studies in Manchu Literature and History (Wiesbaden: Harrassowitz, 2006), 131–75; and Daniel Asen, “‘Manchu anatomy’: Anatomical knowledge and the Jesuits in seventeenth- and eighteenth-century China,” Social History of Medicine 22.1 (2009): 23–44. 24 For a discussion of the collaborative process and the way that Hobson’s resultant texts exemplify cultural dualism and cultural hybridity, see Man Sing Chan, “Sinicizing western science: The case of Quanti xinlun,” T’oung Pao 98.4–5 (2012): 528–56. Hobson’s other medical texts (and the English titles he gave them) were Xiyi lüelun (First Lines of the Practice of Surgery in the West, 1857), Neike xinshuo (Practice of Medicine and Materia medica, 1858), and Fuying xinshuo (Treatise on Midwifery and Diseases of Children, 1858). Hobson also compiled a book on science titled Bowu xinbian (Natural Philosophy and Natural History, 1855). 25 Wang, Chongqing tang, 668. 26 For Wang’s remarks on these two editions, see ibid., 667. Soon after Pan Shicheng’s reprint appeared, Hobson himself published another, slightly modified version. The most widely circulating version of New Discourses, however, was the one published by the London Missionary Society Press in Shanghai in 1853. For details on these editions see Hashimoto Hideshi and Sakai Tatsuo, “‘Zentai shinron’ ni keisaisareru kaibōto no shutten ni tsuite” (“On the sources of the anatomical illustrations appearing in Quanti xinlun”), Nihon ishigaku zasshi 55.4 (2009):463–97; and two articles by Man Sing Chan: “Quanti xinlun de zhuanyi yu zaoqi banben” (“The compilation and translation of the Quanti xinlun and its early editions”), Zhongguo dian ji yu wen hua lun cong 13 (2011): 200–21, and “Quanti xinlun chatu laiyuan de zai kaocha – jian shuo wan qing yiliao jiaoyu de yi duan Zhong Yin yinyuan” (“A further investigation into the origins of the illustrations in the Quanti xinlun, along with a case study of Chinese and Indian factors in late Qing medical education”), Ziran kexue shi yanjiu 30.3 (2011): 257–77. 27 Benjamin Hobson, Brief Notice of the Hospital at Kum-le-fau in Canton, during the Year 1851 (Guangzhou: Canton, 1852); item 5852/43 in “Items acquired with the Morrison and Hobson Papers,” Archives and Manuscripts, Wellcome Library for the History and Understanding of Medicine. Hobson reports it cost $176 for the print run of 1,200 copies, and he states that he sold $2.50 worth to Chinese buyers and received $45.50 in “donations” from interested missionaries (of which $30 came from his colleague William Lockhart in Shanghai). Assuming that Hobson sold them at cost, Chinese buyers accounted for upwards of a dozen copies, and missionary donors for over 300. 28 For the intellectual orientations of the Golden Mirror, see Marta E. Hanson, “The Golden Mirror in the imperial court of the Qianlong Emperor,” Early Science and Medicine; Special Issue: Science and State Patronage in Early Modern East Asia 8.2(2003): 111–47.

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29 These events are described in Wang Qingren, Yilin gai cuo (1st edn. 1830; reprinted Nanjing: Wen Ying Tang woodblock edition, 1849), 1:12a–13b. 30 This information comes from Shen, Nüke jiyao, 64; and Wang, Chongqing tang, 668. 31 For an exemplar, see the facsimile of the Lüliguan jiaozheng xiyuan lu reproduced in the Xuxiu Siku quanshu (A Continuation of the “Imperial Library of the Four Treasuries”) (Shanghai: Shanghai guji chubanshe, 1995–2002). Scholars have conventionally dated this official version to 1694, but Chen Chong-Fang has compellingly argued that the final version was not completed before 1741; Chen Chong-Fang, “Qing ‘Lüliguan jiaozheng xiyuan lu’ xiangguan wenti kaozheng” (“A textual study of questions pertaining to the Qing Records on the Washing Away of Wrongs, Edited by the Codification Office),” Youfeng chuming niankan 6 (2010): 441–55. The above facsimile edition dates from after 1770, as it includes a set of official skeleton charts that were added in that year. 32 For Song Ci’s original work, see Brian E. McKnight, The Washing Away of Wrongs: Forensic Medicine in Thirteenth-Century China (Ann Arbor, MI: Center for Chinese Studies, University of Michigan, 1981); and Joseph Needham, Science and Civilization in China, Vol. 6: Biology and Biological Technology, Part 6: Medicine (Cambridge: Cambridge University Press, 2000). For Qing forensics, see Daniel Asen, “Dead bodies and forensic science: Cultures of expertise in China, 1800– 1940” (Ph.D. dissertation, Columbia University, 2012); Daniel Asen, “Vital spots, mortal wounds, and forensic practice: Finding cause of death in nineteenthcentury China,” East Asian Science, Technology, and Society 3(2009): 453–74; and Pierre-Étienne Will, “Developing forensic knowledge through cases in the Qing Dynasty,” in Thinking with Cases: Specialist Knowledge in Chinese Cultural History, ed. Charlotte Furth, Judith T. Zeitlin, and Ping-chen Hsiung (Honolulu: University of Hawai’i Press, 2007), pp. 62–100. 33 Wang, Chongqing tang, 669. The absence of mechanical metaphors in Chinese medical descriptions of the body strongly suggests that Li Zhirui’s analogy came from his reading of western texts. Benjamin Hobson’s New Discourses, for example, compares the marvelous structure of the human body to a watch; Benjamin Hobson, Quanti xinlun (Guangzhou: Hui’ai yiguan, 1851), 68a–b (I have used the first edition held by the National Library of Australia, which has been digitized and is available online at http://nla.gov.au/nla.gen-vn1869894). The watch analogy was famously articulated by the prominent British theologian William Paley (1743–1805), who argued that just as the complexity of a watch testified to the designing genius of a watch-maker, so did the complexity of human anatomy bespeak a divine Maker. William Paley, Natural Theology, or, Evidences of the Existence and Attributes of the Deity, Collected from the Appearances of Nature (London: Faulder, 1802). 34 Wang, Yilin gai cuo, 1:12a. 35 Wang, Chongqing tang, 670. My translation of the quotation from the Changes is adapted from that of Richard John Lynn, The Classic of Changes: A New Translation of the I Ching as Interpreted by Wang Bi (New York: Columbia University Press, 1994), 120–1.

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36 My discussion here is based on the text and commentaries given in Paul U. Unschuld, trans. and annot., Nan-ching: The Classic of Difficult Issues; With Commentaries by Chinese and Japanese Authors from the Third through the Twentieth Century (Berkeley: University of California Press, 1986). 37 For a fuller discussion of Zhang Jiebin’s views of the mingmen, see Yi-Li Wu, Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (Berkeley: University of California Press, 2010), Chapter 3. Although some earlier doctors also conflated the mingmen with the womb, Zhang is the earliest writer I know also to enshrine this idea in medical illustrations. 38 Li Zhongzi, Yizong bi du (Required Readings for Doctors) (modern recension of 1637 woodblock edition, Beijing: Zhongguo zhongyiyao chubanshe, 1999), 88. 39 Wang, Chongqing tang, 669. 40 Paul U. Unschuld, “Prolegomena,” in Xu Dachun, Forgotten Traditions of Ancient Chinese Medicine, trans. Unschuld (Brookline, MA: Paradigm Publications, 1990), 12. 41 See, for example, Wu Qian, ed., Yizong jinjian (The Golden Mirror of the Medical Lineage) (1742; reprinted SKQS [complete books of the four treasuries], 1782), juan, 61. 42 Ibid., 57:1a–b. 43 Ibid., 34:15b–18b. 44 See Scheid, “Transmitting Chinese medicine.” 45 I have adapted this translation from Xu, Forgotten Traditions, 59–61. 46 Sun Yikui, Yizhi zhuyu (1573; modern reprint in Sun Yikui yixue quanshu (The Complete Medical Works of Sun Yikui) (Beijing: Zhongguo zhongyiyao chubanshe, 1999), 652. 47 Wang, Chongqing tang, 666. 48 Zhuangzi, The Complete Works of Chuang Tzu, trans. Burton Watson (New York: Columbia University Press, 1968), 51. 49 Wang, Chongqing tang, 666. 50 Ibid. 51 Ibid., 669. 52 Ibid. 53 Elman, Philosophy to Philology, p. 6. 54 Wang, Chongqing tang, 671. 55 This essay was part of a collection of Yu Zhengxie’s writings published in 1833, titled Topically Arranged Manuscript of the “Guisi” Year (Guisi leigao, 癸巳類稿). Nicolas Standaert points out that Yu wielded these supposed anatomical differences as evidence for his claim that western religions were not suitable for Chinese people. Thus, Standaert suggests that Yu’s primary intent was to make a “moral” argument rather than a medical one. Standaert, Handbook of Christianity, 792–3. 56 Wang, Chongqing tang, 668. 57 Ibid. 58 Ibid., 666–7. 59 Ibid., 666. 60 Will, “Developing forensic knowledge.” 61 Wang, Chongqing tang, 669.

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62 Ibid., 666. 63 Ibid. 64 Ibid., 670. 65 This error is discussed in the translators’ comments in Wang Qingren, Yilin gai cuo, trans. with commentary by Yuhsin Chung, Herman Oving, and Simon Becker (Boulder, CO: Blue Poppy Press, 2007), 36. 66 Wang, Chongqing tang, 669. 67 See, for example, Hanson, Speaking of Epidemics; Asaf Goldschmidt, The Evolution of Chinese Medicine: Song Dynasty, 960–1200 (Abingdon: Routledge, 2009), especially Chapter  3; Carol Benedict, Bubonic Plague in Nineteenth-Century China (Stanford: Stanford University Press, 1996); and Zhang Zhibin, Zhongguo gudai yibing liuxing nianbiao (Year-by-Year Records of Epidemic Outbreaks in Ancient China) (Fuzhou: Fujian kexue jishu chubanshe, 2007). 68 See Kerrie L. MacPherson, “Cholera in China, 1820–1930: An aspect of the internationalization of infectious disease,” in Sediments of Time: Environment and Society in Chinese History, ed. Mark Elvin and Liu Ts’ui-jung (Cambridge: Cambridge University Press, 1998), 487–519. 69 Hanson, Speaking of Epidemics. 70 See Wang’s preface dated 1862, in Wang, Suixi ju. 71 A good overview of the different explanations appears in Hanson, Speaking of Epidemics. 72 Wang, Huoluan lun, 2:11b–12a. 73 Wang, Yilin gai cuo, 2:14a–15a. The subtitle that Wang Qingren gives this section describes the diseases as “the toxin of warm epidemic causing vomiting, diarrhea, and twisting sinews,” but he also notes in the opening sentence of the discussion that “the ancients named this [disease] huoluan.” 74 Wang, Suixi ju, 141. 75 For historic understandings of sha, see Li Jingwei et al., eds., Zhongyi da cidian (Comprehensive Dictionary of Chinese Medicine) (Beijing: Renmin weisheng chubanshe, 1995), 1548. 76 Wang, Huoluan lun, 2:19a–20b. 77 Ibid., 2:19b–20a. 78 Wang, Yilin gai cuo, 2:14b. 79 Wang, Suixi ju, 141. 80 More research is required to trace the earliest origins of sneezing as a specific treatment for seasonal epidemics. However, an early example is Qi Dezhi, Waike jingyi (Refined Meanings of Medicine for External Ailments) (1335; reprinted in the Siku quanshu), 2:21a–b. 81 Xue Ji, Waike shuyao (Pivotal Essentials of External Diseases), in Xueshi yi’an (Medical Cases of Master Xue) (1529; reprinted in the Siku quanshu), 14:10a–11a. 82 Wang, Suixi ju, 148. Emphasis mine. 83 Wang’s early paraphrase of Hobson’s description of respiratory gas exchange appears in Wang, Chongqing tang, 675. 84 Elsewhere, Hobson proposed tan qi as the Chinese equivalent for both “carbon” and “carbonic acid”; Benjamin Hobson, A Medical Vocabulary in English and

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Chinese (Shanghai: Shanghae Mission Press, 1858), 27, 70. Carbonic acid is a solution of carbon dioxide dissolved in water, and thus carbon dioxide was also historically referred to as “carbonic acid gas.” Chemical nomenclature was still in flux at the time Hobson was writing, and the modern designation of “carbon dioxide” had not yet become standard. In fact, chemists of the time actively debated whether models of molecular structure were a literal description of material reality or whether they were only a heuristic representation. See Alan J. Rocke, Image and Reality: Kekule, Kopp, and the Scientific Imagination (Chicago: University of Chicago Press, 2010). I thank Robert Buntrock for bringing this source to my attention. 85 Hobson, Quanti xinlun, 53b. 86 A detailed description is given in Zhang Jiebin, Jingyue quanshu (The Complete Works of Jingyue) (compiled around 1624–40; Siku quanshu edition), 3:44b–45a. Zhang advises that one can prevent coal poisoning by ensuring that the room is ventilated. 87 Hobson, Quanti xinlun, 53a–b. 88 Ibid., 53b–54a. 89 Wang, Chongqing tang, 675. For the original, see Hobson, Quanti xinlun, 53b. 90 Hobson, Quanti xinlun, 53b. 91 Examples of the cultural arrogance and failure narratives in Chinese history include Immanuel C. Y. Hsu, The Rise of Modern China, 6th edn. (Oxford: Oxford University Press, 2000), Chapter  19; and John King Fairbank, China: A New History (Cambridge, MA: Belknap Press, 1994), Chapter 11. For these narratives in Chinese medical histories, see Ralph Croizier, Traditional Medicine in Modern China (Cambridge, MA: Harvard University Press, 1968), 35; and K. Chimin Wong and Wu Lien-Teh, History of Chinese Medicine, 2nd edn. (Shanghai: National Quarantine Service, 1936), 257. 92 Elman, On Their Own Terms. 93 The numerous studies that discuss these dynamics include Andrea Carlino, Books of the Body: Anatomical Ritual and Renaissance Learning, trans. J. Tedeschi and A.  C. Tedeschi (Chicago: University of Chicago Press, 1999); Jonathan Sawday, The Body Emblazoned: Dissection and the Human Body in Renaissance Culture (London: Routledge, 1995); Andrew Cunningham, The Anatomist Anatomis’d: An Experimental Discipline in Enlightenment Europe (Farnham: Ashgate, 2010) and The Anatomical Renaissance: The Resurrection of the Anatomical Projects of the Ancients (Aldershot: Scolar Press, 1997); and Katharine Park, Secrets of Women: Gender, Generation, and the Origins of Human Dissection (New York: Zone Books, 2006). 94 Bridie Andrews, “Introduction to the Yi Lin Gai Cuo,” in Wang, Yilin gai cuo, trans. Chung et al., v–xiv. 95 The method of execution known as lingchi called for the convicted criminal to be dismembered and then disemboweled after death. See Timothy Brook, Jérôme Bourgon, and Gregory Blue, Death by a Thousand Cuts (Cambridge, MA: Harvard University Press, 2008).

4

Blood in the history of modern Chinese medicine Bridie Andrews Introduction Scientific knowledge about the human body has been changing rapidly since the Enlightenment of the eighteenth century. Generated by professional elites – doctors and scientists – this new knowledge appears in popular culture in ways that are shaped by that culture.1 This chapter investigates how new understandings of the human body were negotiated in Chinese culture during the century between 1850 and 1950, by using a single body fluid, blood, as a case study. This period has been called China’s “century of revolution,” and it coincided with the period of “high imperialism” of western powers. It was also a period of worldwide scientism, in China as elsewhere. My choice of blood as a medium through which to examine the cultural context of medical change was prompted by the observation that this was also when treatments directed at the blood first became popular in Chinese medicine outside gynecology. Where did this shift in the meanings and actions associated with blood come from? And how did they affect how people perceived themselves? In other words, having observed shifts in the epistemology of body-knowledge in China, this chapter will explore whether such shifts also generated a change in the lived experience (or phenomenology) of the body. Blood in the canonical medical literature Literate physicians in imperial China found it natural to ground their understandings of the body in canonical works such as the Yellow Emperor’s Inner Canon (黃帝內經). This compilation of Han Dynasty (206 BCE–220 CE) texts (and a few earlier and later) explains the body, in health and disease, as part of the cosmological order. Since the Song Dynasty (960–1279 CE), the Inner Canon had been available in China in two editions: the Divine Pivot, or Ling shu (靈樞), and the Plain Questions, or Su wen (素問).2

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Chapter 18 of the Ling shu, which is titled “The generation and convergence of nutritive and defensive [qi]” (Ying wei sheng hui, 營衛生會) says that: The middle warmer … receives the qi. It secretes dross, purifies fluids, and transforms them into their essence, transporting upwards to the lung vessels, where they are transformed to become blood, to nourish life and limbs. There is nothing more precious than blood, so it only travels within vessels, and is called nutritive qi.3

In this passage, the blood is formed from the actions of the middle warmer – the stomach and spleen  – on foodstuffs, together with the actions of both endogenous qi (which acts to send the purified products of digestion to the lungs) and the qi of the air in the lungs. Other discussions of blood in the heterogeneous early texts reveal additional understandings of the creation and roles of blood. Thus Unschuld, in his 2003 study of the Su wen, finds that the heart is said to generate the blood in Chapter  5, but in Chapter  9 the liver is said to generate blood and qi. More commonly, the liver has the function of storing the blood.4 In these passages, normal bodily activity, its liveliness, depends on the blood and its proper distribution. In the Su wen, blood should flow smoothly (as should qi), and when it congeals, this stasis causes pain and disease. Paul Unschuld has noted the different emphases among the medical classics and their descriptions of blood, where other scholars such as Shigehisa Kuriyama and Nathan Sivin have attempted to recreate a more coherent synthesis. Thus Kuriyama, citing Sivin, says: In Chinese medicine, blood and qi were essentially the same. Doctors did, to be sure, occasionally spotlight the distinctions. Blood had form, for instance, while qi was formless; the former was constructive, making up the substance of the body, the latter was protective, warding off alien pathogens … Ultimately, blood and qi were complementary facets of a unique vitality, its yin and yang manifestations.5

The main ideas of the Inner Canon are generally thought to have been in circulation by at least the first century BCE. The Shanghan lun (伤寒论, Treatise on Cold Damage) by Zhang Ji (张機 [Zhongjing (仲景)], c. 150–219 CE), mentions the dangers of heat in the “blood chamber” (血室), which is clearly the uterus: When a woman has had wind-stroke for seven or eight days and has periodic chills and fever, and the menstrual fluids are interrupted, this is heat entering the blood chamber; her blood will bind, causing a nüe-like condition [of intermittent fevers] with periodic occurrence. Minor Bupleurum decoction governs.6

Additionally, the smooth discharge of menstrual blood and the postpartum bloodflow (lochia) are a major concern in Chapters 20–2 of Zhang Ji’s Jinkui yao lüe fang lun (金匱要略方論), and there are several prescriptions there

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to replenish blood, to warm the qi and blood to reverse the effect of cold pathology, and to dispel stasis or stagnation of qi and blood. Such attempts to manage the status of blood directly were uncommon outside gynecology and obstetrics until the nineteenth century. Instead, classical Chinese medicine’s “blood disorders” were all cases of blood being expelled from the body in abnormal ways – abjected – and medicine directed itself at the underlying causes rather than at the blood itself. Chinese everyday language of kinship reflects this subsidiary understanding of blood. Where in English, it is common to refer to one’s immediate relatives as one’s “flesh and blood,” in Chinese such immediate relatives are referred to as gurou (骨肉, “bones and flesh.” Flesh and bones are considered part of what is passed on from a father to his children, whereas blood is a yin bodily aspect acquired from one’s mother. Because China has a strongly patrilineal kinship system, a mother’s kin – the blood relatives – were not generally considered as important a part of the social family unit. Blood ailments in Chao Yuanfang’s On the Origins and Symptoms of Ailments In the Sui Dynasty, imperial physician Chao Yuanfang (巢元方) edited On the Origins and Symptoms of Ailments (諸病源候總論) at the Imperial Medical Bureau in 610 CE. The chapter on “The symptoms of blood disorders” (“血 病諸候”) is characteristic of most discussions of blood pathology in Chinese medical history before the eighteenth century. Chao lists nine blood ailments, all identifiable by the appearance of blood at the surface of the body: blood disgorging (吐血), subsequent fever and thirst due to blood depletion (吐血後虛 熱胸中否口燥), blood vomiting (嘔血), spitting blood (唾血), blood extravasation on the tongue (舌上出血), blood in the stool (大便下血), blood in the urine (小便血), bleeding from the nine orifices and the four limbs (九竅四 支出血), and sweating blood (汗血). In each case the pathology is linked to damage to one or more of the inner organs and possibly also to the effects of heat or cold or excessive emotion on the correct flow of qi. That is, damage on the inside of the body is identified by the manifestation of blood on the outside of the body. The condition of the blood itself was not relevant. Blood in Warm Epidemic Disease theory (溫病學說) In his 1642 publication On Warm Epidemics (溫疫論), Wu Youxing (吳有性 [Youke (又可)]), picked up on an idea that had been expressed by both Wang Ji (汪機, 1463–1539) and Zhang Jiebin (1563–1640), that epidemic diseases were not only caused by Cold Damage in winter that is latent and expressed the following spring, as had been asserted in Zhang Ji’s Han Dynasty classic,

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the Treatise on Cold Damage. Instead, he proposed that they were caused by a different kind of qi, “pestilential qi” (liqi, 戾氣). Wu conceptualized this different kind of qi as that which entered the body through the mouth and nose, and could strike at particular organs directly, thus bypassing the usual progression of disease from relatively exterior layers of the body (skin and hair), through the blood vessels to the yang and then yin organs, and finally to the bone marrow. His therapies counseled attacking the “guest evil” qi (客邪) and expelling it, most often with purgatives.7 This was an era of mass relocations of people at the end of the Ming Dynasty, and new diseases brought about by global trading patterns that now included the Americas were likely part of the reason that classical solutions no longer seemed to fit the disease profiles of the day. Wu Youxing’s emphasis on expelling disease-causing “guest evil” was likely to have resonated with folk concepts of disease, which explained epidemics as being caused by “epidemic demons” (yigui, 醫鬼), or by plague deities (wenshen, 瘟神), who had been sent from heaven’s Ministry of Epidemics (瘟部), an office of the heavenly bureaucracy governed by the Five Commissioners of Epidemics (wuwen shizhe, 五瘟使者). Especially in southern China, communities often responded to epidemics by staging collective rituals designed to exorcize these visitations.8 Ye Gui (葉桂 [Tianshi (天士)], 1667–1746) built on Wu Youxing’s ideas in a book compiled by his students after his death in 1742, called Treatise on Warm Fevers (溫熱論).9 In this, he reasserted the idea of a normal progression of disease, even sudden warmth epidemics, from the surface to the interior of the body. His model re-envisaged the stages of disease, from the defensive sector (衛), to qi (氣), to the constructive/nutritive sector (營), and finally to the blood (血). Ye proposed that diseases worked their way through these stages, with invasion of the blood sector being the deepest and most serious. When disease entered the blood sector, it would cause the blood to move in an agitated, disordered manner, and be used up. The treatment principles at this stage were to cool and disperse the blood. To go with his new theory he developed diagnostic methods specific to warm epidemics, such as tongue and tongue-fur descriptions, and examination of the teeth and of the different kinds of skin rashes, spots, and sores. Ye Gui associated specific conditions of the blood (hot, cold, dried up, agitated) with stages of disease. He wrote: “When [disease is] in the defensive [layer/sector], you can sweat them; when it reaches the qi only then can you clear the qi; when it enters the constructive/ nutritive, you can still repel the fever and turn it back toward the qi; when it enters the blood, you must directly cool and disperse the blood.”10 Viewing blood as an important site of disease, and one that could be treated directly, was a significant shift in Chinese ideas of pathology and therapeutics. Later development of “Warm Disease” (wenbing) theory and practice continued to be based in the Lower Yangtze region, where physicians devised new

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treatments for local epidemic diseases, and also new ways of understanding the sudden onset of some of these diseases. By the nineteenth century, these Wu-region physicians identified their writings as a new, and exclusively southern, medical innovation, and the writings of the “School of Warm Disease” were retrospectively assembled into a coherent tradition.11 Blood in Wang Qingren’s Yilin gai cuo Wang Qingren (王清任, 1768–1831), from Yutian (玉田) in Hebei Province in north China is well known for his pioneering attempts to solve the anatomical inconsistencies in the classics of medical literature. His frustration with contradictory texts led him to exclaim in the opening paragraph of his Yilin gai cuo (醫林改錯, Correcting the Errors of Doctors) that in the whole Dao of medicine there had never been a perfect physician, because all their books contained errors about the internal organs. Additionally, as a result of his anatomical findings, he created a whole new class of prescriptions designed to invigorate the blood and promote bloodflow. He examined the dog-eaten corpses of victims of epidemics in charity graveyards, and attended the executions of criminals so that he could watch their dismemberment and compare his findings with the internal organs of the domestic animals that he dissected. He insisted on describing only organs that could be seen, so refused to discuss the Triple Burner (三焦), saying “there is no such thing.”12 He attempted a description of the paths of the major blood vessels, which he called “pipes” (guan, 管) to emphasize their physicality. The more common word for blood vessels, mai (脈), was used by Wang only to refer to the pulse. When examining the corpses of epidemic victims, Wang found pools of coagulated blood had collected in the diaphragm at the back of the thorax, below the heart and lungs. He named this pool the “storehouse of blood” (xuefu, 血府), a term that had previously been used to designate the vessels, or sometimes just the conception vessel (衝脈, also referred to as the “sea of blood” [血海]). In the abdomen beneath the diaphragm, Wang observed the membranous structure of the mesentery, enveloping the bowels. This he named the “storehouse of qi” (qihai, 氣府). This conceptualization of separate qi and blood reservoirs justified separate clinical therapies. Just as ancient Greek physicians had conceived of arteries as transporting pneuma around the body, Wang’s corpses seemed to him not to have blood in the heart or the arteries (arteries continue to pulsate after death, whereas veins accumulate blood and do not pulsate, so that the heart and arteries quickly lose their blood contents on death). Wang theorized that the breath traveled directly into the heart and from there into the major arteries, which, for him, were conduits of qi. This left him without a major role for the lungs. Instead, the “storehouse of qi,” which envelops the intestines, was his

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location of primordial qi (元氣, as opposed to the air/qi breathed, which travels in the arteries). Food goes from the stomach to the small intestine and is distilled (蒸化), or transformed, by the fire of the primordial qi there. He theorized that the blood in the veins was supplied from the storehouse of blood above the diaphragm. Wang Qingren’s book generated a great deal of controversy within scholarly medical circles. Most of his detractors were concerned with the moral implications of knowledge based on direct observation of internal organs. For example, Lu Maoxiu (陆懋修, 1818–86) argued that the knowledge gained in this way was both immoral and irrelevant: This teaches people to study the way of medicine from rotting corpses in burial grounds and on execution grounds … When the breath (qi) has ceased, how can the “gate of breath” be known? When the water is gone, how can the “water way” be known? How can the number [of organs] be determined from dogeaten corpses and the remains of executed people? By grasping the heart, liver, or lungs in your hand, how can their positions [in the body] be known? Even if it were possible to examine the bodies and heads of corpses one by one, it would certainly not be possible to peel away the skin and flesh of living people and compare them!13

By contrast, in nineteenth-century Chinese discussions of western anatomy, Wang Qingren’s findings are frequently invoked as evidence that Chinese had already recognized the importance of direct anatomical observation. Just as western doctors claimed that anatomy was essential to medical practice, Wang had insisted that his observations led him to a new physiology: he reasoned that the congealed blood he had found in the chest of epidemic victims indicated a fatal blood stasis. This was why he created new formulae to enliven the blood and dispel stasis, many of which are still in frequent use today.14 Benjamin Hobson and the translation of western medical “blood” Chinese understandings of blood, its roles in the body, and its pathologies, were also influenced by missionary medicine in the second half of the nineteenth century. The most influential works about western medicine at this time were the translations of Benjamin Hobson and his Chinese co-­workers Chen Xiutang (陳修堂), Guan Sifu (管嗣复), and illustrator Zhou Xue (周學), published between 1851 and 1858.15 As we shall see, at least one of these men had been reading Wang Qingren’s work. Benjamin Hobson (1816–73) was born on January 2 1816 at Welford, Northamptonshire, the son of a Nonconformist church minister. He began his medical studies as an apprentice at Birmingham General Hospital and, in 1835, transferred to University College London, gaining the M.B. degree of

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the University of London, and Membership of the Royal College of Surgeons. In 1839 he left for China as a medical missionary for the London Missionary Society, where he worked in Hong Kong, Canton, and Macao until returning to England in 1859. He was the first qualified medical missionary from Britain to go to China. Hobson’s medicine was the medicine of the early nineteenth century, before Pasteur and the beginnings of germ theory, at a time when most epidemic diseases were considered to be local to the specific conditions of soil and climate.16 Doctors could still be found explaining disorders as imbalances of the four humors of Galenic medicine: blood, phlegm, yellow bile, and black bile. The heart was the source of the “vital spirits,” which kept the body warm. The stethoscope for listening to the chest had only recently been invented, and there was as yet no clinical method for measuring a patient’s blood pressure. In his first medical textbook in Chinese, the Outline of Anatomy and Physiology (全體新論) of 1851, Hobson and his Chinese collaborators made some interesting choices in translation. First of all, their chapters on each of the internal organs refer to the organs as jing (經). For instance, the chapter on the heart is titled “Xin jing” (“心經”). This seems odd, since the term xin jing in Chinese medicine refers to one of the channels of qi used in acupuncture. Second, the word used for “blood vessel” in Hobson’s Chinese is guan (管), or “pipe,” the same word Wang Qingren had used to describe the vessels he had seen. Hobson also used Wang’s term zong guan for the aorta and the vena cavae.17 In his discussion of the circulation of the blood, Hobson explained that there are two types of blood, red and purple. The red blood flows from the heart’s bottom-left chamber (left ventricle) into the aorta (血脈總管), which distributes it all around the body and thereby nourishes life (養生命). In the same section, he wrote: All the structures of the body rely on blood to live. Generating life without end, blood necessarily loses something [in the process]. That’s why it is necessary to eat and drink, in order to supplement it. The refined fluid from food and drink is transported from the capillaries [in the intestines] to the neck, where it joins with the returning blood in the vessel, and reaches the right side of the heart. There it is mixed together and sent from the right side of the heart to the lungs where it is transformed into red blood. Returning to the left side of the heart it circulates to nourish the body.18

Immediately we notice that there is no mention of oxygen or carbon dioxide in this account. The emphasis is very much on the nutritive function of the blood, with the nutrition derived from food and drink. This, of course, is very compatible with the Chinese classical understanding of blood as the nourishing aspect of the blood–qi dyad. In the following section, “On Blood” (“論 血”), Hobson noted that blood circulates continuously in the vessels, and that if it should leave them, it gradually congeals and separates into solid red and liquid yellow sections. He then described the constituents of blood and the

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mechanism of blood clotting. Here, too, the language of constant healthy flow versus unhealthy stasis and clotting would not have seemed strange to Chinese readers. It was not until his chapter on “The lungs and breathing” (“肺經呼吸 論”) that Hobson introduced the concepts of oxygen, nitrogen, and carbon dioxide. Having explained that carbon dioxide is a waste product that turns red blood into purple blood, and that oxygen in the blood is necessary to life, he says: “Exhalation is the disgorging of carbon dioxide; inhalation is the receiving of fresh air. When fresh air enters the blood, it is red. Red blood is normal blood. When carbon dioxide enters the blood, it is purple. Purple blood is static blood [紫為瘀血].” This term “static blood” (or “blood stasis”) is now commonly used in Chinese medicine to refer to pathological conditions of the blood. Hobson and his co-translators may have been making a distinction between blood in the pulsating arteries and the more viscous deoxygenated blood in the less motile veins, but to call venous blood “static” was to invoke ideas of stagnated flow and pain. The importance of blood stasis in disease had also been Wang Qingren’s most important clinical insight. In the late nineteenth century, several Chinese authors compared the new anatomy from the West with Wang Qingren’s observations. In 1893, Zhu Peiwen wrote a book in which Hobson’s western anatomical diagrams were compared and reproduced side-by-side with Wang Qingren’s diagrams, and Luo Dingchang’s The Essences of Chinese and Western Medicine (中西醫醉), written in 1882, published in 1894, also contains a section comparing Wang’s and Hobson’s organ diagrams.19 Others simply supplemented their traditional ideas about pathology and therapy with descriptions of the new anatomy from the West, as in Wang Youzhong’s 1906 Illustrated Treatise on the Convergence of Chinese and Western Medicine (中西匯參醫學圖說). For these authors, western anatomy was a resource with which to argue enduring questions from within their own medical tradition. Western anatomy’s relatively rare appearance in Chinese-medical publications underlines this function as a rhetorical resource rather than a revelation of scientific truth. Blood in Tang Zonghai’s publications Historians of Chinese medicine have created a category of “syncretists” (匯 通派) of Chinese and western medicine in the late imperial period. The authors above who compared Hobson’s and Wang’s anatomical descriptions fall into this category. Perhaps the most famous early syncretist was Tang Zonghai (唐宗海, 1862–1918), who used a combination of Hobson’s and Wang Qingren’s writings to confirm that Chinese and western bodies were indeed sufficiently similar for western anatomical works to be relevant to Chinese.20

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In his 1888 publication, Treatise on Blood Conditions (血証論), Tang reproduced Hobson’s descriptions of the role of food and the air from the lungs to produce blood. Drawing on citations from the Inner Canon, he reintroduced the idea of the Triple Warmer, and explained that the lymph vessels in the body described by Hobson were the same as the fluid tubes described by Wang Qingren, which originated in the spleen. Tang felt that western medicine underestimated the importance of the spleen, but that by triangulating between Wang Qingren and Hobson, he was able to explain the omission and reassert the spleen’s centrality while also assimilating ideas from Hobson into his medical practice. In this way, Tang situated himself in the medical lineage of Li Gao (李杲 [Dongyuan (東原)], 1180–1251), the famous Yuan Dynasty author of the Treatise on the Spleen and Stomach (脾胃論), and reasserted the interactions between water and fire that were so central to the medicine of the Jin and Yuan periods. The fire qi of the heart was the vital force on which life and consciousness depended, which nicely matched Hobson’s description of the heart as the source of “vital spirits.” For Tang, western pulse diagnostics, which overlooked the role of qi in its interpretation of pulses, was necessarily less precise than Chinese pulse lore.21 Here again, we see western anatomical ideas deployed in the service of advancing particular viewpoints within Chinese medicine. Just as one might expect from this combination of Chinese classical exegesis and modern syncretism, the “blood ailments” that Tang described were not completely new, but his category of blood ailments was vastly expanded from earlier texts such as Chao Yuanfang’s On the Origins and Symptoms of Diseases. Tang’s categories of blood ailments included those that abjected blood from the surface of the body, but he also added blood that undergoes stasis or blockage internally, and new categories of blood-related diseases, such as consumption; coughs; some fevers; heart discomfort; swelling disorders (which may have been due to parasitic infections such as bilharzia as well as edema from heart or liver problems); and various diseases of the eyes, ears, mouth, and throat. Tang’s prescriptions for these disorders, many of which he was explaining in a completely new way, remained firmly based on the classical prescriptions of antiquity, such as Four Ingredients Decoction (四物湯) and White Tiger Decoction (白虎湯) from the Shanghan lun. His main methods were to calm the blood (which was considered agitated in fevers, for instance), dispel stasis (止血), tranquilize the blood (消瘀), and supplement depletion (補虛). Tang is most famous for his synthesis of western and Chinese medicine. We can illustrate this with his assimilation of Hobson’s and Chen’s culturally sensitive description of sweat glands, which Tang argues are the location of the wei (衛), or defensive sector of qi (see Figure 4.1). For Tang, it was still possible to accommodate the new knowledge within the framework of the existing medical epistemology.22

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4.1  Tang Zonghai used missionary anatomical drawings to give structure to the outer, wei, defensive layer of the body, equating it with this cross-section through the skin showing the sweat glands, nerve endings, and capillary blood vessels.

Blood as understood by medical missionaries in the nineteenth century Tang Zonghai’s emphasis on blood pathology coincided in time and in emphasis with a translation published by the Jiangnan Arsenal at around the same time: it was a translation of Hooper’s Physician’s Vade Mecum: A Manual of the Principles and Practice of Physic; With an Outline of General Pathology, Therapeutics, and Hygiene. This popular English manual of medicine was first published in London in 1809, and existed in ten editions, the last English edition being published in 1886. Later editions, including the one translated in China, included revisions by William Augustus Guy (1810–85) and John Harley (1833–1921). The original author was Robert Hooper (1773–1835).23 The two translators, Shu Gaodi (舒高第, 1844–1919) and Zhao Yuanyi (趙元 益, 1840–1902), worked as a team: Shu Gaodi orally translated and explained the English original, and Zhao Yuanyi rendered it into elegant written Chinese.

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This text-in-translation is interesting for the overwhelming importance it places on the blood. The very first chapter commences with a discussion of the four constitutions: sanguine (shi xue qi, 恃血氣; lit. “relies on blood and qi,” or “energetic”), melancholic (piruan, 疲軟; lit. “weak and fatigued”), choleric (shan nao nu, 善惱怒; lit. “tends to anger”), and phlegmatic (yi gandong, 易 感動; lit. “easily moved”). Interesting here is the translation of the sanguine constitution or temperament. In the late-eighteenth- and early-nineteenthcentury Greek-derived system of temperaments, sanguine corresponds to blood, and to the element fire. It seems that Shu and Zhao opted for qi instead of fire, in order to render “sanguine” with a well-understood Chinese term, xueqi, meaning “vigorous, energetic”, which matches the desired mapping of the meaning of the sanguine temperament quite well.24 Hooper’s Vade Mecum in Chinese had other, later nineteenth-century ideas about blood within its pages, too. In Volume 3, clauses 209–15, it describes how changes to the blood during disease are critical to survival. Loss of red blood cells will cause inflammations, leading to fevers. Or, if the blood circulation slows, the blood will not be able to discharge its “carbon gas” (tanqi, 炭氣), which will poison the blood, leading to sudden cholera, vomiting and purging, and “blue diseases” (lanbing, 藍病 [cyanoses]). Similarly, after blood loss, it takes a long time to replenish the red blood cells, leading to a pallor and a tendency to inflammatory diseases, especially if there is much fibrin in the blood. Inflammation of the membranes leads to fengshi (風濕; lit. “winddamp,” or rheumatism) of the lungs, laobing (癆病, consumption; inflamed blood vessels) leads to extreme rheumatism, and so on, depending on the concentration of fibrin, protein, and blood cells. Similarly, Vol. 4, clause 773 describes how too much blood impedes heart function, causing an increase in the pulse: the solution is to let some blood, until the pulse slows. Clause 830 lists the causes of hyperventilation as: (1) too much blood in the lungs, (2) changes in the constituents of the blood, (3) too little oxygen, (4) obstructions, (5) weak lung muscles. In Volume 6, on therapeutics, the first specific therapy is called “Method of treating various diseases by combining matter in the blood.” The idea was that ingested drugs, once they reached the blood, would combine with and neutralize poisons from disease. Next, the section on food therapy emphasized supplementing deficiencies of the blood resulting from poor or unbalanced nutrition. In short, Hooper’s Physician’s Vade Mecum was overwhelmingly concerned with the condition of the blood: excess and deficiency of blood each lead to different diseases, and therapy also acted via the blood. It is hard to say how much influence this particular medical translation had, but as a very popular physicians’ handbook, it is representative of the medical orientation of most western physicians in nineteenth-century China. It is reflected quite accurately in Ruth Rogaski’s account of Dr. David Rennie, a surgeon in the British Army

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in Tianjin in the 1860s. Rennie believed that all febrile diseases were “caused by the presence of ‘a latent material in the blood,’” which became active under particular environmental conditions, growing poisonous, and spreading its poison around the body. Rennie’s therapies were aimed at eliminating this “morbid material” from the blood, just as Hooper described.25 We can see this nineteenth-century emphasis on the blood reflected in the writings of several prominent Chinese of the period. For example, Tan Sitong (譚嗣同, 1865–98), one of the leaders of the failed “Hundred Days’ Reform,” gave a lecture in early 1898 to the reformist Southern Study Society in Hunan “On anatomy.” He said that it was shameful not to know the anatomy of the body, just as it was shameful not to know modern astronomy (the heavens) and modern geography (the earth). In his short description of the main inner organs, virtually every paragraph includes a mention of the blood. The heart, he said, does not make the blood as stated in the Chinese medical classics: it changes blood by sending red oxygenated blood around the body, and sending purple blood with carbon gas (Hobson’s term for carbon dioxide) to the lungs. The liver is responsible for changing the blood from fresh, inactive pink blood to fully functional red blood. The spleen is responsible for generating white blood cells, which can kill “worms” (chong, 蟲: presumably an early translation of “germs” or “micro-organisms”), but if there are too many of them, malaria results. The stomach has many fine tubules that can absorb digested foodstuffs to make blood, as can the small intestine.26 As we have seen, the role of the blood in Chinese understandings of health and disease was clearly on the rise, both as a result of changes in indigenous medical theory and also as a result of exposure to western concepts of the blood. Western medical ideas that addressed pre-existing Chinese controversies received the most attention, which is why western medicine was used to validate Warm Disease theory and Wang Qingren’s anatomical ideas. Just as Chinese medicine was changing, so, of course, was western medical thought. Germ theory and blood parasites In France, Louis Pasteur’s 1860s work on fermentation had led him to suggest that disease was caused by analogous processes: a “ferment” or “zyme” introduced into the body would multiply, its poison causing inflammation, sweating, and fever. This was the “zymotic” theory of disease causation. Some doctors considered it a chemical process; others considered the “zyme” to be a living contagion, or contagium vivum. This was contrasted with the septic disease process, in which dead or devitalized body tissues were contaminated, and began to fester and suppurate, leading to fever, the destruction of tissue, and a characteristic “foul sweet smell.” The earlier theory of miasmatic disease causation – the idea that foul odors in themselves caused disease – was

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gradually replaced by the idea that foul air contained toxic “germs” (“germ” in its early meaning of “seed,” or “catalyst”). Contagious diseases such as syphilis, which were known to be transmitted directly from person to person, could also be explained by the transfer of a “zyme” or “ferment.” The “germs” of parasitic diseases, such as intestinal worms, were more obvious  – in the case of worms, their eggs – and this emphasizes the wide semantic range of the word “germ” in nineteenth-century medicine. As an example, Joseph Lister’s famous 1867 paper “On the antiseptic principle in the practice of surgery” did not specify what kind of “minute organisms” in the air were responsible for the decomposition and sepsis of infected wounds.27 Identification of specific bacteria as the causative agents of specific diseases came in the last twenty years of the nineteenth century, perhaps most famously with Robert Koch’s identification of the tuberculosis bacillus in 1880, the cholera Vibrio bacillus in 1883, and the co-discovery of the bacterium of plague during the 1895 Hong Kong epidemic by Koch’s Japanese protégé Kitasato Shibasaburō and Pasteur’s student Alexandre Yersin. The new germs of disease  – bacteria  – were gathered from different parts of the body: the intestines and excreta of cholera patients; the sputum and tubercles of tuberculosis patients; and the blood and buboes of plague victims. Initially, therapies derived from the new bacteriology were few: Koch’s “tuberculin” treatment was infamously ineffective, and the much more successful antitoxin/antiserum therapy against diphtheria did not become widespread until 1895. Antitoxin production against other diseases such as tetanus, cholera, plague, and snake bites were produced but with varying success rates.28 Significantly, though, these therapies were injected directly into the blood. In the same period, research was being carried out on “tropical fevers” that turned out to be due to parasites in the blood. Thus in 1877 Patrick Manson (1844–1922), “father of tropical medicine,” discovered the cause of elephantiasis to be a small, filiarial worm, transmitted into the blood of humans by a mosquito. He conducted this research while a Customs Service Medical Officer in Amoy (now Xiamen), China. In 1880, the Frenchman Alphonse Laveran (1845–1922) discovered small parasites in the blood of malarial patients, and in 1898 Ronald Ross (1857–1932) proved that these, too, were transmitted to humans via mosquito bites. The blood was becoming the prime site for research into disease, and with the advent of social Darwinist theories, it also became a signifier of differences of vitality, intelligence, and racial fitness. Blood in social Darwinism In the early twentieth century, Chinese intellectuals read about natural selection and the survival of the fittest through translations of Herbert Spencer (1820–1903). Several works have documented the heightened sense of China’s

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racial and cultural inferiority that had China’s military defeats as precipitating causes, and social Darwinism as its explanation.29 It is noteworthy that even the future Chairman Mao Zedong’s first publication in 1917 was a social Darwinist rant about the importance of physical education, in which he claimed that “Even though there are several hundred methods of exercise, all of them are aimed at improving the circulation of the blood.”30 As social Darwinism developed into the new “science” of eugenics, blood was vested with new social meaning. In 1926, Liang Boqiang published an article titled “Medical research on the Chinese race,” in which he measured the “index of agglutination” of the blood of different Han Chinese populations. His premise was that the degree of agglutination would reveal the degree of racial intermarriage, and he found that high agglutination rates of the blood of southern Chinese indicated that they were the least intermarried with other races, and thus the “purest” Han Chinese. His research inspired the Chinese eugenicist Zhang Junjun (張君俊) to undertake serological studies of Chinese populations. He took blood samples from every province, and postulating that the ancestors of the Han had pure O-group blood, discovered that the highest incidence of O-group blood occurred in Jiangsu and Zhejiang Provinces, with slightly less in the south, and mostly A-group blood in the multiethnic north. Zhang also observed that most Chinese “geniuses” also came from Jiangsu and Zhejiang, where the original racial purity of the Han was strongest and least polluted by intermarriage with inferior races.31 Blood as symbol of degeneracy in literature Lu Xun (1881–1936), the “father of modern Chinese literature,” was famously pessimistic about the Chinese race-as-nation’s chances of survival. He wrote: “My fellow countrymen, to whom servility has become second nature, will degenerate day by day through natural selection through apes, birds, shellfish, seaweed, and finally to a lifeless thing.”32 In his famous short story “Medicine,” he described how the poor parents of a young man who is dying of consumption pay a huge sum for a “guaranteed” cure, consisting of a steamed bread roll dipped in the blood of a recently executed criminal. The son dies anyway, a symbol of Chinese superstition and of Lu Xun’s abjection of the culture that supported it. Lu Xun did not invent this use of blood. Both menstrual blood and ordinary human blood are described as materia medica by Li Shizhen (李時珍) in his Great Pharmacopeia (本草綱目) of 1596, and several western missionaries report similar uses: in 1914, a German missionary doctor reported that he had observed medical use of “Eingeweide, Blut und Knochen von Menschen (namentlich von Enthaupteten)” (“Viscera, blood, and bones of people (specifically decapitated people)”).33 And the following report appeared in the China

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Medical Journal of 1923, ironically placed right next to an entry reporting the preservation of the embalmed heart of famous physician William Osler in the Library of McGill University: HUMAN HEARTS AS MEDICINE.  – About two weeks ago, in Kweitehfu, Honan, twenty-eight people  – including three women  – were executed outside the west gate. These were all supposed “tufei” (bandits) and were executed summarily. After the execution the hearts of these poor wretches were cut out and carefully preserved for future medicinal and courage-inspiring purposes. A number of soldiers were questioned on the matter of cutting out hearts and the purpose of it, and they all quite frankly avowed that they made excellent medicine. North China Daily News, July, 1923.

So, in popular understandings, the blood and hearts of fierce criminals could cure disease, perhaps by transmitting extraordinary vitality; or perhaps all human blood and hearts had this potential, but only the remains of executed criminals were available for purchase. If these uses of blood resemble the sympathetic magic of folk medicine, they also remind us of the symbolic potency of blood in both Chinese and western cultures. The new blood tonics The surge of medical interest in the condition of the blood in both China and the West led to a huge market in tonic medicines for the blood. From the West, the Deschiens company from France marketed blood tonics such as that advertised in Figure 4.2, published in the China Medical Journal in 1921. In 1912, the American Burroughs pharmaceutical company was advertising its “Beef and Iron Wine” as a specific blood restorative in the pages of Ding Fubao’s Sino-Western Medical Journal (中西醫學報), and the Canadian-owned Dr. Williams Medicine Company advertised its Pink Pills for Pale People from the early 1900s until at least the 1930s (Figure 4.3). This was a mixture of iron oxide and Epsom salts (magnesium sulfate), originally marketed to American Civil War veterans for digestive problems, malaria, wounds, and emotional disturbances. Later advertisements claimed that the pink pills could restore the blood, nerves, and all diseases resulting from the vitiated humors in the blood.34 In the United States, the Pure Food and Drug Act of 1906 required drug manufacturers to list all their product ingredients for the first time. This legislation was only effective within the United States, however. In 1907, the medical conference of the China Medical Missionary Society debated which western drug advertisements it would accept within the pages of the China Medical Journal, given that many drugs did not have published formulae. They decided against enforcing any standards on advertisers.35 Again in 1917,

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4.2  Advertisement for a blood tonic made by a French company.

the foreign medical missionaries in China were scandalized to find the US Consulate issuing a special consular report entitled “Proprietary medicine and ointment trade in China,” which began by saying that “No country offers a richer field for the proprietary medicine trade than China,” and asserting that even though the trade was “still in its infancy,” it was already very lucrative.36 Small wonder, then, that Chinese entrepreneurs emerged to take advantage of the business opportunities in this unregulated market. Sherman Cochran’s book, Chinese Medicine Men: Consumer Culture in China and South-East Asia, documents how Chinese-owned pharmaceutical companies were able to outsell their western competition by establishing national and even Asia-wide

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4.3  Advertisement for Dr. Williams’ “Pink Pills for Pale People” (1937). The two large text windows at the top say “Suitable for women of any age” and “A product that greatly supplements the blood and invigorates the brain.” Other ads targeted male customers, or intellectuals, or working men, etc.

networks of branch stores and advertising aggressively. He notes that a tactic common to many Chinese-owned companies was to blur the boundaries between Chinese and western medicine. “Chinese entrepreneurs … painstakingly invented Chinese ‘traditions’ and they elaborately constructed and aggressively promoted their own (Chinese) images of seemingly western ‘new medicine.’”37 Huang Kewu has confirmed this in his study of medical advertisements in early Republican Shanghai. He noted that in 1923, nearly 35 percent

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4.4  Advertisement for “Chilai blood tonic” (in Chinese: “Man-made running blood,” which is a pun on the new Chinese term for “running water”), manufactured by the Five Continents Drugstores (1919).

of non-news column inches in Shanghai’s most famous newspaper, the Shenbao (申報) were taken up by medical advertisements, and quoted an article published by two Qinghua University professors in 1936 who asserted that there was “No way to determine the boundaries between western and Chinese medicine” when reading drug advertisements. Huang found that there were three main concerns expressed by all drug advertisements, Chinese, western, or indeterminate, and these were: sex, the brain, and the blood.38 Advertisers insisted that ample fresh blood was essential to health; too little would make the body weak and vulnerable to disease. Perhaps the most effectively marketed blood tonic was “Man-Made Blood” (人造自來血), supposed to replenish blood and treat anemia. This product alone was responsible for one-ninth of its manufacturer’s total sales throughout the 1930s. The company, Five Continents Drugstore, was run by a Chinese-

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4.5  Another advertisement for “Chilai blood tonic,” from the November 1939 issue of Liang you pictorial. By this time, purchasers have the choice of a bottle or a packet of phials suggestive of hypodermic syringes.

educated Chinese, Xiong Songmao. He had co-founded the company in 1906 with Huang Chujiu, who had already founded the Great Eastern Dispensary Ltd. Company in 1890 in the French Concession of Shanghai. Huang’s company name in Chinese reads “Sino-French Dispensary” (中法大藥房), and his company had succeeded by inventing new drugs with western-sounding names, such as “Dr. T. C. Yale’s Brain Tonic” (艾羅補腦汁), which was based on a Chinese formula intended to be a sedative. Similarly, the Five Continents Drugstore adopted a consciously modern presentation, with a globe as its trademark, and western-style architecture for its many stores in China and

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throughout South-East Asia.39 The advertisement for “Man-Made Blood” in Figure 4.4 claims that: “The state of the blood has consequences for the strength of the body, so replenishing the blood is the first step in strengthening the body. “Man-Made Blood” contains the raw materials for making new blood.” In Figure 4.5, the appeal to modern values is even more apparent, and the claims made for the product include correcting the most common health concerns of the day in addition to poor blood supply: poor nutrition, early ageing, neurasthenia (“weak nerves”), sexual inadequacy, lack of vitality from previous illness, and “all kinds of weakness.” Blood tonics were not the only commodities available for strengthening the blood: during this same period, the science of blood transfusion and the discovery of blood groups made it possible to sell blood itself. Thus in the famous 1932 story “Young master gets his tonic (“Guanguan de bupin,” “官 官的補品”) by Wu Zuxiang (吴组缃), a sickly young landlord exploits his healthy tenants by first buying the farmer’s blood (on the advice of a foreign doctor) to transfuse for use as a tonic, and then also buying the farmer’s wife’s breast milk to nourish himself, which plays on the idea common to both Galenic and Chinese medicine that milk is transformed blood.40 The story is powerful because it plays on the old metaphor of soldiers giving their blood/life for their country while contrasting how the farmer is forced to sell his blood, humiliate his wife, and deprive his infant of mother’s milk all to ensure the survival of a member of the corrupt and sickly ruling class. In this ghastly commodification, western capitalism is portrayed as exploitative to the point of cannibalism. Discussion Discussion of blood in any culture is bound to be ripe with metaphor. I hope to have shown here that the accelerating emphasis on blood as the site of disorder in Chinese and western bodies contributed to the widespread perception of both individual and collective Chinese weakness. In the decades before the Communist standardization of “traditional Chinese medicine”, doctors concerned with how to treat new epidemics had reconceptualized blood as the deepest and most critical body fluid, so that now men as well as women began to be concerned about the state of their internal blood. The fact that this development occurred mainly in southern China, with its associations of softer and more feminized bodies, may have contributed to the perception of increasing national weakness. In north China, Wang Qingren’s anatomical investigations led him to suppose that internal blood stasis was a widespread but under-recognized problem, and his new blood-enlivening formulae gained wide acceptance and remain highly influential today. Finally, Tang Zonghai merged these trends with new insights from western medicine so that an unprecedentedly large proportion of diseases could now be blamed on disorders of the blood,

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and treated accordingly. Because medicine in the West was also focused so keenly on blood as the key to health and the main site of disease, blood tonics became enormously profitable in China as in the West. In the early twentieth century, no matter if you were a westerner or a Chinese, to feel poorly was to be concerned about your blood. The early twentieth century was also the heyday of eugenic thinking, and concerns with racial hygiene and the relationship of blood groups and blood “agglutination indices” to national strength were commonplace. The metaphorical equivalence between body and nation meant that China’s political weakness in the early twentieth century was easily linked to the high rates of “bad blood” diseases, such as tuberculosis, sexually transmitted diseases (STDs), and schistosomiasis.41 Small wonder that it was precisely these diseases that the new Communist government tackled first in its public health campaigns of the 1950s. This consideration of the perception of blood in modern Chinese history suggests that people did indeed learn to perceive their bodies differently as a result of increasing attention to blood. Chinese medicine provided both rationales and resources for the new blood treatments, while also drawing on both “quack” and orthodox medicine from the West. If there was a determining factor in this change, it was the threat of imperialist aggression, not the “light of science,” that made the blood of the nation the responsibility of every individual Chinese. Notes 1 The scholarly journal Public Understanding of Science (London: Sage, 1992–) is dedicated to exploring this tension between professional knowledge and public perceptions of it. 2 For the textual history of this text, see Paul U. Unschuld, Huang Di Nei Jing Su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text (Berkeley: University of California Press, 2003); and Nathan Sivin, “Huang Ti Nei Ching,” in Early Chinese Texts: A Bibliographical Guide, ed. Michael Loewe (Berkeley: University of California Press, 1993), 196–215. For its cosmological as well as medical relevance, see Nathan Sivin, “State, cosmos and body in the last three centuries BC,” Harvard Journal of Asiatic Studies 55.1 (1995): 5–37. 3 中焦 […] 所受气者, 泌糟粕, 蒸津液, 化其精微, 上注于肺脉, 乃化而为血, 以奉 生身, 莫贵于此, 故独得行于经隧, 命曰营气. My translation. 4 Unschuld, Huang Di Nei Jing Su wen, 147, citing Su wen, 10. 5 Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (New York: Zone Books, 1999), 229, citing Nathan Sivin, Traditional Medicine in Contemporary China (Ann Arbor: Center for Chinese Studies, University of Michigan, 1987), 51–2, 147–64. 6 Shanghan lun, line 144, lesser yang. “妇人中风, 七八日续得寒热, 发作有时, 经 水适断者, 此为热入血室, 其血必结, 故使如疟状, 发作有时, 小柴胡汤主之.” For translation, see Craig Mitchell, Feng Ye, and Nigel Wiseman, trans., Shāng hán

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lùn: On Cold Damage, Translation and Commentaries (Brookline, MA: Paradigm Publications, 1999), pp. 445–6. For a textual history of this work, which exists in editions dating from the Song Dynasty, see Jixing Ma, The Study of Chinese Medical Literature (中醫文獻學) (Shanghai: Shanghai Science and Technology Press, 1990), esp. 125–6. 7 Marta Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China (New York: Routledge, 2011), pp. 91–3. For Wu Youxing’s original text, see Zhejiang Chinese Medical Research Unit, ed., Critical Edition of the “Wenyi lun” (溫疫論評注) (Beijing: People’s Health Press, 1977); Zhia Zhen and Weikang Fu, chief eds., Chinese Medical History (中國醫學史) (Beijing, People’s Health Press, 1991), 308. 8 Carol Benedict, Bubonic Plague in Nineteenth-Century China (Stanford: Stanford University Press, 1996), 115–21; Paul Katz, Demon Hordes and Burning Boats (New York: State University of New York Press, 1995), 62–75. For evidence that these customs were still common in the early twentieth century, see K. C. Wong, “Chinese medical superstitions,” National Medical Journal of China 2.4 (1916): 8–27; Hsiang-ch’un Ch’en, “Examples of charm against epidemics with short explanations,” Folklore Studies (journal of the Museum of Oriental Ethnology, Catholic University of Peking) 1 (1942): 37–54. 9 This book is also referred to by several different, but similar titles. See Li Jingwei et al., eds., Biographical Dictionary of Chinese Medicine (中医人物词典) (Shanghai: Shanghai cishu chubanshe, 1988), 97–8. 10 See Collected Medical Works from Wu: Warm Disease Category (吴中医集: 瘟病 类) (Suzhou: Jiangsu Science and Technology Press, 1989), pp. 154–8: “温热轮” (“Treatise on warmth and heat”). 11 Hanson, Speaking of Epidemics, 112–13. The invention of tongue diagnostics is credited to Dai Tianzhang (戴天章) in his book Treatise on Widespread Epidemics of 1733, and was elaborated by Ye Gui. 12 Wang Qingren (王清任), Yilin gai cuo (醫林改錯), “Preface to the remedies”: “余 不論三焦者, 無其事也.” 13 Quoted by Fan Xingzhun in his Transmission of the Medicine of the Enlightenment from the West (明季西洋傳入之醫學) (n.p., 1943), Vol. 9, 38A. 14 For more on Wang Qingren, see, Kanwen Ma (馬堪溫), “Wang Qingren: Outstanding Qing Dynasty Chinese physician” (“祖國清代傑出的醫學家 王清任”), Collected Papers in the History of Science (科學史集刊) 6 (1995): 66–74; Daw-hwan Wang (王道環), “On the anatomy of Correcting the Errors of Physicians” (“論醫林改錯的解剖學”), New History (新史學) 6.1 (1995): 95–112; Bridie Andrews, “Tailoring tradition: The impact of modern medicine on traditional Chinese medicine, 1887–1937,” in Notions et perceptions du changement en Chine, ed. Viviane Alleton and Alexei Volkov (Paris: Collège de France, Institut des Hautes Études Chinoises, 1994), 149–66. For an analysis of Wang’s main prescriptions, see Tietao Deng(鄧鐵涛), “Wang Qingren of the Qing Dynasty’s contributions to clinical medicine” (“清代王清任在臨床醫學上的貢獻”), Journal of Chinese Medicine (中醫雜誌) (1958): 450–2. 15 For the collaboration between Hobson and his Chinese co-workers, see Ma Kanwen, Gao Xi, and Hong Zhongli, The History of Intercultural Medicine Collaboration

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between China and Foreign Countries (中外醫學文化交流史) (Shanghai: Wenhui Press, 1993), pp. 376–9. 16 For nineteenth-century medicine in Britain, see Carl J. Pfeiffer, The Art and Practice of Western Medicine in the Early Nineteenth Century (Jefferson, NC: McFarland, 1985); M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978). 17 Benjamin Hobson, Quanti xinlun (全體新論) (Guangzhou: Hui ai yi guan, 1851), Vol. 8: “血脈管迴血管論,” 47a–48a, available at National Library of Australia Digital Collections, www.nla.gov.au/apps/cdview/?pi=nla.gen-vn1869894. 18 “人身百體賴血以生生生不已血必有減無增故須飲食以補之食物精液由吸 管遞運至頸入會管與迴血達心右房混然滾和乃由右房過肺化為赤血返心左 房運養身體”; ibid. 19 Peiwen Zhu, Concise Compilation of Chinese and Western Representations of the Inner Organs (華洋臟像約纂) (n.p.: Foshan, 1893); Dingchang Luo, The Essences of Chinese and Western Medicine (中西醫醉) (Shanghai: Qianqing tang shuju, 1921 [preface 1882, first printed 1894]). 20 Tang Zonghai, The Precise Meaning of the Medical Canons [in] the Convergence of Chinese and Western Medicine (中西匯通醫經精義) (Shanghai: Shanghai Zhongguo wenxue shuju, 1937 [1892]), Vol 1, 2. The question of whether western and Chinese bodies were anatomically commensurable was one that occupied both Chinese and western theorists well into the nineteenth century. 21 For Tang on pulses and blood vessels, see, Guoli Pi (皮國立), Medicine to Connect China and the West: Tang Zonghai and the Crisis of Modern Chinese Medicine (醫 通中西: 唐宗海與近代中醫危機) (Taipei: Dongda, 2006), 195–202. 22 Tang, Precise Meaning of the Medical Canons, 下卷, 12. 23 English-language versions of the 10th edn. of 1884 are available at this website (last accessed May 19, 2014): http://books.google.com/books?id=fkkpAAAAYAAJ. 24 ShuGaodi (舒高第) and Zhao Yuanyi (趙元益), trans., Neike lifa (內科理法), translation of Hooper’s Physician’s Vade Mecum: A Manual of the Principles and Practice of Physic; with an Outline of General Pathology, Therapeutics, and Hygiene (Shanghai: Jiangnan Arsenal, [n.d.], c. 1880s), Vol. 1, Chapter 1. 25 Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (Berkeley: University of California Press, 2004), 88–90. 26 Tan Sitong (譚嗣同), “On anatomy” (“論全體學”), in Complete Works of Tan Sitong (譚嗣同全集), ed. Cai Shangsi and Fang Xing (Beijing: Zhonghua shuju, 1980), 403–5. 27 Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000), 34–9. 28 See W. Hamilton Jefferys and James L. Maxwell, The Diseases of China, Including Formosa and Korea (London: John Bale and Danielson, 1911), pp. 268–71; and Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: W. W. Norton, 1997): 442–3. 29 For example: Benjamin I. Schwartz, In Search of Wealth and Power: Yen Fu and the West (Cambridge, MA: Harvard University Press, 1964); James Reeve Pusey, China and Charles Darwin (Cambridge, MA: Harvard University Press, 1983); Frank Dikötter, The Discourse of Race in Modern China (London: Hurst and Co.,

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1992); Andrew Morris, “‘To make the four hundred million move’: The late Qing Dynasty origins of modern Chinese sport and physical culture,” Comparative Studies in Society and History 42.4 (2000): 876–906. 30 Mao Zedong, “A study of physical education,” Xin Qingnian, April 1917. 31 Dikötter, The Discourse of Race, 133–5. 32 From Lu Xun, Brief Outline of Chinese Geology (中國地質略論), cited in Akira Nagazumi, “The diffusion of the idea of social Darwinism in East and Southeast Asia,” Historia scientiarum 24 (1983): 1–18 (9). Further examples of the influence of social Darwinism on the attitudes of the famous reformers Liang Qichao, Kang Youwei, and Tan Sitong toward medicine are given in Ralph C. Croizier, Traditional Medicine in Modern China: Science, Nationalism and the Tensions of Cultural Change (Cambridge, MA: Harvard University Press, 1968), Chapter 3. As noted previously, the idea of degeneration was also current in western society at this time. 33 Vortisch van Vloten, Chinesische Patienten und Ihre Ärzte: Erlebnisse eines deutschen Arztes (Chinese Patients and Their Physicians: Experiences of a German Physician) (Gütersloh: Bertelsmann, 1914), 21. See also William C. Cooper and Nathan Sivin, “Man as a 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 Nathan Sivin (Cambridge, MA: MIT Press, 1973). 34 See the reproduced copy and company history on the Kansas State Historical Society website, www.kshs.org/cool3/pinkpills.htm (last accessed May 19, 2014). 35 “Medical Missionary Conference,” China Medical Journal 21.3 (1907): 151–69. 36 Editorial, China Medical Journal 31.6 (1917): 316–17. 37 Sherman Cochran, Chinese Medicine Men: Consumer Culture in China and SouthEast Asia (Cambridge, MA: Harvard University Press, 2006), 10–15. 38 Huang Kewu (黃克武), “Medical advertisements in the Shenbao as reflections of medicine, culture, and social life in Shanghai, 1912–1926” (“從申報醫藥廣 告看民初上海的醫療文化與社會生活, 1912–1926”), Bulletin of the Institute of Modern History, Academia Sinica (中央研究院近代史研究所集刊) 17.2 (1988): 141–94. 39 Cochran, Chinese Medicine Men, Chapter 2. 40 Hanson, Speaking of Epidemics. 41 For tuberculosis, see Bridie J. Andrews, “Tuberculosis and the assimilation of germ theory in China, 1895–1937,” Journal of the History of Medicine and Allied Sciences 52.1 (1997): 114–57. For STDs, see Christian Henriot, “Public health policy vs. colonial laissez-faire: STDs and prostitution in Republican Shanghai,” in Sexual Cultures in East Asia: The Social Construction of Sexuality and Sexual Risk in a Time of AIDS, ed. Evelyne Micollier (London: RoutledgeCurzon, 2003); for schistosomiasis, see Miriam D. Gross, “Chasing snails in the People’s Republic of China” (Ph.D. dissertation, University of California, San Diego, 2010).

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The only options? “Experience” and “theory” in debates over forensic knowledge and expertise in early twentieth-century China Daniel Asen At a May 1928 meeting of standing councillors of the Beijing Bar Association, one of the issues on the agenda was the forensic examination procedures used in criminal cases.1 Members of the association proposed petitioning judicial authorities to employ those with specialized knowledge as outside experts in legal cases while improving the courts’ existing forensic practices. Within a judicial system that continued to grapple with the legacies of the governing institutions of the Qing, forensics was another area in which Republican law, for various reasons, maintained older practices.2 Judicial functionaries known as forensic inspection clerks (jianyan li, 檢驗吏), a position translated here as “coroner,”3 examined bodies of the living and the dead in accordance with the Records on the Washing Away of Wrongs (Xiyuan lu, 洗冤錄), a text that constituted the official standard of forensic evidence during the Qing.4 In calling for reform of these practices, the Bar Association was promoting an agenda steadily gaining support among Chinese professionals in law, medicine, and, by the late 1920s and early 1930s, legal medicine.5 In late July, the Bar Association sent a letter to officials of the Beiping Local Court criticizing procuratorial officials’ continuing reliance on coroners and the Washing Away of Wrongs, and arguing that the latter lacked scientific knowledge: The Washing Away of Wrongs was completed during the Song [in the thirteenth century] and was passed down without changing through the Yuan, Ming, and Qing Dynasties. It is purely the experience of individuals [geren jingyan, 個 人經驗] and has no scientific knowledge [kexue zhishi, 科學知識]. At a time when science is thriving and human affairs are in flux, anatomy, physiology, legal medicine, and legal chemistry develop every day. Instruments of killing become stranger and stranger while methods of killing change accordingly. Only relying on those old doctrines included in the Washing Away of Wrongs as the grounds for forensic examinations will in many instances be neither fitting nor complete.6

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Whether the knowledge contained in the Washing Away of Wrongs accorded with modern science – implicitly that of the West and Japan – was a crucial question for the Bar Association and other individuals and organizations contemplating the reform of Chinese forensics. The idea that knowledge from academic and scientific disciplines should both guide professionals’ work and serve as an epistemological guarantee of their expertise reflected the institutional and intellectual transformations that had made the academy a crucial locus of professional authority in the modern West, a model of expertise that rapidly gained traction in Republican China.7 Under this new conception of occupational expertise, questions of epistemology  – defined in very specific ways  – became inseparable from assessments of professional authority. By implication, the quality of knowledge contained in the Washing Away of Wrongs became an important consideration in assessments of coroners’ suitability for a legal system now judged by global standards of forensic practice. Similarly entangled questions of professional and epistemological authority informed contemporary discussions of Chinese medicine.8 A senior coroner in Beijing named Yu Yuan (俞源) responded to the Bar Association’s criticisms in a letter that he submitted to procuratorial officials in early August 1928.9 Yu was an older, experienced coroner who trained younger generations of coroners in Beijing and performed all manner of forensic work for city and regional authorities. Acknowledged to be an authority and an expert in forensics, Yu was often tapped for examinations of skeletal remains, an area of forensic practice acknowledged to be particularly difficult. It is clear from this document and from other traces left in the police and judicial archives that Yu was quite literate. For example, it was not uncommon for Beijing judicial authorities to have Yu send written reports or explanations to regional authorities seeking forensic assistance.10 After praising the Bar Association’s good intentions in writing the letter, Yu launched directly into an abstract discussion of epistemology meant to demonstrate its mistaken understanding of the practice of forensic examination. He argued that in forensics, jingyan (經驗, experience) was more essential than xueli (學理), which might be translated as “theory,” the generalized principles and laws developed within scientific disciplines: The Washing Away of Wrongs excels at experience while ignoring theory. Legal medicine excels at theory while ignoring experience. This is because forensic examinations in China attach importance to the discovery of corpses [因中 國檢驗注重屍體發現故也].11 It is no doubt best to make use of theory and experience together. Yet, while one can rely exclusively on experience, one cannot abandon experience and solely rely on theory. Hence a western proverb has said “experience is better than [academic] learning [故西諺有云經驗 長於學問也].”12

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Thus, according to Yu, the Bar Association was wrong in its appraisal of the Washing Away of Wrongs as well as its slighting of the “experience of individuals” in favor of scientific knowledge. In fact, it was experience (jingyan) that was the more essential form of knowledge in forensics, a complex claim that will be the subject of this chapter. In making this argument, Yu Yuan addressed two other assumptions of the Bar Association. First, he argued that the Washing Away of Wrongs was, and long had been, highly effective in practice. That the knowledge in the text worked was demonstrated by the fact that the physical signs which Yu and other coroners observed on corpses exactly matched those which were described in the text.13 Second, Yu argued that the Washing Away of Wrongs could in fact be used to investigate deaths involving new methods of killing that had arisen under modernity, thus refuting the Bar Association’s assumption that scientific knowledge was necessary for Chinese forensics to respond to the pace of modern change: The Washing Away of Wrongs undoubtedly lacks those newly invented deaths that have appeared in recent years [至近年新發明各種變死, 洗冤錄固尚闕如]. But those deaths not included in its pages are not only those of recent times. Let us ask, how did one handle those deaths not included in the Washing Away of Wrongs before the Bar Association made its recommendations? This is the greatest misunderstanding of the Association and is tantamount to the error of only relying on theory while completely disregarding [the importance of] experience.

It is important to acknowledge from the outset that Yu’s defense of the Washing Away of Wrongs could only have been articulated under modernity. The pairing of jingyan and xueli had not been part of the discourse of forensic knowledge prior to the first decade of the twentieth century. The word jingyan had appeared in earlier forensic discourse, as it had in other areas of classical and vernacular writing, but this was a different “conceptual space”14 from the modern, globally oriented discourse of empiricism and science that invested jingyan with the complex meanings of “experience.”15 In this sense, this exchange parallels the history of jingyan in modern polemics surrounding Chinese medicine. As Sean Lei has argued, the idea that Chinese medicine was based on centuries of accumulated “experience” was a complex and politically charged claim, one that reinforced the notion that practitioners of Chinese medicine did not possess the most authoritative forms of scientific knowledge.16 The Bar Association’s claim that the Washing Away of Wrongs embodied the “experience of individuals” and not “scientific knowledge” was a similar kind of argument. Likewise, Yu’s adoption of these categories signaled his participation in a discourse that often reinforced the intellectual authority of professionalized (western and Japanese) sciences vis-à-vis other forms of knowledge. At the same time, it would be a mistake to interpret Yu’s response to the Bar Association as simply part of the story of the rising hegemony of new discourses of science and expertise. Behind concepts like jingyan and, we will

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see, shiyan (實驗) were notions of knowledge and authority that exceeded the usual modern meanings of these words as “experience” and “experiment.”17 By the first decade of the twentieth century, an interest in the practical verification of text-based forensic knowledge had become a concern shared by many who were interested in the Washing Away of Wrongs, including coroners and legal officials. In complex ways, concepts like jingyan could reference these alternative notions of empirical knowledge and verification that had developed within the specific context of late imperial forensics. Thus, untangling the meanings and implications of jingyan reveals not only the significant post-imperial “afterlife” of this rich field of technical knowledge, but also the possibilities that still existed for reimagining it under the new intellectual conditions of modernity. A new discourse of forensic knowledge The modern concepts xueli and jingyan entered the lexicon of Chinese forensics during the decade that preceded the collapse of the Qing. During the latter part of the New Policies reforms (1901–11), a decade of state-building that established the foundations for modern state institutions, Qing officials and some of those who studied in Japan developed an interest in the forensic practices that supported the legal system of Meiji Japan. The focus of their interest was legal medicine (hōigaku/fayixue, 法醫學), a branch of scientific medicine that used medical knowledge to address problems encountered in the law, including the forensic examination of dead and living bodies.18 Legal medicine was practiced in Japanese and continental European academic institutes equipped with facilities for the forms of laboratory investigation that had become a crucial epistemological foundation of scientific medicine by the start of the twentieth century.19 It was in these facilities that a range of activities were carried out: certification and training of examiners, medical students, and judicial officials; forensic investigation services for local and regional authorities; and research on a range of medico-legal problems.20 Several Chinese-language works on legal medicine were produced during this period on the basis of translations from Japanese textbooks as well as instruction by personnel of the Tokyo Metropolitan Police.21 These works introduced readers to new understandings of the body, new conceptions of pathology and cause of death, and new bodies of psychological and sexological knowledge. While there had been persistent fields of interaction between medical knowledge and forensics in late imperial China prior to the appearance of legal medicine, the vision of forensic expertise in these works involved a completely new relationship between medical authority and forensic expertise.22 Legal medicine was understood to be one specialized subdiscipline of scientific medicine among numerous others, a reflection of the disciplinary

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structure of professional science as it had developed in the West and Japan. As articulated by the eminent medico-legal institution builder Lin Ji (林幾, 1897–1951) almost two decades later, legal medicine took as its “foundation” (jichu, 基礎) the natural sciences and medicine.23 Thus, it was claimed, the authority underlying medico-legal expertise derived from the analytical concepts and techniques of scientific medicine, a field of professional knowledge that was institutionally separate from the law. Wang Dingguo and Li Jinyuan described the epistemological status of legal medicine on the first page of their introductory remarks in Legal Medicine (1907), one of the early translations produced during this period: In Japan the subject of legal medicine is included in the medical university. The matter is regarded as weighty and its research is likewise extremely fine. None of its examination methods are not based on theory (xueli, 學理) and obtained from experience (jingyan, 經驗) while also referencing all kinds of medicolegal books. This is certainly different from books like China’s Washing Away of Wrongs.24

In this text and others, the concepts xueli and jingyan described distinct but related forms of knowledge. In abstract discussions of epistemology that appeared in intellectual publications in China during this period, the word xueli was explained as the kinds of explanatory and predictive principles derived from systematic observation of facts, analysis of their regularities, and testing of hypotheses.25 Xueli is conventionally translated as “theory,” even though it literally means “principles of xue [學],” fields of academic learning, or sciences.26 For example, xueli such as Boyle’s Law  – the inverse relation between the pressure exerted upon a gas and its volume at constant temperature  – were developed through repeated and informed observation and testing.27 These solid epistemological foundations guaranteed that, ideally, “theories” conformed to the “facts” (shishi, 事實) from which they had been generalized. In this same conceptual space, the word xueli was often related to jingyan, a word with a range of meanings. As a neologism, the word could be used to reference knowledge gained through observation (“experience”), a crucial empirical foundation on which “theories” were established. The concept had several other meanings, however, reflecting the complex meanings of “experience” within western intellectual traditions.28 These categories were ubiquitous in the early twentieth-century discourse on forensics. An early assessment of the Washing Away of Wrongs that made use of them can be found in a 1909 preface written by the eminent legal scholar and reformer Shen Jiaben (沈家本, 1840–1913) for a new edition of the Yuan Dynasty forensic treatise Avoidance of Wrongs (Wuyuan lu, 無冤錄).29 This modern edition of the Avoidance of Wrongs had been edited and annotated by Wang You (王佑), one of the early translators of Japanese legal medicine in China. Wang had encountered the original text, which had been copied from

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a Korean edition, during his study of the subject in Japan. He subsequently annotated this unusual edition with discussions of the medico-legal knowledge and practices of “each country” (geguo, 各國) while relating knowledge contained within to “the principles of the sciences of recent times” (近時科學 所言之理) and modern disciplines such as physiology and obstetrics. While Shen Jiaben acknowledged that these new bodies of knowledge had much to contribute to Chinese forensics, he also argued that modern (western) science had no monopoly on epistemological authority: Generally speaking Chinese doctrines largely stem from experience [jingyan, 經驗], while western learning is largely based on theory [xueli, 學理]. If theory is not understood, then even with experience one cannot gain complete mastery. If one does not gain experience, then even with theory one has no way to verify the truth. Experience and theory are mutually interdependent.30

Shen thus established a favorable comparison between the new forensic knowledge that Wang had studied in Japan and that contained in existing forensic texts. By claiming that “experience” was just as important as “theory,” Shen posited that both Chinese knowledge and “western learning” had valuable epistemological approaches. In one sense, Shen’s association of Chinese forensic texts, including the Washing Away of Wrongs, with “experience” was a conventional, or generic, move intrinsic to the new discourse of science-based expertise. That is, “experience” and “theory” were relational terms within this new discourse, a point that is clear given their frequent pairing in later texts. Yet Shen also had specific, and good, reasons to associate imperial forensic texts with this new category – for example, when he claimed that the Washing Away of Wrongs had been completed on the basis of “several hundreds of years of experience” (由 數百年經驗而成). Later on we will explore reasons why those who were most invested in the Washing Away of Wrongs found the concept jingyan to be particularly appropriate for the kind of knowledge contained in its pages. Detractors of the Washing Away of Wrongs mobilized these concepts in a different way, usually arguing that the scientific “theories” that informed legal medicine were a more authoritative form of knowledge than the “experience” underlying the Washing Away of Wrongs. For example, in a serial installment that appeared in Republican Journal of Medicine under the title “The past, present and future of medicine in China,” the author Liu Tiecheng criticized at length legal officials’ continuing use of the Washing Away of Wrongs.31 Liu argued that the text was not completely wrong and actually had some “reasonable” (heli, 合 理) points, but that they did not necessarily accord with modern science: But those things that might be said to be reasonable do no more than accord with the axioms of human sentiment, and whether they can be said to accord with the truths of physics, chemistry, and science is hardly certain. The axioms of human sentiment are [based on] the principles of experience and imagination. The truths of science are [based on] those of experiment and proof [人情

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之至理為經驗想像之理。 科學之真理為實驗證明之理]. Thus those things that do not accord with scientific truth are not reasonable. Thinking that their judgements were reasonable [officials in late imperial times] recorded them in the Washing Away of Wrongs. Given that it was a time when science was not understood, their misjudgements should not be surprising. It is acceptable for a book completed during a time when science was unknown to be used in such a period. Yet is it not strange to use it, let alone establish it as a legal standard, during a period in which science is flourishing?32

Liu’s underlying assumption was that medico-legal science – which, Liu also noted, had developed in accordance with scientific “theory”33 – was a more certain form of knowledge than that contained in the Washing Away of Wrongs because it depended on “experiment and proof,” not “experience and imagination.” In this piece, as in others, the Washing Away of Wrongs was associated with the less authoritative form of knowledge while legal medicine was, categorically, associated with the more authoritative one. In the process of making such distinctions, however, the category jingyan underwent a subtle semantic shift. Much as Sean Lei has shown in discourse on Chinese medical knowledge, the concept came to reference less certain forms of knowledge that had more in common with “imagination” than with “experiment and proof.”34 “Experience” was no longer the foundation of generalized scientific principles; it was now a less desirable alternative. Reading Yu Yuan’s argument within the context of this discourse underscores both the generic nature of his claims and the distinctiveness of his conclusions. Yu’s discussion was generic in the sense that commenting on the jingyan of the Washing Away of Wrongs and the xueli of legal medicine had clearly become a commonplace way of comparing these competing forms of knowledge. Yet, Yu Yuan was also drawing on these categories to launch a counter-discourse against the usual valorization of xueli over jingyan. In Yu’s defense of the Washing Away of Wrongs, the latter did not signify the kinds of empirical knowledge possessed by non-specialists who had not theorized cause-and-effect relations – the very meaning that jingyan often took on as the less desirable alternative to xueli. Yu claimed rather that jingyan itself was the more essential form of knowledge. While he justified this appraisal on the basis of a “western proverb,” his understanding of the concept had other dimensions that, we will see, must be sought in developments that had been transforming the conception and practice of forensic knowledge in China long before the newfound interest in legal medicine. Empirical knowledge and the Washing Away of Wrongs By the beginning of the twentieth century, the body of forensic knowledge on which officials and coroners relied had gone through a number of consequential

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developments. One of the most important had occurred early in the reign of the Qianlong Emperor (r. 1736–95), when Qing officials completed a new, official edition of the Washing Away of Wrongs, drastically different in form and content from Song Ci’s (1186–1249) Collected Records on the Washing Away of Wrongs (Xiyuan jilu, 洗冤集錄).35 A number of officials and legal specialists soon authored critical commentaries, case collections, and other treatises in order to expand and improve the official text.36 While these critical works existed in uneasy tension with the official body of knowledge that officials were expected to rely upon in forensic cases, they had a significant impact on the development of forensic knowledge in the decades preceding the fall of the Qing. They also shaped the body of knowledge that Republican officials and coroners utilized in a judiciary that largely followed the Qing state’s forensic practices. The most consequential of these works for the development of forensic knowledge after the Qing was the Detailed Explanations of the Meaning of the Washing Away of Wrongs (Xiyuan lu xiangyi, 洗冤錄詳義, preface 1854), a work authored by Xu Lian (許槤), an experienced official and jinshi who authored a number of works on philology and medicine.37 Xu’s years of experience in handling legal cases as well as his skills in philological research informed his critical engagement with the Washing Away of Wrongs. Both laid the foundations for Xu’s reassessment of the official knowledge of the skeleton, one of the major contributions of the Detailed Explanations. In a substantial section of the work, Xu critically assessed the existing skeletal knowledge of the Washing Away of Wrongs and added new observations obtained from his own considerable experience in personally examining bodies. These discussions were accompanied by careful, new images of individual bones that present a sharp contrast to the official forensic images of the skeleton. In these ways, Xu’s Detailed Explanations fits into a broader story of nineteenth-century literati interest in investigating the anatomical structure of the body by testing doctrinal claims in medicine and forensics against observation and critically engaging western anatomical knowledge.38 Xu Lian’s discussions of the skeleton as well as his emphasis on the observation of actual bodies deeply informed the development of forensic knowledge through the rest of the Qing and even after its collapse. The latest critical treatments of the Washing Away of Wrongs, including Evidence on the Meaning of the Washing Away of Wrongs (Xiyuan lu yizheng, 洗冤錄義證, 1891)  by Gangyi (剛毅), and References for the Washing Away of Wrongs (Xiyuan lu cankao, 洗冤錄參考, 1918) by Wang Chichang (王熾昌), discussed below, took Xu’s work as an essential point of reference. Knowledge of the body contained in Xu’s Detailed Explanations also informed the Board of Justice’s 1918 revision of the official forms used to record forensic examination findings, one of the most important post-Qing forensic developments.39 The new forms, which replaced the ones that had been in use under the Qing, soon became a standard

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for forensic examinations that was followed in practice in many localities and throughout the Republican period. The new forms incorporated Xu Lian’s corrections of the old forms’ terminology and underlying understanding of the body, in the process valorizing the kinds of empirical observation of bodies that had formed a crucial element of Xu’s approach. For example, the Board included a passage almost verbatim from the Detailed Explanations when explaining its corrections to the erroneous claims that had been made in the official Washing Away of Wrongs that males have twelve ribs on each side and females fourteen: This maintains the errors contained in the “dimensions of the bones” [gudu, 骨 度] chapter of the Inner Canon [of the Yellow Emperor]. From all previous examinations in the past as well as from having checked leading cases [cheng’an, 成案], in nine out of ten cases both men and women have eleven ribs on each side. Not more than one or two out of ten have ten, eleven, twelve, thirteen, fourteen, or fifteen.40

This passage described the kinds of bodily inquiry that one finds more generally in Detailed Explanations, including Xu’s own observation of bodies and his collection of the insights of other officials and coroners. Xu Lian also used the incidental descriptions of dead bodies recorded in legal cases as a “database” of anatomical information that could be used to construct general claims about the structure of the body. It was in part on this basis that Xu was able to quantify the small likelihood that a body would have more than eleven ribs on each side. During a period in which the description and representation of western anatomical knowledge constituted a strong claim to the real, not to mention a crucial source of the professional authority of western-trained physicians, it is striking that coroners and judicial officials routinely utilized an alternative tradition of corporeal inquiry just as rooted in concerns about the epistemological foundations of knowledge about the body.41 These approaches also informed the training of coroners in Republican Beijing, an activity with which we know that Yu Yuan was involved. Trainees’ testing papers indicate that Yu and the other instructors, all of whom were senior coroners, had accepted the imperatives of grounding forensic knowledge in the observation of actual bodies even when this involved challenging claims made in the Washing Away of Wrongs. For example, in his written response to a test question about the differences between male and female skeletons, a coroner named Fu Changling, who received training in Beijing during this period, began by enumerating the differences as stated in the official text: According to the Washing Away of Wrongs, the skeletons of men and women have four differences. The skulls of men are made up of eight pieces and those of women six. The backs of men’s skulls have a vertical suture whereas those of women do not. Thus it is also said that the occipital bone of women does not have left and right sides. Men also have the ulna, the bone next to the radius, and

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the fibula, the bone next to the tibia, while women do not. Men have twelve ribs on each side, while women have fourteen on each side.42

As Catherine Despeux has shown, the differences between male and female skeletons constituted a central question in the scholarly literature on forensics in late imperial China.43 Authors like Xu Lian had refuted, if not qualified, many of the claimed differences that had appeared in the official Washing Away of Wrongs. In Republican Beijing, coroner trainees were expected not only to be able to recite these differences on their testing papers, but to indicate the points that had been critically challenged. Thus, Fu continued: However, it has been verified in practice44 that [bones of] men and women do not have great differences. If one calculates the measurements of the bones, those of women are generally shorter and more delicate. As for that which can be used to distinguish them, the abutted place in between the pubic bones of the pelvis [seemingly, the pubic symphysis] is long and narrow in men but wide and short in women. In women, this place is usually closed but opens during childbirth. As such, it is vital for parturition.45

While Fu did not mention the sources on which he based his claims about the differences between male and female pubic bones, there is some evidence that he consulted either Xu Lian’s Detailed Explanations or a later work that incorporated Xu’s corrections to the official Washing Away of Wrongs, such as that of Gangyi, a Manchu bannerman experienced in provincial administration who participated in the turbulent high politics of the late Qing.46 Xu himself had described the “abutted place” (xianglong chu, 鑲攏處) between the pubic bones, mentioned by Fu, and its role in childbirth. Xu’s claim that this part of the pelvis “opens during birth while remaining closed ordinarily” appeared almost verbatim in Fu’s response.47 Yet, Fu’s claim that the space was “long and narrow in men but wide and short in women” did not appear in Xu Lian’s text. This notion of sex difference resonates with the claim made by Gangyi that male and female pelvic bones differed both in size and in the width of the pelvic cavity,48 even though Gangyi did not claim (as did Fu) that it was the length and width of this space in particular that reflected this difference. In the last portion of his answer, Fu was even clearer about his use of critical editions of the Washing Away of Wrongs: As for the idea that the “secret modesty bone”49 and the [number of] apertures in the coccyx also distinguish men and women, if one consults the various editions of the Washing Away of Wrongs, one will see that it is untrue. This is shown by practical verification as well [shiyan yi ran ye, 實驗亦然也].50

While Fu did not specify the editions of the Washing Away of Wrongs that he consulted, his answer indicates engagement with the late imperial scholarly forensic project. The notion that there was a secret modesty bone, which the official Washing Away of Wrongs claimed existed in female skeletons, had long been

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refuted by Xu Lian and others. And these refutations were made on the basis of the authors’ observations of remains during the investigation of actual cases. One of Fu’s classmates indicated the crucial status of practical verification in his own answer to the same question on the test, noting that “each of our instructors [ostensibly including Yu Yuan, who directed the training] has repeatedly examined bones, and there has never been a secret modesty bone.”51 If “experience” means, among other things, knowledge gained from observation, there is no question that this general epistemological approach informed the development of forensic knowledge in China prior to the appearance of modern legal medicine.52 Yet it is another question entirely whether the approaches to knowledge that appeared in the works of Xu Lian and others could be reconceptualized, approvingly, as jingyan  – a concept so deeply implicated in the “political epistemology,” in Lei’s words, informing the new discourse of scientific knowledge and professional expertise.53 Could jingyan actually form the basis for a competing claim of authority for coroners and the Washing Away of Wrongs? This was one of the larger issues at stake in Yu’s response to the Bar Association. Jingyan and modernity: Wang Chichang’s References for the Washing Away of Wrongs A linkage between these older approaches to forensic knowledge, the concept jingyan, and the modern adaptability of the Washing Away of Wrongs – a central issue for Yu Yuan – appears in another text, one connected to both the late imperial project of scholarly forensic knowledge and the legal institutions of early twentieth-century Beijing. This is the References for the Washing Away of Wrongs (Xiyuan lu cankao), an early Republican commentary and expansion on the Washing Away of Wrongs authored by Wang Chichang (courtesy name Yuxun, 豫恂).54 A former juren who held a series of high judicial posts after the fall of the Qing, Wang served in both the high and local procuracies in Beijing as well as procuratorial organs in Zhejiang. It was there that Wang made the professional acquaintance of the circuit administrator Huang Qinglan (黃慶 瀾), who encouraged Wang to publish his manuscript, given that it could assist legal officials who still had to rely on the Washing Away of Wrongs in forensic examinations. Huang’s preface suggests that it had become increasingly difficult to find forensic personnel with suitable experience or knowledge of forensic examination techniques. While Wang’s References was printed, and at least two copies are preserved, it is unclear how widely this intriguing modern work on the Washing Away of Wrongs was actually disseminated.55 Wang’s References was a product of the late imperial textual tradition of scholarly forensic knowledge. The work was informed by many of the same questions that had occupied the late imperial officials and legal specialists who

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authored forensic commentaries and case collections. These included the challenges of working with a body of official knowledge understood to be inconsistent, an interest in expanding available forensic knowledge through textual research and personal experience, a willingness to incorporate the insights of experienced coroners, and an interest in testing the Washing Away of Wrongs against actual cases. The work also used knowledge drawn from western medico-legal science and anatomy to critique and supplement the claims made in the Washing Away of Wrongs. In this sense, Wang’s References demonstrates a kind of forensic syncretism that appeared in other contemporary attempts to reconcile legal medicine and the Washing Away of Wrongs without completely abandoning the latter.56 As in Yu Yuan’s response to the Bar Association, Wang framed the authority of the Washing Away of Wrongs in terms of its practical efficacy, demonstrated in the match between actual situations encountered in practice and the passages and explanations in the text. For example, in describing a case involving the skeletal examination of a victim of strangulation, Wang noted that the signs observed on the body – including the predicted eruption of a slight protrusion at the frontal area of the top of the skull57 – exactly matched those that the Washing Away of Wrongs indicated would be there in this kind of case: “The coroner filled in [the observed signs] one by one in a clear manner, identifying each wound according to the Washing Away of Wrongs. Thus it is evident that the Washing Away of Wrongs is a book [completed on the basis] of experience and is dependable and proven” (檢驗吏一一填註明晰 皆據錄文而定為何傷。可見宋錄係經驗之書, 信而有徵).58 Elsewhere in the text, Wang cited several cases he had personally handled in Beijing that illustrated the point made in the Washing Away of Wrongs that severe wounds on non-vital spots could kill while light wounds on vital spots might not lead to death. These cases served as concrete “proof ” (zheng, 證) of claims made in the text.59 The word jingyan appears in the References in the sense of “experience,” even though Wang’s usage of the term also often implies the verification of knowledge-claims. For example, in discussing Xu Lian’s claims regarding the lack of substantial differences between male and female skeletons, Wang noted that “while there was experience [of it], this did not come from research” (雖有 經驗尚非從研究得來), after which he presented skeletal dimensions drawn from western and Japanese anatomical studies to demonstrate the contributions that such knowledge could make to the identification of the sex and age of skeletal remains.60 Or, in describing Xu’s claim that most male and female skulls he had examined had a vertical suture – a refutation of the claim made in the Washing Away of Wrongs that female skulls lacked this feature – Wang noted that “this explanation comes from experience” (其說由經驗得來).61 As a final example, in summarizing a number of Xu’s other claims about the

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skeleton, Wang noted that “while Xu’s Detailed Explanations does not agree with what the Washing Away of Wrongs said [on these points], there is truly experience underlying it” (許氏詳義雖與錄文不符,實有經驗可為依據).62 In describing Wang’s contribution to the forensic literature, Huang Qinglan noted that Wang had “addressed all that was not complete in the Washing Away of Wrongs thoroughly using that which has been obtained from experience” (凡洗冤錄所未備者, 每以經驗所得詳細說明).63 In the text itself, this “experience” often took the form of appended cases. For example, in a section that discussed the forensic signs and examination techniques for each part of the body listed on the official examination forms, Wang appended the following case: In April 1910 I took part in the examination of Zhang Renju, who had been poisoned with red arsenic. The body had been buried for a month. The pads of the fingers [zhidu, 指肚] appeared scorched and withered. According to the coroner, Song Yuanhe, this could only be a sign of arsenic poisoning. Checking the chapter on the various poisons in the Washing Away of Wrongs, it was only said of white arsenic that the ten fingernails would be livid. There was no explanation regarding the ten finger pads being withered. Now that this has been verified, it can supplement that which is incomplete in the text [事已經驗, 可補錄文所未備].64

In this case, the coroner Song knew of an alternative set of signs that could be used to detect arsenic poisoning. While Wang noted that they did not include this explanation in the official documentation because it was not mentioned in official doctrine, this did not mean that such a method should not inform subsequent forensic practice. Thus, Wang noted, “in my humble opinion, when there are leading cases [pertaining to a forensic technique] and it has been found to be correct time and again, even if the Washing Away of Wrongs does not contain a passage on it, it should be added and cases should be appended for reference.”65 The concept of the “leading case” (cheng’an, 成案) was an important one in late imperial law and forensics.66 Leading cases provided precedents that officials could use when handling situations that did not match those described in the legal code or, in forensics, the official Washing Away of Wrongs. It was through the accumulation of cases that new insights and observations could be incorporated into the collective record, providing acceptable ways of handling analogous situations in the future.67 Coroner trainees’ study of such cases was part of the 1919 training curriculum devised by Yu Yuan and the other senior coroners in Beijing.68 In fact, this is the context in which we should understand Yu Yuan’s argument for the modern applicability of the Washing Away of Wrongs on the basis of its connection with jingyan. It was precisely through addition of cases and observations that the text could be made to address forensic situations that were not originally included in its pages. Wang inserted another case that

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demonstrated exactly how those deaths not included in the original Washing Away of Wrongs could be integrated into the text: In the summer of 1909 when serving at the High Procuracy I examined the body of Mrs. Xu née Ren, who was poisoned by consuming matches. The ten fingernails were a purplish-livid color. The coroner, in accordance with the chapter on taking poison in the Washing Away of Wrongs, stated that the fingernails were livid. Because the Washing Away of Wrongs does not contain leading cases on match poisoning, we feared incurring higher authorities’ refutation and scrutiny.69

In this instance, there were no leading cases that could be used as precedents. Because of the ever-present concern that higher authorities would refute the case, Wang and the coroner submitted documentation that matched the expectations of reviewing authorities that fingernails would be livid in poisoning cases, a claim made in the Washing Away of Wrongs. Yet it was precisely through the addition of this case in his References that Wang could expand the body of usable forensic knowledge, a point that he discussed in greater detail later on: For all that the Washing Away of Wrongs and old cases do not have, I have supplemented on the basis of the Golden Mirror of Medical Orthodoxy. For the cases involving ingesting acid, match poisoning, and touching electrical wires, which are neither included in the Washing Away of Wrongs nor in the Golden Mirror and old cases, the relevant markings and colors [i.e. that need to be examined] as found in new cases from recent times can be appended as supplements.70

This use of cases was not unique to Wang Chichang’s References. In his own presentation of cases to supplement the Washing Away of Wrongs, Shen Jiaben too had included a case involving fatal poisoning from matches, an invention of the West that, Shen noted, “did not exist in China in former times.”71 As such, because “there were no leading cases that could be checked,” Shen added his own. In these ways, the Washing Away of Wrongs could provide a structure through which previously unrecorded situations and methods of killing, including those that arose under the new conditions of modernity, could be incorporated into the collective body of forensic knowledge as cases. This is the context in which we should understand Yu Yuan’s claim that the Washing Away of Wrongs was a suitable guide for forensic practice in the modern moment of the late 1920s. The Bar Association did not understand that those who used the text had long had to grapple with new forensic situations and that the text itself was adaptable through the addition of new cases and observations. Thus, they had gravely underestimated the value of jingyan. Conclusion The history of empirical observation and experience in modern China is rendered exceedingly complex by the multiplicity of approaches to empirical

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knowledge that existed during the late imperial period. Forensics was one field among many in which practical verification was an important route to knowledge. Other technical fields also valorized empirical knowledge, even though it is important to remember that in each the meanings and practices of “observation” were specific to particular texts, individuals, and intellectual concerns.72 If the new comparisons of “experience” (jingyan) and “theory” (xueli) tended to assume the coherence of experiential knowledge as a stable epistemological category, it is important to remember that this coherence was a construction. Associating the Washing Away of Wrongs with “experience” made the knowledge contained within commensurable to Japanese and continental European legal medicine, thereby establishing grounds for locating it within a new global order and its associated notions of scientific and technological progress.73 The spread of the new discourse of jingyan into the field of forensics also signaled the new accessibility of coroners’ knowledge to standardizing impulses at the convergence of new conceptions of modern statecraft, new formations of disciplinary knowledge, and the widespread dissemination of concepts like jingyan via China’s modern publishing industry.74 It is important to emphasize that concepts of knowledge like jingyan (經驗, experience), shiyan (實驗, experiment), and shishi (事實, fact) gained their overwhelming authority under the new conditions of modernity.75 At the same time, the modern history of such concepts must take into account the older linguistic resonances that modern intellectual concepts often had during this period.76 Concepts that were fundamental to new notions of (western) scientific knowledge such as jingyan and shiyan could contain within them dimensions of meaning inflected by “alternative” forms of knowledge. Likewise, such concepts could be mobilized in support of cultural or professional interests that diverged from the most conventional forms of modern western and Japanese disciplinary knowledge.77 In this sense, Yu Yuan was a participant in a wide-ranging dialogue on science that was shaped not only by the more familiar concerns of kexue (科學) but also by alternative, and equally pressing, questions of knowledge and authority. Notes 1 Beijing Municipal Archives (BMA) J174-2-152, 1928, 1–14. 2 E.g., Jennifer M. Neighbors, “The long arm of Qing law? Qing Dynasty homicide rulings in Republican courts,” Modern China 35.1 (2009): 3–37. 3 This position was created during the New Policies reform period as a way of improving the status of the Qing empire’s existing forensic examiners, called wuzuo (仵 作). With the change in nomenclature came the unprecedented possibility for coroners to attain official rank, a significant change from their previously low social status. The term wuzuo has been translated as “coroner” or “ostensor” in the scholarly literature. For the latter, see “Forensic medicine,” in Science and Civilisation in China, Vol. 6, ed. Nathan Sivin (Cambridge: Cambridge University Press, 2000), 191.

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I use the more common “coroner” while acknowledging fully the significant differences that existed in conception and practice between wuzuo in late imperial China and coroners in England and the United States. 4 For more on the origins of the official Washing Away of Wrongs and an important reassessment of its date of completion, see Chen Chong-Fang (陳重方), “Qing ‘Lüliguan jiaozheng xiyuan lu’ xiangguan wenti kaozheng” (“清 ‘律例館校正洗冤 錄’ 相關問題考證,” “A textual study of questions pertaining to the Qing Records on the Washing Away of Wrongs, Edited by the Codification Office”), Youfeng chuming niankan 6 (2010): 441–55. 5 For more on legal medicine and its interactions with coroners and the Washing Away of Wrongs during this period, see Daniel Asen, “Dead bodies and forensic science: Cultures of expertise in China, 1800–1949” (Ph.D. dissertation, Columbia University, 2012). 6 BMA J174-2-152, 78–89. 7 For discussion of this aspect of modern professionalization, see Thomas Broman, “Rethinking professionalization: Theory, practice, and professional ideology in eighteenth-century German medicine,” Journal of Modern History 67.4 (1995): 835–72. For the significant role that academic institutions play in legitimating modern professions, see Eliot Freidson, Professional Powers: A Study of the Institutionalization of Formal Knowledge (Chicago: University of Chicago Press, 1986). 8 See Sean Hsiang-Lin Lei, “How did Chinese medicine become experiential? The political epistemology of jingyan,” positions: east asia cultures critique 10.2 (2002): 333–64. Also see David Luesink’s chapter in this volume (160–187). 9 BMA J174-2-152, 102–8. 10 For example, see BMA J174-1-184, 1923, 71–4. 11 The word faxian (發現) was used in newspapers and official documents to describe the discovery of a corpse. It was also used to describe the discovery of forensically significant signs on the body. This sense of faxian appears in the testing papers of one of the coroners that Yu Yuan instructed in Beijing in response to the question “When examining a corpse, why does one first examine the facial complexion?” The trainee wrote: “Because findings made on the facial complexion can assist with finding cause of death. For example, if the complexion is pallid and withered and the limbs are emaciated, it must have been death after prolonged illness” (因 面色之發現足以協辨其死因也. 例如面色萎黃四肢乾枯必為久病而死者是 也). BMA J174-2-52, 1942–3, 130. 12 The proverb to which Yu was referring might have been “Personal experience is better than book learning.” See Robert Christy, Proverbs, Maxims and Phrases of All Ages (New York : G. P. Putnam’s Sons, 1887), 318. 13 If the Washing Away of Wrongs did not in fact embody lasting authority and efficacy, Yu asked, “how could it [continue to] match exactly each discovery of corpses [不然, 與屍體發現何能一一吻合]?” 14 For more on this concept, see Arnold I. Davidson, The Emergence of Sexuality: Historical Epistemology and the Formation of Concepts (Cambridge, MA: Harvard University Press, 2001), especially p. 141.

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15 For example, Wang Mingde (王明德) used the word in Washing Away of Wrongs with Supplements (Xiyuan lu bu, 洗冤錄補, 1674), to explain that he had personally verified the healing techniques that he was now suggesting to readers (noting, for example, that he recorded a technique after having “undergone it myself ” (此 係身所經驗, 故特詳而筆之). Wang Mingde, A Bodkin for Untangling Difficulties when Reading the Code (Dulü peixi, 讀律佩觿) (Beijing: Falü chubanshe, 2001), 332. Also see 326 and 342. 16 Lei, “How did Chinese medicine become experiential?” 17 Thus, locating such concepts within specific historical contexts is crucial. For the epistemological and cosmological dimensions of jingyan in contemporary Traditional Chinese Medicine, see Judith Farquhar, Knowing Practice: The Clinical Encounter of Chinese Medicine (Boulder: Westview Press, 1994). Also see Eugenia Lean’s discussion of the role that shiyan (實驗) played in the articulation of new notions of authenticity and practical knowledge in the industrialist Chen Diexian’s technical manuals. Eugenia Lean, “Proofreading science: Editing and experimentation in manuals by a 1930s industrialist,” in Science and Technology in Modern China, 1880s–1940s, ed. Jing Tsu and Benjamin A. Elman (Leiden: Brill, 2014). 18 For an overview of legal medicine in Japan during this period, see Jia Jingtao (贾 静涛), Shijie fayixue yu fakexue shi (世界法医学与法科学史, The World History of Forensic Medicine and Sciences) (Beijing: Kexue chubanshe, 2000), 296–303. 19 For an account of this transformation in mid nineteenth-century German academic medicine, see Arleen Tuchman, Science, Medicine, and the State in Germany: The Case of Baden, 1815–1871 (New York: Oxford University Press, 1993). 20 For an overview of various countries’ medico-legal institutions and plans for such institutions at the end of the 1920s, see The Rockefeller Foundation, Division of Medical Education, Methods and Problems of Medical Education, 9th series: Institutes of Legal Medicine (New York: The Rockefeller Foundation, 1928). 21 See, for example, Li Jinyuan (李錦沅) and Wang Dingguo(王定國), Fayixue (法 醫學, Legal Medicine) (Tokyo: Namiki kappanjo, 1907). Li and Wang drew on the instruction of personnel of the Tokyo Metropolitan Police, supplemented with Ishikawa Kiyotada (石川清忠), Practical Legal Medicine (Jitsuyō hōigaku, 實用法 醫學) as well as other Japanese books on forensic medicine and chemistry. For a translation of Ishikawa’s Practical Legal Medicine, see Wang You (王佑) and Yang Hongtong (楊鴻通), Great Compendium of Practical Legal Medicine (實用法醫 學大全) (Tokyo: Kanda insatsujo, 1909 [1908]). Also see Ding Fubao (丁福保) and Xu Yunxuan (徐蘊宣), Modern Legal Medicine (近世法醫學) (Shanghai: Wenming shuju, 1911). This work was a translation of the medico-legal work Kinsei hōigaku (近世法醫學) of Tanaka Yūkichi (田中祐吉), a prolific author on pathology, hygiene, and sexology. 22 For example, see Catherine Despeux’s discussion of the development of skeletal knowledge in late imperial forensics as a site of interaction between medical and forensic literatures. Catherine Despeux, “The body revealed: The contribution of forensic medicine to knowledge and representation of the skeleton in China,” in Graphics and Text in the Production of Technical Knowledge in China, ed. Francesca Bray, Vera Dorofeeva-Lichtmann, and Georges Métailié (Leiden: Brill, 2007).

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23 Lin Ji (林幾), “Niyi chuangli Zhongyang daxue yixueyuan fayixueke jiaoshi yijianshu” (擬議創立中央大學醫學院法醫學科教室意見書, “Opinion regarding a proposal to establish a medico-legal institute at Central University”), Zhonghua yixue zazhi 14.6 (1928): 205. 24 Li and Wang, Fayixue, liyan, 1–2. 25 See, for example, Ye Jingxin (葉景莘), “Theory and experience” (學理與經驗), Da Zhonghua zazhi 1.5 (May 1915); Du Guoxing (杜國興), “Theory and hypothesis” (學理與假說), Xueyi zazhi 5.2 (June 1923); Sun Tongkang (孫同康), “Theory and fact” (學理與事實), Minda yuekan 7 (September 1925): 1–5. 26 In this sense, Mathews’ inclusion of “scientific principle” in the entry for xueli, alongside “doctrine” and “theory,” suggests the multiplicity of potential English correlates. See R. H. Mathews, Mathews’ Chinese–English Dictionary, rev. American edn. (Cambridge, MA: Harvard University Press, 1966), 417. 27 The example was given in Ye, “Theory and experience,” 1. Ye referred to this law as Se’er gongli (色耳公例), a possible misspelling or typographical error for the Chinese transliteration of “Boyle.” Ye noted that gongli (公例, general rule) as well as lilun (理論, theory) fit under the category of xueli. 28 See, for example, the entry in Wang Tang (王倘), Dictionary of Education in China (Zhongguo jiaoyu cidian, 中國教育辭典) (Shanghai: Zhonghua shuju, 1933), 829. For the range of meanings that the word “experience” has in English see Raymond Williams, Keywords: A Vocabulary of Culture and Society (New York: Oxford University Press, 1985), 115–17. The word jingyan had existed in medical discourse, as Lei (“How did Chinese medicine become experiential?,” 334) notes, and elsewhere prior to its redefinition as the modern concept “experience.” It could mean, for example, that something had been verified or personally experienced. See Hanyu dacidian (汉语大词典) (Shanghai: Shanghai cishu chubanshe, 2008), Vol. 9, 870. 29 See Shen Jiaben, “Preface for Wang [You] Mubo’s Avoidance of Wrongs with New Annotations” (王穆伯佑新注無冤錄序), included in Jiyi wencun (寄簃文存, Collected Writings of [Shen] Jiyi), 6.9a–11b. See the undated Republican edition of this collection in Xuxiu siku quanshu (續修四庫全書) (Shanghai: Shanghai guji chubanshe, 1995), Vol. 1563, 527–8. 30 Ibid., 6.11a. 31 Liu Tiecheng(劉鐵城), “The past, present and future of medicine in China, Part 9: Medical laws and legal medicine in China” (中國醫學的過去現在及將來: 九. 中 國醫法及法醫), Minguo yixue zazhi 3.2 (February 1925): 41–8. 32 Ibid., 45–6. 33 Ibid., 48. 34 Lei, “How did Chinese medicine become experiential?,” 337–41 and 348–9. 35 Chen, “Qing ‘Lüliguan jiaozheng xiyuan lu’ xiangguan wenti kaozheng.” 36 Pierre-Étienne Will, “Developing forensic knowledge through cases in the Qing Dynasty,” in Thinking with Cases: Specialist Knowledge in Chinese Cultural History, ed. Charlotte Furth, Judith T. Zeitlin, and Ping-chen Hsiung (Honolulu: University of Hawai’i Press, 2007). Also see Despeux, “The body revealed.”

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37 For more on Xu and his contributions to forensic knowledge, see Chang Che-chia, “The verification of forensic knowledge in the Qing Dynasty: The case of Xu Lian’s researches on osteology.” Paper presented at “Global perspectives on the history of Chinese legal medicine,” University of Michigan, Ann Arbor, October 2011. Cited with written permission of author. Also see discussions of Xu’s Detailed Explanations in Despeux, “The body revealed,” and Will, “Developing forensic knowledge.” References to Xu’s Detailed Explanations below refer to the edition of the office of the Provincial Administration Commissioner of Hubei (1877) included in Xuxiu siku quanshu, Vol. 972. 38 For example, see Yi-Li Wu’s chapter in this volume (80–112). 39 “An order on the promulgation of the corpse examination form, skeletal examination form, and wound list,” in Sifa ligui bubian (司法例規補編, Supplementary Collection of Judicial Regulations) (Beijing: Sifa gongbao faxingsuo, 1919), 238–61. 40 For the Board’s explanation, see “An order on the promulgation of the corpse examination form,” 260. Compare with the original in Xu, Detailed Explanations, 1.56a–b, 366. Confusingly, officials of the Board seem to have mistakenly included “eleven” in the list of uncommon rib counts, which originally read “ten, twelve, thirteen, fourteen, or fifteen” in Xu’s text. This was clearly an error given that the point of Xu’s passage was that eleven was the most common number and that it was rarer to find an individual who had a greater or lesser number of ribs. 41 For more on the cultural authority of anatomical knowledge during this period, see Ari Larissa Heinrich, The Afterlife of Images: Translating the Pathological Body between China and the West (Durham, NC: Duke University Press, 2008). For the significant role that anatomy played in new conceptualizations of professional authority and state power, see David Luesink, “Dissecting modernity: Anatomy and power in the language of science in China” (Ph.D. dissertation, University of British Columbia, 2012). 42 BMA J174-1-67, 1928, 107. 43 Despeux, “The body revealed,” 654–60. 44 “然據實驗男女原無甚大別 …” While the word shiyan (實驗) took on the new meaning of “scientific experiment” during this period, it could also be used to denote practical verification in a broader set of contexts. For more on this notion of shiyan, as investigating or testing in practice, see Lean, “Proofreading science,” especially 197. This seems to have been, broadly speaking, the sense in which Fu was using the word. 45 BMA J174-1-67, 1928, 107. 46 Gangyi (剛毅), Evidence on the Meaning of the Washing Away of Wrongs [Xiyuan lu yizheng, 洗冤錄義證] (Guangdong Governor’s Office, 粵東撫署重刊, 1892 [1891]). 47 Xu, Detailed Explanations, 1.62a. Gangyi, Evidence, 1.96a–1.97b. 48 Gangyi, Evidence, 1.97b. As Catherine Despeux has noted, the description and representation of sex difference in Gangyi’s text, based in part on the width of the pelvic cavity, were an innovation in late imperial forensic knowledge. Despeux, “The body revealed,” 658–9.

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49 Late imperial forensic authors disputed the existence of this bone, which the official Washing Away of Wrongs erroneously claimed as one point of difference between male and female bodies. See Despeux, “The body revealed,” 659–60. 50 BMA J174-1-67, 1928, 108. 51 BMA J174-1-67, 136–7. 52 As observed, for example, by Will, “Developing forensic knowledge,” 86–7. 53 Lei, “How did Chinese medicine become experiential?” 54 See brief biography in Tahara Tennan (田原天南), Shinmatsu minsho Chūgoku kanshin jinminroku (清末民初中國官紳人民錄) (Taipei: Wenhai chubanshe, 1973 [1918]), 64. 55 Wang Chichang’s preface was dated December 1918 and that of Huang Qinglan was dated March 1919. Copies of this text are held at the Library of Ancient Books of the National Library of China (国家图书馆古籍馆) and Chinese Academy of Social Sciences (CASS) National Institute of Law (中国科学院法学研究所). The conservative intellectual Ye Dehui (葉德輝), who like Wang Chichang was from Xiangtan County (湘潭) in Hunan, also wrote a preface for Wang’s References, yet it does not appear in the CASS copy of the text and provides no information about where or how References was published. Ye’s preface was included in Collected Writings from the Northern Travels of Mr. Xiyuan (郋園北遊文存). See Ye Dehui, Ye Dehui wenji (葉德輝文集, Collected Works of Ye Dehui) (Shanghai: Huadong shifan daxue chubanshe, 2010), 120–1. 56 Asen, “Dead bodies and forensic science,” 290–313. 57 The Washing Away of Wrongs claimed that this phenomenon was caused by “qi and blood surging upwards” (氣血上湧所致) upon the (forced) cessation of respiration. See passages and commentary in Xu, Detailed Explanations, 3.2a, 413. 58 Wang Chichang (王熾昌), References for the Washing Away of Wrongs (Xiyuan lu cankao, 洗冤錄參考, 1919), 1.7b–8a. 59 Ibid., 1.8b. 60 Ibid., 2.23b–26b. 61 Ibid., 2.26b. 62 Ibid., 2.28b. 63 Ibid., preface, n.p. 64 Ibid., 1.31a. 65 Ibid., 1.51b. 66 Will, “Developing forensic knowledge,” 64–8. 67 Aside from ibid., see “Four cases to supplement the Washing Away of Wrongs” (“Bu Xiyuan lu si ze,” 補洗冤錄四則), contained in Jiyi wencun (寄簃文存, Collected Writings of [Shen] Jiyi), 5.18b–22b, in which Shen Jiaben discusses in detail cases with forensic situations and signs not described, or insufficiently described, in the official Washing Away of Wrongs. The purpose of the piece was to assist judicial authorities faced with similar situations in the future. See Xuxiu siku quanshu, Vol. 1563, 516–18. 68 BMA J174-1-27, 1919–20, 10. 69 Wang, References, 1.45b. 70 Ibid., 1.52b.

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71 See Shen, Jiyi wencun, 5.22a, in Xuxiu siku quanshu, Vol. 1563, 518. 72 See, for example, Carla Nappi, The Monkey and the Inkpot: Natural History and Its Transformations in Early Modern China (Cambridge, MA: Harvard University Press, 2009). 73 Cf. Helen Tilley, “Global histories, vernacular science, and African genealogies; or, Is the history of science ready for the world?” Isis 101.1 (2010): 110–19. 74 For more on the ways in which these forces affected the field of Chinese medicine during this period, see David Luesink’s chapter in this volume. 75 For the case of shishi (fact), see Tong Lam, A Passion for Facts: Social Surveys and the Construction of the Chinese Nation-State, 1900–1949 (Berkeley: University of California Press, 2011). 76 See, for example, Wang Hui’s study of the interplay between concepts of modern science and notions of natural inquiry in late imperial literati intellectual culture. Wang Hui, “The fate of ‘Mr. Science’ in China: The concept of science and its application in modern Chinese thought,” in Formations of Colonial Modernity in East Asia, ed. Tani E. Barlow (Durham, NC: Duke University Press, 1997). 77 For example, see Erik Hammerstrom’s study of the Buddhist modernism of Wang Xiaoxu, an industrialist and scientist who argued that Buddhist approaches to knowledge were entirely compatible with, if not more empirically minded than, modern western science. Erik J. Hammerstrom, “Science and Buddhist modernism in early 20th century China: The life and works of Wang Xiaoxu 王小徐,” Journal of Chinese Religions 39 (2011): 1–32.

6

State power, governmentality, and the (mis)remembrance of Chinese medicine David Luesink Introduction: anatomo-medicine and the body of Yuan Shikai On June 6, 1916 at ten o’clock in the morning, President Yuan Shikai died in Beijing. Attending were his two western-style physicians, Drs. Wong Wen-tso and J. A. Bussière, but also present were the Chinese-style physicians of his many wives, concubines, children, and servants.1 Here the stage was set for a battle of two therapeutic forms over the body of the most powerful man in the very fragile Republic: between the old medicine – Chinese medicine (zhongyi, 中醫) – and the new medicine that emphasized anatomy – western medicine (xiyi, 西醫).2 The editorial of the National Medical Journal took the occasion to bemoan the state of affairs in China where western-style physicians did not have complete control in the household of the Head of State, despite offering evidence of his having a “stronger leaning towards western than eastern medicine.”3 For the physicians of the National Medical Association (NMA), China was an anomaly in world affairs for countenancing the interference of what they called “blind quacks” in the diagnosis and recovery of a Head of State: “In every country but China the serious illness of such an important person as the President would at once have been left to his trusted medical advisors, who would prescribe medicines, engage nurses and generally manage affairs for the comfort of the sick.”4 Yuan’s leaning toward western medicine was evidenced in his establishment of the Army Medical College in Tianjin while he was Viceroy of Zhili in the waning years of the Qing, and in his maintenance of Dr. Wong as his personal physician from 1908 to 1916. Dr. Bussière had been present as the family physician of Yuan’s oldest son, Yuan Keding. But despite this apparent preference for Western medicine, the body of the ailing President had been a battleground for the prescriptions of competing physicians, and the advice of Drs. Wong and Bussière was not strictly followed. Instead, “countless relatives, friends, hangers on, and even servants stepped in, each ready with his so-called physician, theory, ideas, and quick restorer.” Rather than allowing one round of medicine to work its course, “[a]ll sorts of

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concoctions – hot-cold and intermediate – were poured into the poor man’s stomach in quick succession.” If the two western-trained physicians were in agreement about diagnosis and treatment, the Chinese physicians were not. Yuan’s life ended with all physicians in a joint consultation  – one can only imagine the absurd and dramatic scene of multiple physicians arguing over Yuan’s ailing body “until coma and then death set in.”5 It is unlikely that any medical treatment, whether from Chinese or western-trained physicians, would have saved President Yuan, given his run-down physical condition – Yuan over-indulged his appetite and “burnt the candle at both ends,” with the result that his renal and circulatory systems were giving way.6 Multiple and even simultaneous consultations were not an uncommon occurrence among those patients wealthy enough to confer with more than one physician, who were in fierce competition with each other for the social capital of treating famous persons.7 But practitioners of biomedicine sought exclusive authority over the bodies of individuals, populations, and environment. Biomedicine meant science and standardization, and would brook no epistemological or therapeutic challenge from older medical practices. The editorial of the previous issue of the National Medical Journal, for June 1916, had been ecstatic about the lengthy presidential order of 1915, which had finally given official status to the new medicine in three categories: medicine, pharmacy, and veterinary science.8 Notably missing in this official order was any reference to Chinese medicine, or, as they termed it, “China’s old, completely corrupt medical practices.” The editors interpreted this as the desire of the government no longer to tolerate old medicine. But Yuan Shikai’s death in June also meant the death of most of his policies, tied as they were to his aborted attempt to restore the monarchy.9 The question of how the medical market would be regulated, or if it would be regulated at all, was thus left open for the time being and would, in fact, remain contested throughout the twentieth century. The accusation of modernizers against China’s “old” medicine was that it was blind: it was blind in diagnosis and blind in theory. Specifically, it was considered blind because of its inability to accurately identify the “seat of disease” in the anatomically correct body. Chinese medicine was blinded in its capacity accurately to describe the anatomical surfaces revealed through dissection. And the body, once opened, required thousands of precise terms for the vertical, horizontal, median, sagittal, frontal, transversal, medial, or intermediate surface of each wing, alveolus, ampulla, ring, angle, cave, aperture, etc. The result of this failure to see details was that China’s old medicine would now be castigated as weak and powerless to save China in the era of explicit social Darwinism of the 1920s and 1930s. Other contributions in this volume have demonstrated the various ways in which the theoretical epistemology of Chinese medicine encountered that of biomedicine in the late nineteenth and twentieth century. This chapter

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demonstrates that the displacement of the epistemology of Chinese medicine would be attempted, and to a large degree achieved, through mundane activities that have largely been ignored in previous studies. Fundamental to the project of the modernizers was inserting a new translated and standardized technical terminology for the myriad surfaces of the body that were revealed to a trained eye following the perforations made by the skilled hand holding a scalpel. In the 1910s and 1920s, the development of an anatomy law, of routinized dissection practice, and of a standardized anatomical terminology was prosecuted by the same group of western-trained physicians who attempted to regulate and even abolish Chinese medicine. They were not only the same group, they actually used the annual terminology meetings to organize anti-Chinese medicine action. These men, who sought both to eliminate competition in the medical field and to establish detailed anatomical knowledge in Chinese, were led by Tang Erhe (湯爾和, 1878–1940), Yu Fengbin (兪鳳賓, 1884–1930), and Yu Yunxiu (余雲岫, 1870–1954). The fundamental basis of the critique of Chinese medicine was its perceived lack of anatomical knowledge.10 Euro-American medicine since the nineteenth century had shifted from Greek humoral medicine to a medicine that sought an anatomically discrete seat of disease for all diagnosis. To see anatomically was to see truly; to see without proper anatomical knowledge was to be blind and necessarily superstitious. In an unsigned article concluding the first issue of the National Medical Journal, the new-style physicians pitted themselves against the old-style with images comparing the “inaccurate” Chinese view of the body beside the “accurate” western view (Figure 6.1). The anatomical gaze, for these physicians, was the only authentic one.11 The principal cause of the backwardness of Chinese as compared with western medicine lies in the wrong foundation upon which the former is built. Take for instance the structure of the human body. In Chinese books, the drawings and descriptions are mostly inaccurate, as can be ascertained by dissection. Our modern native physicians continue to rely upon this deceptive knowledge for the treatment of their patients, and do infinite harm to our people. Every branch of knowledge must nowadays be exact, and medicine is one of the most important. We cannot afford to play with it or with the future of our race. In order to show the fallacy of these old ideas, I have taken a photo of a Chinese medical engraving placed side by side with an accurate picture of the human body. The difference is obvious.12

One wonders to what degree the difference was obvious, and whether such low-quality “accurate” images could convert new believers to western medicine. There is no evidence that they did. Rather, articles and images published in the National Medical Journal of China were merely preaching to the converted, who had already opened cadavers themselves. The battle for the public

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6.1  “Inaccurate” Chinese view of the body vs. the “accurate” western view of the body.

was not a battle that could be won with propaganda in professional journals: real governmental power to establish the anatomical view of the body would be needed. But with an increasingly weak central government in the post-Yuan Shikai era, where would such power reside? Yu Yunxiu made it explicit: anatomically based medicine had not become popular in Japan without the backing of political power, and neither would it become popular in China without legislative and police powers.13 Likewise, Tang Erhe also argued for a close relationship between medicine and politics. It is easy to interpret such comments about political power and medicine as an attempt of physicians to nakedly seize the reins of government to build medicine – and this was also the case for both. If one looks deeper at the results of their broader activities, one can see the insinuation of a new logic governmentalizing medicine so that if Tang’s political faction were to fall out of favor, or Yu’s political machinations were rebuffed, then the incremental, bureaucratic accomplishments of a new form of medicine would not be turned back. The unintended result of their attempts to use coercion to eliminate Chinese medicine was the governmentalizing of Chinese medicine itself. It was the coercion, reclassification of knowledge, and self-governmentalization of Chinese medicine that resulted in its (mis)remembrance as a new form of standardized medicine that must take into account the anatomo-medical view of the body.

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The key to this argument is tying the work of the Joint Terminology Committee to attempts to restrict and abolish Chinese medicine (zhongyi, 中醫). The project of the Joint Committee served to standardize the reproduction of physicians through medical textbooks and lectures in medical schools while also allowing for the unambiguous communication of original scientific research. Successful unification of nomenclature aimed to produce a one-toone correspondence and allow medical findings in China or another part of the globe to be rapidly and definitively translated and disseminated to all other nodes of the network of global medicine. These were recognized by physicianpoliticians like Yu and Tang as necessary steps to establish a bulwark for western medicine. Yet at another level, this process of rationalizing terminology was a crucial part of governmentalizing medicine in China. The instrumental goal of proponents of the “new medicine” was to establish it according to internationally recognized standards and then to regulate, subsume, and (for the most extreme) abolish the “old medicine.” In fact, they were almost in lockstep with a small group of elite American physicians and educators funded by the Rockefeller and Carnegie Foundations who were making decisions to standardize medical education through various carrot-and-stick methods in the USA, Canada, Europe, and also in China.14 Homeopathy, irregular medicine, independent midwives (and other female medical practitioners), and medical schools judged “second-rate” created ambiguity in the Euro-American medical market, and great efforts were made to eliminate them.15 This drive toward medical standardization was echoed in China by Japanese-trained physicians like Yu and Tang. How, then, should advocates of anatomo-medicine displace advocates of Chinese medicine? Short of effective measures of regulation or complete abolition, the complete rationalization, standardization, and institutionalization of the new medical tradition in translation was necessary. Institutionalization included the formation of professional associations and standards: legal reforms allowing regularized anatomical investigations. These goals would be accomplished by imbricating the new medicine with state power wherever possible. No aspect was more important to the formation of an indigenous, selfreplicating profession than the standardization of translated terminology. It should, then, be no surprise that Yu Yunxiu and Tang Erhe, two of the most powerful opponents of Chinese medicine, involved themselves in the business of the Joint Terminology Committee, or that Yu Fengbin and Liu Ruiheng (劉 瑞恆, 1890–1961) of the NMA, also members of the committee, would have strong opinions about sublimating Chinese medicine. Tang was representative of the Chinese Ministry of Education to the committee from 1916 to 1920, the same period when he attempted to regulate Chinese medicine according to the Meiji Japanese regulations of Kanpō Seiyaku (漢方製薬; shortened as Kanpō, 漢方) medicine. Yu was delegate to

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the committee from 1922 to 1927, in the years when his battles with practitioners of Chinese medicine accelerated into a life-and-death struggle, as Yu partnered with Nationalist Minister of Health Liu Ruiheng to abolish Chinese medicine at the turn of the decade. Before proceeding to examine the terminological standardization work as one part of the larger project of reclassification of traditional knowledge, I will examine a seminal article written by Yu Fengbin in the National Medical Journal about whether Chinese medicine was worth saving. I will then recount the attempts of Tang Erhe and Yu Yunxiu to regulate and abolish Chinese medicine. The chapter will conclude with reflection on the self-governmentalization of Chinese medicine in the wake of these attempts by anatomo-medical practitioners to abolish it. Sublimation and preservation: Chinese medicine as national essence The NMA, formed in 1915 by primaries Wu Liande, Yu Fengbin, and Yan Fuqing – all educated in England or the United States – promoted a laissezfaire view of medical transformation. Rather than a complete revolution and abolition of Chinese medicine, for which Japanese-trained Tang Erhe and Yu Yunxiu aimed, the Anglo-Americans adopted a more liberal approach that promoted the new medicine while sublimating, but preserving, the old. If Continental European and Japanese preferences were for a large government and top-down regulation of the medical field, the Anglo-American tradition preferred less government regulation and more market self-regulation. I have argued elsewhere for such an approach to understanding the instrumental role of the English-language History of Chinese Medicine by Wu Liande and fellow NMA member, Wang Jimin. That book, along with Wang Jimin’s carefully preserved museum collection of manuscripts and artifacts, aimed to preserve pre-twentieth-century Chinese medicine to demonstrate the national heritage (guocui).16 There are important debates about this issue in the Chinese pages of the National Medical Journal, including one by Yu Fengbin. Yu Fengbin was a key member of the Joint Terminology Committee from its inception, and author of many of the sixty-six items about the committee published in the National Medical Journal between 1916 and his premature death in 1930. In a substantial article, “A discussion of the preservation of ancient medicine,” published in 1916, Yu argued that ancient medicine had long been stagnant, but nonetheless contained elements that were valuable and must be preserved. Quoting from The Doctrine of the Mean (Zhongyong, 中庸) and The Great Learning (Daxue, 大學) that learning must renew itself constantly, Yu argued (erroneously) that Chinese medicine had had no innovations for thousands of years since the ancient materia medica attributed to the mythical figure Shennong,

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and had simply followed old ways.17 Yu argued that western and Chinese medicine were radically divergent, with western medicine having science as its basis (by which he appears to mean a constant search for truth), while Chinese medicine claimed to be nearly complete. In other words, for Yu, western medicine’s strength was its constant search for new knowledge, while the weakness of Chinese medicine was its satisfaction with ancient knowledge.18 Yet Yu Fengbin differentiates his position from that of the physicians trained in Japan who sought to reform medicine completely on the Meiji model. In China, Yu argued, this antagonistic approach had thus far led to a polarization of medical politics, so that those promoting the new medicine could no longer speak to supporters of Chinese medicine. Its opponents argued that Chinese medicine was corrupt and must be abolished, while the latter, without investigating the new medicine, argued that their medicine was completely beneficial and even had supernatural powers. Yu’s position appeared to fall somewhere in between: Chinese medicine’s weakness was a lack of significant change over thousands of years. But its corresponding strength was the accumulation of thousands of years of significant experience and service to humanity. Given this recognized contribution, it would be a pity if Chinese medicine were completely lost. As to the argument that China should follow Japan in legally eliminating its old medicine, Yu argued for a substantial differentiation between the two countries. Japan had merely imported its old medicine from China, so it had no substantial sense of national essence attached to it.19 Yet even there, the old medicine maintained the trust of the people because of long experience. How much more so, Yu argued, did Chinese medicine exhibit the national essence of China? On the other hand, western medicine had only begun to experiment and advance in the nineteenth century, so it was equally false to say western medicine was all good and Chinese medicine was all false. The solution Yu proposed was to cleanse China’s ancient medicine of its dross and the unwanted residues of the past, while retaining its best features. The best features he explored were primarily its pharmacopoeia, and he charged his colleagues with rigorously testing herbal ingredients chemically and physiologically, eliminating those that were dangerous and retaining those that were active and useful. Rather than eliminate Chinese medicine completely, Yu argued that the best of each medical tradition – western science, and ancient Chinese medical experience – should be combined, so that Chinese medicine would push ahead vigorously.20 Yu’s approach was what would now be called integrationist, a popular position in the contemporary People’s Republic of China.21 As we shall see below, all of “traditional Chinese medicine” (TCM) as it now exists is integrationist to a significant degree – it has been transformed by its encounter with anatomomedicine. The question, however, was (and is): Who sets the terms for integration? Generally, anatomo-medicine has been able to set the terms, insisting on reductionist anatomical, chemical, and biological explanations for all forms of

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acceptable TCM practice, even more so in adopting TCM drugs and therapies outside China. But this result was as yet unknown during this first, extended encounter, between 1916 and 1930, when China attempted to adopt German and Japanese models using new police forces to regulate the medical field in favor of biomedicine. Coercion: the Japanese Medical Police method In the late nineteenth century, Japan adapted the German model of Staatsmedizin. By 1893 the Japanese had transferred public health to the police department, and in 1895 Japan officially prohibited the practice of traditional Chinese medicine.22 When Tang Erhe (1900s) and Yu Yunxiu (1910s) followed the high tide of over 10,000 elite Chinese students to study in Japan in the first two decades of the twentieth century,23 Japan had already largely eliminated most of its physicians of kanpo (Chinese) medicine, and had begun initiating restrictions on practitioners in its colonies of Taiwan (1895) and Korea (1905). Both Tang and Yu were inspired by the success of Japan’s medical elites in displacing Chinese medicine through regulation. Tang Erhe was the key physician in establishing anatomo-medicine in China in the 1910s and 1920s. While Wu Liande, Yan Fuqing, and other Anglo-American-trained physicians have received much attention,24 Tang has been deliberately excluded from these largely celebratory accounts because of his collaboration with the occupying Japanese between 1937 and his death in 1940.25 Yu Yunxiu has received much attention for his flamboyant attempts to abolish Chinese medicine, but his context as a highly networked member of Tang Erhe’s Republic of China Medico-Pharmaceutical Association and the nationally important Jiangsu Provincial Educational Association has not been addressed. These men were at the center of the transfer of Japanese medical knowledge and institutions to China during this crucial phase. It was Tang Erhe who established the government medical school in Beijing on the Japanese model and applied to the Ministry of Education for permission to legalize and institutionalize dissection as the basis of medical education. In 1916, while Ministry of Education representative to the Joint Committee for Medical Terminology, he submitted a proposal to the Ministry of Education to regulate all Chinese medical practitioners along the lines of the Meiji regulations.26 Historian Zhao Hongjun writes, “Around 1916, [Tang Erhe] submitted a request to the Ministry of Education to implement Japanese Meiji-era health measures, and this had a significant influence on the Beiyang government.”27 The first issue of the journal of the Republic of China Medico-Pharmaceutical Association (Zhonghua minguo yiyao xuehui, 中華民國醫藥學會) includes Tang’s reports submitted to the Ministry of Education regarding the first three meetings of the Joint Terminology Committee in 1916 and 1917, followed by his

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“Memorial submitted to the Ministry of Education requesting rectification of the procedure for physicians preparing to practice,” the source of Zhao’s comments. According to Tang Erhe’s memorial, his request for national standardization of medicine was preceded by one from the former Imperial Physician, Zhang Zhiting, and Zhao Cunren,28 who asked for a national examination to regulate physicians. The Republican government did not accept this request, and instead turned to Tang and his professional association for a second opinion. Tang suggested adopting Korean colonial measures to regulate medicine, stricter than those implemented in Japan in the early Meiji period, and perhaps even stricter than those actually implemented in Korea. In his memorial, Tang mocked Zhang and Zhao’s suggestion of an examination system with essays as a system to produce regulated practitioners of Chinese medicine. It was impractical since the level of scientific knowledge in Chinese society was so low and there were few organizations to improve this situation. Tang argued that practitioners of Chinese medicine were clueless about the fundamental principles of dissection. However, because properly qualified medical personnel were few, he suggested that practitioners of Chinese medicine should be utilized and regulated rather than abolished, although abolition might be desirable in the future.29 Tang’s memorial, like a previous one institutionalizing regulated dissection as the basis of the medical profession (1912), was accepted by the Beiyang government. The first stage was to implement a census investigation of all medical practitioners in China, but because of the lack of national unity after Yuan Shikai’s attempt to make himself Emperor (1915), followed quickly by his death (1916), most provinces did not pay attention to the census, and so it failed. So despite Tang’s success in influencing the Beiyang government, there was no way to implement supervision of physicians.30 In 1917 Tang went on his educational fact-finding mission to Japanese areas of Manchuria, Japanese-occupied Korea, and Japan itself, spending much of his time investigating the relationship between the colonial police, who were the front line in implementing public health measures (including regulating practitioners of Chinese medicine); anatomy in medical education (including various means of acquiring sufficient corpses for student learning and advanced research); and the ongoing standardization of Japanese terminology for medicine, particularly that of anatomy.31 “Diary of a madman” and critique of the Triple Burner

Tang Erhe’s critique of Chinese medical ideas became explicit and public when his friend Chen Duxiu published a private letter in the pages of New Youth (Xin qingnian, 新青年). The thrust of New Youth as a journal was a rejection of traditional Chinese culture.32 As it happened, this was the same issue of the radical journal where Lu Xun published his first short story, “Diary of a madman”; Cai Yuanpei published his plan for university reform; and Qian

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Xuantong, Li Dazhou, Zhou Zuoren, Hu Shi, and Liu Bannong weighed in on issues of abolishing the old language and establishing the new culture.33 These men, mostly from Zhejiang and occupying top positions at Beijing (Peking) University and other nationally influential institutions of higher learning, had been students and revolutionaries in Japan. Tang Erhe was a prominent leader among these men, as early as 1903 passionately organizing hundreds of Chinese students in Japan willing to fight Russian aggression in Manchuria.34 Chen Duxiu would call Tang “Erhe, my schoolmate” in this exchange. Lu Xun (Zhou Shuren) was not yet prominent, and his story of a madman seeing only cannibalism written between the lines of 4,000 years of Chinese culture that preached the virtues of “benevolence, righteousness, and morality” had to be interpreted in a later issue.35 Tang’s 1918 letter “Triple Burner! Cinnabar Field!” was apparently a response to a question posed privately by Chen Duxiu asking Dr. Tang about these Chinese medical concepts. In two short sentences Tang gave the approximate anatomical location for the Chinese organ of the Triple Burner (sanjiao, 三焦) as the cavity housing the internal organs. But for Tang, those who came up with the concept in the Jin and Yuan Dynasties were blind because postmortem dissection revealed no such organ.36 The Cinnabar Field (dantian, 丹田) Tang found to be an even more preposterous concept than the Triple Burner – this was the area around the navel where life was fed into the baby in the womb through the umbilical cord, through the mucous membrane.37 Tang’s terse response to Chen Duxiu describing these concepts of Chinese medicine in anatomical terms demonstrates that he had little patience for those Chinese concepts that could not be mapped onto the anatomical body. Chen Duxiu would then publish Tang’s response, bewailing that the scholarly thought of China was still in the period of religion and superstition, and so they were forced to look to western science for knowledge that could be verified. Chinese medicine, like the orthodoxy of the Confucian canon, Chinese natural studies, history, and belles lettres must, according to New Youth, be discarded. Lu Xun’s madman searched for any youths who were not yet cannibals: “There may be some children who haven’t yet become cannibals? Save the children …”38 Chen Duxiu published these private exchanges “to lead the youth off the wrong path and onto the right path.”39 Tang Erhe and Chen Duxiu deeply believed that they were correct in discrediting the concepts of Chinese medicine along with much else they considered corrupt in Chinese culture, but Yu Yunxiu took this project much further. The “Medical Revolution” and the Joint Terminology Committee By the mid-1920s, Yu Yunxiu had become a lightning rod for those who opposed the old medicine. He published an endless series of articles exploring,

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and then denouncing, the teachings and practice of Chinese medicine. Then, in 1929, he saw an opportunity to use the newly established Ministry of Health of the Nanjing government to abolish the old medicine completely. Yu’s attempts to abolish Chinese medicine have been explored in detail elsewhere in English and Chinese, so here I will summarize these accounts and draw some connections that have been previously overlooked.40 Yu Yunxiu studied in Japan only a few years after Tang Erhe, and famously promoted the idea of a Chinese “Medical Revolution,” which became memorialized in his various publications after 1928.41 His antipathy toward Chinese medicine elicited much heat and light from his intellectual adversaries, especially Yun Tieqiao, in the 1920s,42 but it was not until his attempt to abolish Chinese medicine completely within four years (i.e. by 1931) through the power of the newly unified Nationalist state that his full purpose became clear: “To abolish the old-style practice in order to remove the obstacles to medicine and public health.”43 Yu’s reasons for abolition included the accusation that the theories of Chinese medicine had “not a grain of truth,” were “absurd,” and “may be classified in the same category as astrology.”44 Moreover, since their diagnosis was fundamentally flawed, they were “completely useless for the purposes of administration/government.”45 Finally, the “reactionary thoughts” of the old-style physicians were “a hindrance to Scientization [of people’s medical beliefs].”46 If the first two reasons aimed to reclassify Chinese medical knowledge (see below) then the second two reasons pointed toward a governmentalization of the field of health – a movement from a particular individual’s disease and cure to the management of whole populations subsumed under the sign of the nation.47 To see the political connection between the work of the Joint Terminology Committee and Yu’s attempts to abolish Chinese medicine in 1929, we must go back to 1925. That year practitioners of Chinese medicine and their allies met at the Society for the Advancement of Education to propose that the newly established schools of Chinese medicine be recognized by the Ministry of Education. This proposition was adopted by the Society and presented to the Ministry for consideration. In 1926 the National Educational Conference was held at Hankou, and the provincial educational associations of Zhejiang and Hubei presented similar proposals that were passed by the assembly. Meanwhile, in Shanghai, the annual meeting of the Scientific Terminology Committee was being held. Key members Yu Yunxiu and Yu Fengbin proposed that a telegraph be sent to all Provincial Educational Associations exhorting them to advocate for scientific medicine instead of “turning back the wheels of history” and endorsing the institutionalization of Chinese medicine. The NMA, the Chinese Medical and Pharmaceutical Association, and the Shanghai Medical Association joined in the protest. The result was that the resolution that had been passed by the Hankou Conference failed.48

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The link between the terminological work and Yu’s attempts to abolish Chinese medicine can be seen in his extensive involvement in the committee in which Tang had played such an important part in the late 1910s and in which Yu Fengbin continued to be a key participant. In the six years (1921–26) leading up to this first, tentative political clash, Yu Yunxiu was a regular delegate at the Scientific Terminology Committee, representing both the Republic of China Medico-Pharmaceutical Association and the Jiangsu Provincial Educational Association, and sitting on the both the executive subcommittee and various technical committees on physiology, pathology, parasitology, and internal medicine. Of the seventeen signatories on Yu Yunxiu’s petition to abolish Chinese medicine – the members of the National Board of Health (Zhongyang weisheng weiyuanhui, 中央衛生委員會) – five of them had been active members of the Joint Terminology Committee between 1916 and 1926, in addition to the chairman of the committee, and Vice-Minister of Health, Liu Ruiheng. This, I argue, is more than mere coincidence. The logic of standardizing terminology was the same logic that led to the elimination of ambiguity in the medical field. Nonetheless, the attempts of Yu and his colleagues in the Ministry of Health to abolish Chinese medicine in 1929 failed. The federation of native practitioners was able to establish a supervisory board, the Central Bureau of Native Medicine, not directly under the antagonistic Ministry of Health. However, we should look beyond the personalities and politics of this period to see the larger themes apparent here. The key theme is the governmentalizing of western medicine in China, both in the earlier period of a weak state (1916–26) following the death of Yuan Shikai and in the following decade of a stronger state (1927–37). The logic of governmentality led men like Tang and Yu to eliminate ambiguity in the medical field by establishing a clear standard for medical education, based on anatomical interventions and a standardized terminology. Chinese medicine as it existed stood in their way, but if its knowledge could be degraded and subsumed it would no longer pose an obstacle. The key was to reclassify those aspects of its knowledge that could be readily absorbed by scientific medicine. Reclassifying Since fundamentally they (old-style physicians) do not know diagnosis, it is impossible for them to certify the causes of deaths, classify diseases, combat epidemics, not to mention eugenics and racial improvement, which are completely beyond their reach. Yu Yunxiu, 1929

Reclassifying is a process that has been explored in some depth in other contexts under the neologism of “agnotology.”49 Historians of imperial science

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since George Basalla have recognized that each colonial context had something to offer universal science – raw data.50 These data, primarily in the form of disease and plant knowledge, were extracted from their “non-scientific” form, then classified and organized around the current dominant classification system of the national culture of the European explorer/collector (pre-1880s), then later standardized by international committees and conventions that became ubiquitous in diverse fields of science after the 1880s.51 Yet, as Londa Schiebinger has described, particular knowledge about the medicinal uses of a particular plant was not accepted if it did not fit the cultural priorities and gendered power relations of Europe, as in the notable case of abortifacients from the slave islands of the West Indies. In the case of Chinese herbal knowledge, nothing was accepted unless it could be chemically isolated for mass production in the just-then burgeoning global pharmaceutical industry. There were professional and even financial rewards to be gained from being the first globally networked scientist to “discover” particular qualities of this or that herb.52 And so, among western- and Japanese-trained scientists in China, there was no shortage of attempts to do so, as we saw already in Yu Fengbin’s article analyzed above. Both before and after Yu Yunxiu’s failed 1929 attempt to have Chinese medicine abolished, Yu pursued the governmentalizing task of studying “old medical works for the purposes of pharmacological research.”53 Yet this knowledge first had to be isolated from its context in Chinese herbal manuals, translated, classified, and made equivalent to the prevailing Latin terminology. Reclassification here refers to the extraction of knowledge from one form of classification and renaming it and reclassifying it in order to insert it into another. We have already seen the scornful comments of Tang and Yu toward Chinese medical knowledge demonstrating their overt political attempts to abolish Chinese medicine. One might argue, however, given their political failure, that the more significant work was the more mundane one – that of standardizing terminology. When Japanese-, European-, and American-trained Chinese physicians began collaborating with medical missionaries, publishers, and educators to standardize medical terminology in Shanghai in 1916, they largely ignored the categories and classifications of existing Chinese medical thought. The anatomical body, for them, was not equal to the body described in Chinese medical literature with the six zang (viscera), which included such items as the Triple Burner. The anatomo-medicine institutionalized in China in the 1910s deterritorialized spaces of health in order to reterritorialize it with its own alternative authority and knowledge.54 Health, disease, and the natural world had been studied in East Asia before contact with Western Europe, but “this native endeavour was soon to be dominated by Europeans, with their superior classificatory systems.”55 Yet this superiority was not demonstrated by logic or inherent veracity, as Basalla’s misremembered account would have it.56

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Yu Yunxiu and Tang Erhe recognized that the “superiority” of scientific medicine was not self-evident in China’s medical marketplace; it must be politically instituted and allied to the State. As Yu said, the problem was the capacity of Chinese people to hold two contradictory views at the same time.57 This required displacing the diverse existing classification systems, practices, language, and institutions of medicine and natural knowledge. Missionaries and foreign-educated Chinese might claim that all their translations and dictionaries were doing was giving “new terms for new ideas,”58 but they were far more than that. In the late nineteenth century in China, translated western anatomical texts were greeted by a few as part of a renaissance of classical medical learning – a return of Chinese medicine to its golden age of the Inner Canon (黃帝内經).59 In 1884, scholar Tang Zhonghai used western anatomical illustrations to attack contemporary Chinese medicine. Anatomical knowledge would allow a renaissance of Chinese medical knowledge, a return to the true meaning of the classics like the Inner Canon.60 Yet Tang Zhonghai was no medical revolutionary like Yu Yunxiu forty years later. Instead, anatomical knowledge recovered from corpses allowed only an examination of the basic configuration, not the qi transformation observable in live patients made clear through Chinese medical classics.61 Most Chinese elites would have gone no further than Tang’s tepid acceptance of western anatomical knowledge as a tool to reform Chinese medicine back to its ancient glory. Yet after China’s embarrassing loss to Japan in 1895, the mood among many elites shifted rapidly. The ti–yong formulation of Chinese learning as the essence (ti) and western learning for practical use (yong) employed in the self-strengthening reforms of late Qing statesmen Zhang Zhidong and Li Hongzhang, and echoed in Tang Zhonghai’s words, now seemed far too conservative. Influenced strongly by the 1895 loss to Japan and by the failure of the 1898 Hundred Days’ Reform, with which he was intimately involved, scholar Tan Sitong argued that China’s lack of anatomical knowledge was a symbol of its backwardness.62 Tan became a martyr to the failed reforms of 1898 and his writings spread like wildfire. Elite Chinese students like Tang Erhe and Yu Yunxiu began to choose to study in Japan rather than prepare for the civil service examinations. In one generation anatomy was transformed for a growing number of Chinese elites, from being a possible source of renewing the classics of Chinese medicine, to becoming the exclusive truth about man’s relation to reality. Yet it was not only the apparent truth about “one’s own body” that mattered for Tang and Yu. As Yu earnestly put it: Is there any other reason that I have shouted out to promote medical revolution and appealed to my people in tears? What deeply agonized me were the following: the Old-style Medicine did not obey science, the medical administration was not unified, public health constructions stagnated in many respects, and the shameful name of the “The Sick People of the East” was not deleted.63

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Proper scientific knowledge of anatomy for Tang and Yu in the 1910s and beyond was the basis for a new governmentality that included racial medicine, eugenics, and public health, a governmentality that sought to manage a national population – a concept that had only recently been invented.64 It is no coincidence, then, that the first set of terms to be reclassified and standardized were those for the human body – terms from anatomy. Tang Erhe’s 1916 report to the Ministry of Education made these points explicit.65 The formation of the Joint Committee for Terminology described by Tang Erhe signaled a shift toward reclassifying knowledge about the body. This shift was from missionaries trying to make the new knowledge conform to Chinese patterns of thought, to the modernizing elites of the committee, who were confident in both their knowledge of classical terminology and the novelty of modern concepts, and thus were not afraid to coin new terms. Protestant missionary writers and translators in the nineteenth and twentieth centuries were at pains to use pre-existing terms, even obscure or obsolete ones, to represent their knowledge in Chinese. Since they had first arrived in the Qing Dynasty, they had turned to the dictionary compiled under the Kangxi Emperor as their standard authority (Kangxi zidian, 康熙字典). Some of their constructions were awkward and unwieldy, and difficult to remember. Some key terms, like the terms for anatomia or dissectio, were euphemisms to avoid referring to the cutting of the body with the “dao” (刀) radical. So instead of the Japanese terms jiepou for dissection and jiepouxue for anatomy, many missionaries had used terms like “the study of the whole body” (quantixue), “the study of the body” (tixue), or “the study of the structures of the body” (shenti gouzaoxue).66 Tang euphemistically calls the disagreements over terms as each group having their own scholarly habits.67 In the heat of debate over important terms the shift became clear, as it did for the proposed Chinese terms for artery and vein, key anatomical and physiological terms since William Harvey’s discovery that the heart circulated blood throughout the body. Missionaries proposed repurposing the Chinese concept of mai (脈, pulse), by adding the clarifying term guan (管, tube, pipe) for artery/arterius, representing the outward flow of blood toward the tissues. Similarly they proposed huang (衁, a rare term for blood) plus guan (管), or hui (迴, return) plus guan (管), for vein/vena, to represent the return of blood from the capillaries.68 Classically-trained philologist/educational reformer Shen Enfu, the most prominent delegate of the Jiangsu Provincial Educational Association, disparaged the Kangxi Dictionary, on which the missionaries had depended to create their terms, as “a late-appearing book” that lacked proper explanations. If one wanted old terms, as the missionaries seemed to, Shen said, one should look to the Shuowen jiezi (說文解字),69 the Han Dynasty proto-dictionary popular with late Qing philologists. Yet in the modern era, Shen said, “objects in the civilized world proliferate daily and we should not be afraid to create new terms.”70

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At this point, Tang Erhe took up the exposition, expressing great gratitude for the painstaking labors of the missionaries over the previous three decades who had translated many medical books: Yet [Chinese] society has not been able to accept the books published by the missionaries. Why is this so? It is not because Chinese people do not like the techniques [expounded in] eastern medical books. One of the biggest reasons they are not accepted is the use of unfamiliar terms [yongzi shengpi, 用字生僻] that are unpalatable when read [duzhiwuwei, 讀之無味]. Early on, many friends were in high spirits when they purchased books of the Medical Missionary Association, then later dejectedly bound them together and placed them on a high shelf. This situation has been repeated many times, the reason being simply that there were many unfamiliar terms within. Starting today we must change our guiding principles. Then, the books of the Medical Missionary Association will be an extravagant waste no more. Rather, the painstaking efforts of the Medical Missionary Association will become something that all Chinese people can be exposed to.71

In the end, the committee opted to accept the term dongmai,72 actually an old term that had also been standardized in Japan, and jingmai, a term coined in Japan. Missionaries had sought to distinguish the flow of blood from the Chinese medical conception of mai/pulse by adding to it the word guan/tube, while the elite Chinese felt that the mai concept could be usefully redeployed along the lines that the Japanese anatomists had standardized it in 1905. While this debate can profitably be analyzed from the perspective of the attempts of Chinese elite doctors both to sublimate and to enroll missionaries within their State-centered projects, it can also be seen in terms of the mundane reclassifying of knowledge. Between 1916 and 1919 when the Joint Terminology Committee standardized Chinese anatomical terminology there were three possible existing sources for nomenclature: old Chinese terms (benguo jiuming, 本國舊名), old translated terms (jiu yiming, 舊譯名), and Japanese terms (riben, 日本). The existing old Chinese terms represented 18 percent of the final decided-upon terms. The main selection criterion was everyday common usage, primarily for visible or well-known body parts. These would not necessarily have been selected from Chinese medical classics; they were usually an embedded part of the vernacular, although regional variations and dialects could sometimes confuse the situation. Nonetheless, members of the Joint Terminology Committee often arrived at the meetings with large libraries of Chinese medical texts and dictionaries in tow. Any terms that could be extracted and rerouted from Chinese medicine to describe anatomical structures were acceptable, while those terms, like sanjiao, or dantian, describing a function that could not be easily mapped onto the anatomical body were derided and ignored.

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The project of Yu Fengbin, Tang Erhe, Yu Yunxiu, and their many colleagues to reclassify knowledge from previously existing forms (i.e. Chinese medicine) to the anatomo-medical form was a mundane form of governmentality perhaps more powerful in constraining and redirecting Chinese medicine than the overt political attempts to abolish it. Most of the terminology for anatomy accepted by the Joint Terminology Committee originated from, or was influenced by, new terms coined by the Japanese in those three short years. Established Japanese terminology provided one-quarter of the adopted terms and inspired the compound terms the committee tinkered with for another 50 percent. Old Chinese and missionary-translated terms made up the final quarter. The activities of these self-proclaimed medical scientists shifted not only the Chinese language, but the whole conceptualization of the cosmos. The old worldview was dislodged in the circulation of new terms, and a new, “more technocratic” worldview came to govern the Chinese thought world in all fields from the sciences to the humanities. On this point Wang Hui argues that “[a] large portion of the vocabulary of modern Chinese was created by conscious, linear design; these words were the products not of a natural process but of a technical one.” This was prosecuted most clearly in the work of the Joint Terminology Committee. This instrumental creation of vast numbers of terms would shape the way Chinese would now look at the world. Language precipitated a Copernican revolution whereby throughout the twentieth century the majority of educated Chinese would find it increasingly impossible to understand Chinese medicine apart from the terminology of biomedicine and the anatomo-medical view of the body. For Wang, “[t]he technical design of language satisfied the needs of both the scientific community and of a modernizing society and technocratic structure.”73 While Wang Hui’s focus is exclusively on the participation of the Association of Chinese Scientists (Zhongguo kexue she, 中國科學社), as I have demonstrated, the process was well under way with the activities of missionaries, philologists like Shen Enfu, and physicians like Tang Erhe and Yu Fengbin before the scientists joined the expanded committee to standardize scientific terminology in 1919. Yet Wang, in the context of his larger work on the origins of modern Chinese thought, captures well the significance of this mundane work in deterritorializing, word by word, the “cosmic order” of the late imperial period and replacing it with a more technocratic one – what I have here called a logic of governmentality. (Self)-governmentalizing of Chinese medicine The attempts of anatomo-medical modernizers like Yu Yunxiu, Tang Erhe, Yu Fengbin and Liu Ruiheng to constrain or eliminate Chinese medicine may have

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been a significant factor in its survival. C. C. Chen, the Peking Union Medical College-trained rural health expert, no great supporter of Chinese medicine, would write in his memoirs that these “modern physicians [of the 1920s] … inadvertently delayed the diffusion of scientific medicine probably by many decades through their demands for the abolition of traditional medicine.”74 But with what result exactly? I would like to offer a reading of several important recent texts on TCM and attempt to draw the connection between the governmentalizing logic that Tang and Yu tapped into in their attempts to coerce and reclassify Chinese medicine and the ongoing attempts to standardize terminology, knowledge, practice, and materia medica in what has come to be known as TCM. Scientizers like Tang and Yu attempted to establish and institutionalize scientific medicine and practice by diminishing, reforming, and eliminating existing knowledge and networks. Yet Chinese medicine (among other forms of pre-existing knowledge) did not disappear, even if it was radically transformed through its encounter with the institutionalizing power of sciencemodernity-capitalism. Historians of Chinese medicine have often traced the attempts of Chinese medical practitioners to “scientize” and (re)organize their practice under the state to the 1929 abolition proposal, or to the earlier attempt to get state recognition in 1925 described above. Yet as we have seen, as early as 1915, previous to Tang’s first attempt to regulate medical practitioners in China through a census and strict regulations, some physicians had tried to initiate institutionalization of Chinese medicine.75 Following the work of anthropologists and historians of Chinese medicine, I see at least two themes in this period that continue in a dialectic from the 1910s, past the attempt at abolition and the early Maoist period, and have accelerated in the reform era of the past thirty years. The first is the survival of Chinese medicine as an alternative medical system, an effective cure for diseases that baffle biomedicine. The second is the subordination of Chinese medicine to a scientific worldview. The first theme – that Chinese medicine should be understood to be an alternative to western medicine – is evident as early as 1921. In the preface to the Chinese Medical Dictionary published that year, general editor Xie Guan admitted what is in the twenty-first century a familiar rationale for Chinese medicine – that despite the rise of western medicine, and Chinese medicine becoming “an object of public denunciation,” there are diseases that western medicine cannot heal and that Chinese medicine can.76 This relegation of Chinese medicine as the (scientific) medicine of exceptions is confirmed in Mei Zhan’s recent ethnography where she explores the role of clinical miracles as both the proof for the effectiveness of Chinese medicine and, at the same time, a mechanism for keeping it marginal and an alternative to western medicine, rather than allowing it to become a fully universal therapeutic system on its own.77

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The second theme, the ongoing attempts at scientizing and standardizing Chinese medicine, is more cogent to the argument of this chapter regarding the logic of governmentality. Farquhar tells us that “[a]mong those members of Chinese medicine’s next generation of leaders who have glimpsed the world of cosmopolitan science … there seems to be little nostalgia for a ‘pure’ Chinese medicine of practical clinical work. Science is the weapon of their generation in a struggle to ensure a future for themselves and their students.”78 This was the same approach that Tang Erhe and Yu Yunxiu and their colleagues took to bring western medicine up to their conception of a scientific standard in the 1910s and 1920s. There is a straight line of attempts by men in laboratories to isolate effective chemical ingredients of Chinese herbs so that substitutes and new drugs can be formed into standardizable pills for the mass market: from the rudimentary investigations of medical missionaries in the nineteenth century, through Yu Yunxiu’s lifelong investigations, and into the present day.79 Since the 1910s (some) practitioners of Chinese medicine have attempted to establish State-sponsored medical schools and a unified medical curriculum, and this process accelerated after 1929, 1949, and continues in the post-Mao period. As Chinese medicine goes on attracting patients and non-Chinese-speaking practitioners, there is now a new attempt to standardize translations of medicine, only now the source language is Chinese and the target language is English (or German or French). The problems that would-be language standardizers like Nigel Wiseman or Shuai Xiezhong and his colleagues in Changsha face are not equal to those faced by the translators and standardizers who gathered in Shanghai in 1916, but the principles run parallel.80 I would argue that all of these standardizations represent the logic of governmentality working its way through TCM. If other scholars have called this process the “worlding” of Chinese medicine,81 or a product of its “globalization,” I would not disagree, but would emphasize the point that both western medicine and Chinese medicine have been subject to these processes: “Within China [such globalization] refers to attempts to infiltrate territory that was once the sole domain of biomedical power and technology. It refers to the standardization of teaching, practice, and bureaucratic control necessary for such a process to succeed.”82 So, if political power was the conscious goal of the scientizers, whether those of western medicine or indigenous medicine, then the governmentalizing of medicine in China, both western and Chinese, was the long-term result that we can see in the 100-year arc from the 1910s to the 2010s. In a period when the state became very weak, the practitioners of both medical traditions began taking up a new logic of organizing themselves and their knowledge. Anglo-American-trained physicians organized the NMA (中華醫學會) in 1915; Japanese-trained physicians organized the Republic of China Medical and Pharmaceutical Association (中華民國醫葯學會) in the

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same year, entering into China’s already rapidly modernizing medical field centered on the Beijing–Shanghai dyad. Also in the 1910s, physicians of Chinese medicine began organizing beyond lineage and teacher–student relations into powerful federations, from individual clinics into hospitals, and from informal instruction usually reserved only for sons and favored students to larger educational institutions. This chapter has argued for the significance of the mundane activity of linguistic standardization to the overt political goals of medical activists and the governmentalization of the medical field in China. It has attempted to push the argument further to say that the logic of governmentality inherent in the activity of language standardization and related processes was more than the result of the instrumental activities of a few politician-physicians like Tang Erhe and Yu Yunxiu, but was rather operating on a logic all its own that subsumed both China’s new and its old forms of medical therapy. This logic of governmentality has now absorbed much of the visible structure of Chinese medicine, although we hear many hopeful accounts that plurality continues to exist and even proliferate: “Plurality, as I have labored to show, is the essential factor in the origin not merely of nature but also of society. Repression of such plurality  – even or especially where it is carried out in the name of science – is only ever driven by two forces: ignorance and the desire for power.”83 In arguing for the universality of a science centered in Euro-America, George Basalla mockingly included a quote from an early nineteenth century “Chinese dignitary” that points to the myopia of a science that looks only for details: “With a microscope you see the surface of things. It magnifies them but does not show you reality. It makes things seem higher or wider, but do not suppose you are seeing the things in themselves.”84 The question anthropologist Volker Scheid would put to scientizers who would potentially abolish plurality is this: “What, ultimately, is gained from restraining Chinese medicine by means of a rationality blind to its own irrational constitution, and gained for whom? What would be lost by embracing its different aesthetics of practice?”85 The debate over the body of Yuan Shikai in 1916 may be seen as an early episode of the phenomenon that Sean Lei has described as Chinese medicine encountering the State.86 Practitioners of the new medicine were for the first time attempting to exert exclusive authority. But that attempt failed, like the abolition attempt of 1929. The more important event of 1916 was the terminology meeting that met in Shanghai, with a group of newly professionalized AngloAmerican-trained physicians led by Yu Fengbin, and German-Japanese-trained physicians led by Tang Erhe, who also represented the State. The mundane work of this committee established a base line of technical terminology that would irretrievably shift the epistemology of the Chinese language, at least for educated elites, toward anatomical medicine and away from Chinese medicine.

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1 Jerome Chen claims there were three French doctors in attendance; Jerome Chen, Yuan Shih-k’ai (Stanford: Stanford University Press, 1972), 192. 2 In this chapter the new medicine will be called anatomo-medicine, not because it was an actor’s category, but because it describes the fundamental difference between the two forms of medical therapy as expressed in the words and actions of its key proponents; see David Luesink, “Dissecting modernity: Anatomy and power in the language of science in China” (Ph.D. dissertation, University of British Columbia, 2012). 3 Editorial, National Medical Journal of China 2.3 (1916): 1–5. 4 Ibid., 2. 5 Ibid. 6 Ibid., 3. 7 Volker Scheid, Currents of Tradition in Chinese Medicine: 1626–2006 (Seattle: Eastland Press, 2007), 184. 8 “Editorial: The official recognition of western medicine,” National Medical Journal 2.2 (1916): 1–2. The original law was submitted by Tang Erhe and is examined below. 9 For an evaluation of Yuan’s policies and his legacy, see Chen, Yuan Shih-k’ai, 179– 215; Ernest Young, The Presidency of Yuan Shih-k’ai: Liberalism and Dictatorship in Early Republican China (Ann Arbor: University of Michigan Press, 1977), 177–254. See also Paul Cohen, “The post-Mao reforms in historical perspective,” Journal of Asian Studies 47.3 (1988): 6–7, 11–19; and Philip Kuhn, “The development of local government,” in Cambridge History of China: Republican China, 1912–1949, Part II, ed. John K. Fairbank and Albert Feuerwerker (Cambridge: Cambridge University Press, 1986), 329–60 (339). 10 For a sophisticated counter-argument, see Yi-Li Wu, Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (Berkeley: University of California Press, 2010), esp. 84–119; and Pi Guoli, Jindai zhongyi de shentiguan yu sixiang zhuanxing: Tang Zonghai yu Zhong-Xiyi huitong shidai (Modern Chinese Medical Conceptions of the Body and Intellectual Transition: Tang Zonghai and the Era of Chinese–Western Medical Convergence and Communication) (Beijing: Sanlian Shudian, 2008). 11 Never mind the “accuracy” of the “Accurate (western)” (!) second image. Lorraine Daston and Peter Galison discuss the changing modes of truth-to-nature in scientific representation, from idealized images of the eighteenth century to the apparently more objective lithographed, and then photographed, images of the nineteenth and twentieth centuries; Lorraine Daston and Peter Galison, Objectivity (New York: Zone Books, 2007). 12 National Medical Journal of China 1.1 (1915): 51–2. 13 Yu Yunxiu, “Yixue geming de guoqu gongzuo, xianzai xingshi he weilai de celue” (“The past work of the medical revolution, its present state and future strategy”), Zhonghua yixue zazhi 20.1 (1934): 11–23. 14 See Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (New York:

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[n.p.], 1910); Abraham Flexner, Medical Education in Europe (New York: [n.p.], 1912); and China Medical Commission of the Rockefeller Foundation, Medicine in China (Chicago: University of Chicago Press, 1914). Significantly, the China Medical Commission believed that English was the preferred medium to transmit their standardized version of medicine to China. 15 Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982). See the essays in Norman Gevitz, Other Healers: Unorthodox Medicine in America (Baltimore: Johns Hopkins University Press, 1988), for the fate of unorthodox medicine in the USA. 16 David Luesink, “The History of Chinese Medicine: Empires, transnationalism and medicine in China, 1908–1937,” in Uneasy Encounters: The Politics of Medicine and Health in China, 1900–1937, ed. Iris Borowy (Frankfurt am Main: Peter Lang, 2009), 149–76. Wang’s collection became the basis for the impressive collection now housed at the Shanghai University of Traditional Chinese Medicine’s museum. 17 On Shennong’s materia medica see Paul U. Unschuld, Medicine in China: A History of Ideas (Berkeley: University of California Press, 2010), 113–14. 18 Yu Fengbin, “A discussion of the preservation of ancient medicine,” National Medical Journal 2.1 (1916): 4–6. This has been widely demonstrated to be an inaccurate representation of medicine in China. See especially Carla Nappi, The Monkey and the Inkpot: Natural History and Its Transformations in Early Modern China (Cambridge, MA: Harvard University Press, 2009); Scheid, Currents of Tradition; Marta Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China (New York: Routledge, 2011). I argue in “The History of Chinese Medicine” that even K. Chimin Wong and Wu Lien-Teh, History of Chinese Medicine, 2nd edn. (Shanghai: National Quarantine Service, 1936) speak with two voices about whether Chinese medicine had been stagnant or not. 19 Compare Margaret Lock, East Asian Medicine in Urban Japan: Varieties of Medical Experience (Berkeley: University of California Press, 1980), 50–66. 20 Fengbin, “A discussion.” See also Wang Songyuan, “Zhongguo gudai yixue shifou you baocun zhi jiazhi,” National Medical Journal 8.3 (1922): 152–3, which responds to Yu Fengbin’s article directly and argues China’s ancient medicine has only historical reference value, and no preservation value. 21 See Kim Taylor, Chinese Medicine in Early Communist China, 1945–63: A Medicine of Revolution (London: RoutledgeCurzon, 2005), 136–7; T. J. Hinrichs and Linda Barnes, Chinese Medicine and Healing: An Illustrated History (Cambridge, MA: Belknap Press, 2013), especially Chapters 7–8. 22 See Angela Leung and Charlotte Furth, Health and Hygiene in Chinese East Asia: Policies and Publics in the Long Twentieth Century (Durham, NC: Duke University Press, 2010), 280. For more on the Japanese adoption of Staatsmedizin, see Michael Shiyung Liu, Prescribing Colonization: The Role of Medical Practitioners and Policies in Japan-Ruled Taiwan, 1895–1945 (Ann Arbor: Association of Asian Studies, 2009). 23 Besides medicine, these students studied in military academies and various technical schools. The increase in numbers in this period is striking between 1898

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and 1901, then doubling or tripling each year until 1905, with a peak of 12,000 in 1906; Sanetō Keishū(實籐惠秀), Zhongguo yi Riben shu zonghe mulu (Hong Kong: Chinese University Press, 1980), 47. 24 Qian Yimin and Yan Zhiyuan, Yan Fuqing zhuan (Biography of Yan Fuqing) (Shanghai: Fudan daxue chubanshe, 2007); Wang Zhe, Guoshi wushuang Wu Liande (Man of Superior Talent: Wu Liande) (Fuzhou: Fujian jiaoyu chubanshe, 2007). 25 Historian of Chinese medicine Zhao Hongjun says that Tang has become a laughing stock in medical circles for taking money from the enemy; Zhao Hongjun, Jindai zhongxiyi lunzhengshi (A History of the Controversy between Chinese and Western Medicine in the Modern Period) (Hefei: Anhui Kexuejishu chubanshe, 1989), 102. 26 He followed up this deep connection between anatomo-medicine and the regulation of Chinese medicine in his fact-finding mission to Japanese Manchuria, Korea, and Japan in 1917; Tang Erhe, “Dongyou riji” (“Diary of a journey to the East”), Zhonghua minguo yiyao xuehui huibao 1 (1917): 1–48. 27 Zhao, Jindai zhongxiyi lunzhengshi, 102. 28 Ibid., 103 says this was in approximately 1915, although Tang’s original memorial is not clear: “Cheng jiaoyubu qingzhengqing yishi yubei kaiye shiyan you” (“A request for the Ministry of Education to enact procedures to regulate physicians”); Tang, “Dongyou riji,” 5. 29 “Request to regulate physicians”; ibid. 30 Zhao, Jindai zhongxiyi lunzhengshi, 103. 31 Tang, “Dongyou riji.” Tang gave no reason for not surveying Japanese medical developments in Taiwan. 32 Chow Tse-tsung, The May Fourth Movement: Intellectual Revolution in Modern China (Stanford: Stanford University Press, 1960), 41–8 is still an excellent summary. 33 Several of these men were founding members of the Chinese Communist Party and others were prominent liberal intellectuals throughout the 1920s and beyond. 34 Tang Yousun (Tang Qi), Tang Erhe xiansheng (Mr. Tang Erhe) (Beijing: Yadong Shuju, 1942), 19–23; see also Timothy Weston, The Power of Position (Berkeley: University of California Press, 2004), 61; Paula Harrell, Sowing the Seeds of Change: Chinese Students, Japanese Teachers, 1895–1905 (Stanford: Stanford University Press, 1992), 135. 35 Chow, The May Fourth Movement, 308. 36 Volker Scheid argues that a stream of Chinese medicine as early as the Nanjing, or Classic of Difficulties, ceased to link the functions of the sanjiao to concrete anatomical structure; quoting the Nanjing, the sanjiao “has a name, but no bodily shape”; Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis (Durham, NC: Duke University Press, 2002), 28. 37 Tang Erhe, “Sanjiao! Dantian!” (“Triple Burner! Cinnabar Field!”), Xin Qingnian 4.5 (1918): 483. 38 Translated in Chow, The May Fourth Movement, 308.

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39 Duxiu, “Sanjiao! Dantian!,” 484. 40 Ralph C. Croizier, Traditional Medicine in Modern China: Science, Nationalism and the Tensions of Cultural Change (Cambridge, MA: Harvard University Press, 1968); Zhao, Jindai zhongxiyi luzhengshi; Bridie Andrews, “The making of modern Chinese medicine, 1895–1937” (Ph.D. dissertation, Cambridge University, 1996); Sean Hsiang-lin Lei, “When Chinese medicine encountered the State: 1910–1949” (Ph.D. dissertation, University of Chicago, 1999); Xiaoqun Xu, Chinese Professionals and the Republican State: The Rise of Professional Associations in Shanghai, 1912–1937 (Cambridge: Cambridge University Press, 2001); Scheid, Currents of Tradition. 41 Yu Yunxiu, “Yixue Geming de guoqu gongzuo, xianzai xingshi he weilai de celue” (“The past work of the Medical Revolution, its present state and future strategy”), Zhonghua yixue zazhi 20.1 (1934), 11–23; Yu Yunxiu, Yixue Geming lunwenxuan (Collected Essays on Medical Revolution) (Taipei: Yiwen chubanshe, 1976). 42 These other authors, such as Qin Danwei (秦但未), Zuo Zhihen (鄒趾痕), Li Weinong (李慰農), and Yun Tieqiao (惲鐡樵) himself, appeared in journals of Chinese medicine like the 三三醫報 (Minguo yixue, Republican Medicine; 1923– 29, published in Hangzhou, Shanghai Library [2004]: 22), whereas Yu Yunxiu tended to publish his refutations of Yun Tieqiao in either the German-focused medical journal民國醫學雜誌 (1923–32) or the women’s literary supplement Xinsheng: Funu wenyuan (心聲:婦女文苑). 43 K. Chimin Wong and Wu Lien-Teh, History of Chinese Medicine (Shanghai: National Quarrantine Service, 1936), 162. 44 Ibid., 162. 45 Chen Bangxian, Zhongguo yixueshi (History of Medicine in China) (Shanghai: Shangwu yinshuguanm, 1937), 267. 46 Translation, Lei, “When Chinese medicine encountered the State,” 83. 47 See Sean Hsiang-Lin Lei, “When Chinese medicine encountered the State: 1910– 1949” (Ph.D. dissertation, University of Chicago, 1999); Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (Berkeley: University of California Press, 2004). 48 Yu, “The past work of the Medical Revolution,” 13. 49 Londa Schiebinger, Plants and Empire: Colonial Bioprospecting in the Atlantic World (Cambridge, MA: Harvard University Press, 2004); Robert Proctor and Londa Shiebinger, eds., Agnotology: The Making and Unmaking of Ignorance (Stanford: Stanford University Press, 2008). 50 For Basalla each “colony” (his colonies include the whole world, except western Europe) was a tabula rasa of data and samples to be gathered by practitioners of western science; there is no specific mention of cribbing or culling from existing knowledge as was the case. George Basalla, “The spread of western science,” Science, new series, 156.3775 (1967): 611–22. 51 Anatomists began standardizing terminology only in 1895 in Basle, Switzerland, not long after the invention of chloroform made major surgery a regular form of therapy.

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52 See Fa-ti Fan, British Naturalists in Qing China: Science, Empire, and Cultural Encounter (Cambridge, MA: Harvard University Press, 2004), and especially the extensive publications of Beijing-based pharmacy professor, Bernard Read, from the early twentieth century; for example, Botanical, Chemical, and Pharmacological Reference List to Chinese “Materia medica,” (Peking: Bureau of Engraving and Printing, 1923). 53 Scheid, Currents of Tradition, 213 only indicates that Yu pursued this after his failed attempts, but Yu also published on this topic as early as 1923, in the middle of his Terminology Committee involvement. See Yu, “Yixue Geming,” 11–14. 54 James L. Hevia, English Lessons: The Pedagogy of Imperialism in Nineteenth-Century China (Durham, NC: Duke University Press, 2003); Gilles Deleuze and Félix Guatarri, Anti-Oedipus: Capitalism and Schizophrenia (Minneapolis: University of Minnesota Press, 1983). 55 Basalla, “The spread of western science,” 156. 56 For the nineteenth-century encounter between British naturalists and Chinese counterparts see Fan, British Naturalists in Qing China. 57 Yu, “The past work of the Medical Revolution,” 16. 58 This phrase comes from the titles of two books about lexical change in China in the late nineteenth and early twentieth centuries: Ada Haven Mateer, New Terms for New Ideas: A Study of the Chinese Newspaper (Shanghai: Presbyterian Mission Press, 1917); and Michael Lackner, Iwo Amelung, and Joachim Kurtz, eds., New Terms for New Ideas: Western Knowledge and Lexical Change in Late Imperial China (Leiden: Brill, 2001). 59 This renaissance of classical learning has been called “revolutionary archaism” in the Chinese context. The larger move toward a revival of the ancients in the nineteenth century is associated with Han learning. See Benjamin A. Elman, From Philosophy to Philology: Intellectual and Social Aspects of Change in Late Imperial China (Cambridge, MA: Council on East Asian Studies, Harvard University Press, 1984). 60 Compare this use of anatomical knowledge to boost the study of ancient learning in Europe – the so-called “anatomical renaissance.” See Andrew Cunningham, The Anatomical Renaissance (Aldershot: Scholar Press, 1997). 61 Compare to Wang Qingren’s controversial 1830 book on anatomy, Correcting the Errors of Physicians (醫林改錯), which claimed, “on the basis of first hand information, that the anatomical contents of the ancient medical classics were all wrong”; trans. Andrews, The Making of Modern Chinese Medicine, 36. Although Wang’s critique is stronger than Tang Zhonghai’s, and preceded it by some fifty years, it remained a controversial, if seminal, work in gradually opening minds to western anatomy. 62 Tan Sitong, “Lun quanti xue” (“Treatise on anatomy,” 1898), in Tan Sitong Quanji (Complete Works of Tan Sitong), (Taibei: Zhonghua shuju, 1981), 403. 63 Yu Yunxiu, “Preface,” Xingyi yu Shehui Huikan (The Collected Papers from the New Medicine and Society) 1(1928): 1–2, trans. Lei, “When Chinese medicine encountered the State,” 80. 64 See Sean Lei’s discussion of the significance of Yu Yunxiu’s connection of the abolition of Chinese medicine and national affairs – i.e. the governmental practices

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of collecting “national vital statistics” such as “certifying the causes of death,” “classifying diseases,” etc.; ibid., 86–7. See Malcolm Thompson, “The birth of the Chinese population” (Ph.D. dissertation, University of British Columbia, 2013)  for an extended exploration of the significance of vital statistics, and the creation of the concept that China had a “population.” For more on eugenics in Republican China, see Frank Dikötter, Imperfect Conceptions: Medical Knowledge, Birth Defects, and Eugenics in China (New York: Columbia University Press, 1998); Juliette Yuehtsen Chung, Struggle for National Survival: Chinese Eugenics in a Transnational Context, 1896–1945 (London: Routledge, 2002). 65 Tang Erhe, “Cheng jiaoyubu qingzhengqing yishi yubei kaiye shiyan you” (“A request for the Ministry of Education to enact proceedures to regulate physicians”) Zhonghua minguo yiyao xuehui huibao 1 (1917): 5. 66 For a discussion of quanti and quantixue, their origin in the works of Benjamin Hobson, and later deployment by Liang Qichao and Tan Sitong, see Federico Masini, The Formation of Modern Chinese Lexicon and Its Evolution toward a National Language: The Period from 1840 to 1898, Journal of Chinese Linguistics Monograph Series 6 (Berkeley: Project on Linguistic Analysis, University of California, 1993), 192–3. The other terms are taken from the General Committee on Scientific Terminology, Medical Terminology Serial No. 1, Anatomy: Osteology (public domain, 1919) list of osteological terms, including pre-existing terms and the final terms approved by the Ministry of Education. Actually, jiepou has been accepted by many Chinese scholars as a Japanese neologism, yet it first appeared in the Lingshujing (靈樞經) – a Tang Dynasty medical textbook – was later forgotten in China, and reintroduced from Japan in the last decade of the nineteenth century (Masini, Formation of Modern Chinese Lexicon, 181). For further discussion of missionary use of this term and its alternatives, see Gao Xi, “‘Jiepouxue’ zhongwen yiming de youlai yu queding – yi Dezhen Quanti tongkao wei zhongxin” (“The source and determination of the Chinese translation of ‘anatomy’: With reference to J. Dudgeon’s Reference on the Whole Body [Grey’s Anatomy]),” Lishi yanjiu 6 (2009): 80–104. 67 Tang, “Cheng jiaoyubu,” 5.2. 68 General Committee on Scientific Terminology, Medical Terminology Serial No. 1, 5, 16; cf. Yu Fengbing, “Yixue mingci shencha hui di yi ci kaihui jilu” (“Minutes of the first meeting of the Medical Terms Investigation Committee”); “Yixue mingci shencha hui di er ci kaihui jilu” (“Minutes of the second meeting of the Medical Terms Investigation Committee), Zhonghua yixue zazhi 3.2 (1917): 34–5. 69 For a detailed explanation of the role of this book, see William G. Boltz, The Origin and Early Development of the Chinese Writing System (New Haven: American Oriental Society, 1994), 142–3. 70 Yu, “Yixue mingci shenchahui di yi ci kaihui jilu,” “Yixue mingci shenchahui di er ci kaihui jilu,” 35. 71 Ibid. 72 Nigel Wiseman translated dongmai in Chinese medicine as “stirred pulse; pulsating vessel,” clearly a radically different classification than the post-Harvey western conception of the artery as the flow of the blood away from the heart, and veins as flowing in the opposite direction, as Tang describes in Yu, “Yixue mingci

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shenchahui di yi ci kaihui jilu,” “Yixue mingci shenchahui di er ci kaihui jilu,” 34. Nigel Wiseman, Ying–Han, Han–Ying Zhongyi cidian (Dictionary of Chinese Medicine) (Changsha: Hunan kexue jishu chubanshe, 2006), 447. The concept of blood circulation this way did not exist in Chinese medicine, and so there was no term for the jingmai, or “tranquil” vessels, until the Japanese coined it. 73 Wang Hui, “Discursive community and the genealogy of scientific categories,” in Everyday Modernity in China, ed. Madeline Yue Dong and Joshua Goldstein (Seattle: University of Washington Press, 2006), 80–120 (91–2). 74 After decades of forced accommodation of Chinese medicine, C.  C. Chen still had “no question in my mind of the superiority of modern medicine to our own traditional system”; C.  C. Chen, Medicine in Rural China: A Personal Account (Berkeley: University of California Press, 1989), 3. 75 For more on this see Scheid, Currents of Tradition, 189–222. 76 Xie Guan, Zhongguo yixue dacidian (Chinese Medical Dictionary) (Shanghai: Shangwu yinshuguan, 1921). In the wake of its success with a new term dictionary, the Ciyuan, the Commercial Press of Shanghai published medical texts of both the “new” and “old” medicine, including a brand new form of text, the medical dictionary. See Scheid, Currents of Tradition, 357–87 for more on Xie Guan, Wu Jin, and the Menghe current of Chinese medicine. The clinical miracle as rationale for TCM in contemporary Shanghai and San Francisco is explored in Mei Zhan, Other-Worldly: Making Chinese Medicine through Transnational Frames (Durham, NC: Duke University Press, 2009), Chapter 3. 77 The clinical miracle as rationale for TCM in contemporary Shanghai and San Francisco is explored in Mei Zhan, Other-Worldly: Making Chinese Medicine through Transnational Frames (Durham, NC: Duke University Press, 2009), Chapter 3. 78 Farquhar, Knowing Practice: The Clinical Encounter of Chinese Medicine (Boulder: Westview Press, 1994), 19. 79 Sean Hsiang-Lin Lei, “How did Chinese medicine become experiential? The political epistemology of jingyan,” positions: east asia cultures critique 10.2 (2002), 333–64. 80 Wiseman, Zhongyi cidian; Shuai Xuezhong, ed., Han–Ying shuangjie changyong Zhongyi mingci shuyu (Terminology of Traditional Chinese Medicine) (Changsha: Hunan kexuejishu chubanshe, 2006). See especially the lengthy bilingual introduction given by Wiseman (1–105), which parallels the comments of Philip Cousland in his English–Chinese medical lexicons (An English–Chinese Lexicon of Medical Terms, Compiled for the Terminology Committee, 1st edn. [Shanghai: American Presbyterian Mission Press, 1908]; An English–Chinese Lexicon of Medical Terms, Compiled for the Terminology Committee, 2nd edn. [Shanghai: American Presbyterian Mission Press,1915]; etc.) and Yu Fengbin’s lengthy comments in his regular columns on language standardization in the National Medical Journal (a bilingual quarterly known as Zhonghua yixue zazhi in Chinese) from 1916 to 1927. 81 Zhan, Other-Worldly.

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82 Scheid, Chinese Medicine in Contemporary China, 269. 83 Ibid., 272. 84 Quoted in Basalla, “The spread of western science,” 617. 85 Scheid, Chinese Medicine in Contemporary China, 273. Scheid is referring to Bruno Latour’s discussion of the modern constitution that insists on purifying the connections between nature and culture (reductionism and increasing disciplinarization) even while such acts of purification actually create a proliferation of hybrids of nature and culture that the constitution does not allow us to see; Bruno Latour, We Have Never Been Modern, trans. Catherine Porter (Cambridge, MA: Harvard University Press, 1993). 86 Lei, “When Chinese medicine encountered the State”; and Sean Hsiang-lin Lei, Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity (Chicago: University of Chicago Press, 2014).

7

Slow medicine: how Chinese medicine became efficacious only for chronic conditions Eric I. Karchmer For many observers outside China, the efficacy of Chinese medicine remains in doubt or is only now just tentatively being confirmed by double blind clinical trials for a few specific interventions. Inside China, the picture is more complicated. Although there is no shortage of detractors, who reject Chinese medicine as a superstitious practice with little clinical merit, large numbers of people seem to accept the efficacy of Chinese medicine as well established for a very wide range of conditions. On a visit to a hospital of Chinese medicine on any given day, one will probably find long lines of patients with conditions as wide-ranging as rheumatoid arthritis, psoriasis, polycystic ovarian syndrome, diabetes, gastric reflux, stroke complications, chronic hepatitis B, infertility, congestive heart failure, asthma, headaches, and so on, seeking professional attention from a local specialist. According to the Ministry of Health, there were more than 327  million outpatient visits at Chinese medicine institutions in 2010.1 The first affiliated hospital of the Guangzhou University of Chinese Medicine claims to be the most highly visited hospital in the entire city of Guangzhou, with over 3 million outpatient and emergency room visits in 2013.2 This apparent embrace of the clinical efficacy of Chinese medicine is not, however, boundless, and patients and physicians also recognize the many benefits of “western medicine” (the name for biomedicine in China) therapies. One of the most widely recognized limits to the clinical efficacy of Chinese medicine is that it is considered to be slowacting, making it most suitable for chronic diseases, where speed is not a requirement of the therapeutic process. This claim is almost always made in comparison to the efficacy of western medicine, which is considered to be fast-acting and more appropriate for acute conditions. Indeed, this comparison peppers conversations about the relative strengths and weaknesses of the two medical systems in the form of the well-worn maxim: “Western medicine treats acute diseases; Chinese medicine treats chronic diseases” (“西医 治急性病; 中医治疗慢性病”).

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To both laypersons and doctors alike, this dichotomy of fast- and slowacting medicines treating acute and chronic diseases respectively seems to capture inherent differences between the two medical systems and their therapeutic potentials – so much so that as a student in the five-year Chinese medicine program at the Beijing University of Chinese Medicine in the late 1990s, I rarely heard anyone contest this statement during all of my training. Yet it turns out that as recently as the Republican era (1911–49), perceptions about the two medical systems were dramatically different. In 2008 and 2009, I had the honor of interviewing thirty-nine senior doctors, all of them octogenarians and nonagenarians, who repeatedly told me that Chinese medicine therapies were known to be fast-acting, effective treatments for acute illnesses in this period. Because contemporary beliefs are so deeply ingrained, some readers may be surprised to learn of these Republican era views. As both a researcher and practitioner of Chinese medicine, I was incredulous when I first encountered these claims and was only gradually able to accept them upon further research and reflection. How can we explain this dramatic shift in the public perception of the efficacy of Chinese medicine over a relatively short span of time? Is it possible that western medicine was not well understood in early-twentieth-century Chinese society? Perhaps patients’ familiarity with Chinese medicine gave them an undue faith in this medical system that gradually weakened with the spread of the modern education system? In this chapter, I argue that Republican era beliefs about the two medical systems are not a case of mistaken perceptions. Based on my interviews with senior doctors who trained and practiced prior to the Communist Revolution in 1949, I argue that there is compelling evidence to take Republican era observations at face value – doctors of Chinese medicine were once quite adept at using herbal and other therapies to achieve quick, decisive clinical results. What has changed is Chinese medicine itself and the social and political conditions under which it is practiced. Today both Chinese medicine and western medicine are part of a highly institutionalized national healthcare system that did not exist before 1949. The apparent “slowing down of Chinese medicine” was the result of a broader epistemological transformation in this medical system, so often imagined to be timeless and unchanging, that was brought about by this institutionalization process.3 The emergency room The slowness of contemporary Chinese medicine today is most apparent in emergency medicine, where speed is of the essence. Patients in need of urgent medical care in China today are most likely to receive it at the emergency room of their nearest hospital or medical center, much as one might expect in Europe, North America, and major metropolises around the world. Emergency

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medicine in China differs somewhat from these other locales in that it may be delivered through either western medicine or Chinese medicine hospitals. China’s national healthcare system consists of various tiers of State-run clinics and hospitals that that are divided into two parallel sets of medical institutions, one for Chinese medicine and one for western medicine. Although western medicine institutions dominate today, accounting for between roughly 75  to 80 percent of doctors, schools, and hospitals, the presence of Chinese medicine is not insignificant.4 All major cities have hospitals of Chinese medicine, and in the early 1980s all county seats were directed to establish at least one hospital of Chinese medicine as well. In addition to promoting two different types of medical services, state policies also encourage the integration of medical practices. General hospitals of western medicine (综合医院) can only receive the coveted top-tier ranking if they have a department of Chinese medicine; hospitals of Chinese medicine rely significantly on western medicine and biomedical technologies in their diagnosis and treatment. Despite state support for Chinese medicine institutions and policies to preserve some balance between the two main types of medical practice, there is a clear professional bias toward western medicine in the delivery of emergency medicine care. Patients can expect, and doctors will deliver, biomedical care whenever urgent medical attention is needed, whether they arrive at the emergency medicine department of a western medicine hospital or of a Chinese medicine hospital. In the late 1990s, I witnessed first-hand this bias toward biomedicine in emergency medicine care when I was a full-time student of Chinese medicine at the Beijing University of Chinese Medicine, training at the affiliated teaching hospital. All students were required to do a five-week clerkship in the Emergency Medicine Department (急诊科). Going into this clerkship, I was already aware of the strong focus on biomedicine in the department, but I was nonetheless surprised by the almost total absence of Chinese medicine interventions there. In other divisions of the hospital there might be a greater or lesser emphasis on biomedicine, but Chinese medicine treatments were almost always an essential part of the clinical work. Scholars and administrators have recognized the need to address the apparent deficiencies of Chinese medicine in the field of emergency medicine for quite some time. In the early 1980s, the Department of Chinese Medicine in the Ministry of Health (卫生部中医司) began organizing training courses in Chinese emergency medicine (中医内科急症进修班). The well-respected physician Huang Xingyuan (黄星垣), who had first trained in western medicine before studying Chinese medicine in the late 1950s, was entrusted with bringing together the materials from these courses into one of the first texts devoted to this topic.5 Projects such as this one eventually led to the development of a new textbook in 1997 (part of the 6th edition of the national textbooks of Chinese medicine) called Chinese Emergency Medicine (中医急诊 学). I happened to be a fourth-year medical student when this new textbook

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was published, and the course was added to that year’s medical school curriculum. Although this course was allotted a relatively small number of hours compared to the major courses, such as Chinese internal medicine (中医内 科), Chinese gynecology (中医妇科), (western) internal medicine, surgery, and so on, the teaching staff repeatedly reminded us of its importance. Many top doctors in our teaching hospital were brought in to lecture on specific subjects, unlike on other courses, which were usually taught by junior faculty. Unfortunately, the energy of this experimental new class did not carry over into our clinical training. Perhaps that should not have been surprising; doctors from the Emergency Medicine Department had only been minimally involved in teaching the course. The physicians of the Emergency Medicine Department, with one exception, had all been trained in Chinese medicine.6 But they relied almost entirely on biomedicine therapies in their clinical work, not the Chinese medicine approaches found in our new textbook. They had worked hard to acquire these skills. During my clerkship, my clinical teacher was particularly focused on mastering the department’s new ventilator. Although she and her colleagues prided themselves on their command of lifesaving western medicine technologies and drugs, they did not see their clinical work as a rejection of Chinese medicine, with which they still had a strong professional identification. Rather, they explained that their patients would have plenty of time to experience the benefits of Chinese medicine, once their conditions had been stabilized and they could be transferred to other departments of the hospital for more careful management. The absence of Chinese medicine in the emergency room was not regularly discussed; it was too routinized to merit this kind of attention. But I do remember one highly idealistic student, who was clearly upset about the situation. Although contemporary Chinese medicine education entails significant training in western medicine  – an integrative approach that most doctors and students appreciate – this particular student was deeply committed to learning only traditional medicine. He had never been happy about the strong emphasis on biomedicine in our curriculum, but his clerkship in the Emergency Medicine Department seemed to provoke a crisis. He became so distressed by the bias toward biomedicine in this department that my clinical teacher actually took him aside one day to discuss the “realities” of Chinese medicine. She explained that we couldn’t ignore the advantages of western medicine, particularly in fields such as emergency medicine, but that that fact does not diminish the many other benefits of Chinese medicine. In today’s society, with the knowledge we have, we cannot practice a pure Chinese medicine. Each medical system has its strength, she explained, and we should not ideologically limit ourselves to using just one approach. When I personally queried my teacher about the possibility of incorporating more Chinese medicine therapies into the department’s clinical work, she gave me a more practical answer, focusing on the logistical hurdles the department

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faced, particularly in the preparation of herbal medicines. Most herbal medicine prescriptions consist of a combination of herbs, often a dozen or so, that must be weighed, assembled, and brewed before they can be administered. Even with the aid of speedy pharmacists, cooking times can be significant – probably no less than a minimum of fifteen to twenty minutes but potentially requiring an hour or more  – thereby delaying time-critical interventions. Moreover, the hospital pharmacy and herbal preparation departments were designed to serve outpatient and inpatient needs and had no system in place for expediting emergency medicine orders. It usually took the hospital pharmacy about one to two hours to fill a typical outpatient prescription. Inpatient herbal medicine orders took a good bit longer, as they must also be cooked and delivered to the patient’s room. Thus a prescription for an admitted patient ordered by the attending physician in the morning will not be consumed by the patient until the mid-afternoon or later. To make matters worse, the hospital closes the Chinese medicine pharmacy at 5 p.m. everyday, leaving only the western medicine pharmacy open in the evenings when a large number of admissions to the Emergency Medicine Department are being made. Of course, these logistical obstacles are not insurmountable, but they nonetheless exacerbate the perception of slowness. One possible and partial solution to the difficulty of herbal preparation, a solution that many doctors insist is imperative to the future of the profession, is the development of new drug forms (剂型) beyond the traditional herbal decoction. Today granulated herbs that can be dissolved quickly in hot water are becoming popular, particularly for patients whose busy work schedules make preparing herbal decoctions at home very burdensome. Some of my clinical teachers were experimenting with these granules in the late 1990s, and now most major hospitals of Chinese medicine carry a full selection of bulk herbs and their granulated versions. Another example of a new drug form that has more significance for emergency medicine and critical care is Chinese medicinal infusions. During the 1990s, the State Administration of Traditional Chinese Medicine (SATCM), the highest government agency overseeing the Chinese medicine profession in China, developed a selection process to identify the most essential “Chinese patent medicines” (中成药) for emergency medicine. There is a long history of patent medicines in China – pre-made powders, pills, boluses, and other drug forms – that have been used in addition to herbal decoctions. New drug forms adopted from biomedicine, such as infusions, capsules, and syrups, are now also being used in the creation of Chinese patent medicines. The shortcoming of patent medicines is that as pre-made formulas they do not allow doctors to tailor their prescriptions to the individual needs of the patient, a feature of Chinese medicine therapies that most doctors consider essential to clinical efficacy. But their other qualities – readiness for immediate use, suitability for mass production – make them particularly appealing for emergency medicine use. As a result, the SATCM first identified fifteen essential patent medicines

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for emergency medicine in 1992, increasing that number to forty in 1995 and fifty-seven in 1997.7 Of the SATCM’s fifty-seven recommended patent medicines, the only one that I witnessed being used on a somewhat regular basis during my training was the infusion Qingkailing (清开灵), a formula based on the famous but expensive “Calming the Palace Bovine Bezoar Pill” (安宫牛黄丸). In the Emergency Medicine Department where I trained, Qingkailing was sometimes used in the treatment of acute strokes or high fevers but always in conjunction with standard biomedical interventions. Doctors seemed intrigued by this relatively new drug, but primarily as a supplement to the biomedical protocols they already had in place. On the whole, Chinese medicine treatments were so infrequent in the emergency room that I remember clearly one day when all the medical students came running to watch a doctor attempt an acupuncture treatment. It was the only time we witnessed an acupuncture treatment during our five-week rotation. The patient had suffered a stroke. He was unconscious, breathing with difficulty, and febrile, perhaps because of an infection whose location had yet to be identified. The admitting doctor had already initiated several western medicine interventions, and one of the residents decided to try an acupuncture treatment to help lower the patient’s fever. He pricked the patient at all ten fingertips (十宣穴), squeezing a couple drops of blood from each finger. We excitedly watched as the patient’s temperature inched downward, until it had fallen about 1 °C in about fifteen minutes. Acute illness in the Republican period I eventually came to inhabit this prejudice that Chinese medicine was too slow to be effective for most acute conditions. After completing my clerkship in the Emergency Medicine Department, I began to look back on my course on Chinese emergency medicine as less of a guide to clinical work than a description of an ideal that would probably never come to fruition. I did not give my training in emergency medicine or the related course much serious thought until nine years later, when I was involved in a new research project to collect oral histories from doctors born and trained in the Republican period. One of the most unexpected discoveries from this series of interviews involved the nature of the clinical work that these doctors did in the pre-Communist period. For example, Zhou Zhongying (周仲英) of Nanjing recalled assisting his father in successfully treating many cases of smallpox during epidemics in 1946, 1947, and 1948.8 He also remembered his father saving the lives of cholera patients in another 1946 epidemic, often using formulas like Poria Five Powder (五苓散) to open up yang and transform qi (通阳化气).9 Zhu Liangchun (朱良春), from Nantong, told me how he first made a name for himself during a dengue fever epidemic in 1940.10 Drawing on his apprenticeship

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experience with two different teachers, he was able to cure most of his patients from this disease in just three days.11 Shen Fengge (沈凤阁), who grew up in Chongmingdao (崇明岛) not far from Shanghai, remembers accompanying his teacher as he made home visits to the sickest patients. “They all had acute illnesses with fevers,” he told me, “such as pneumonia [肺炎], Cold Damage [伤寒, typhoid and other diseases], dysentery [痢疾], malaria [疟疾] … His results were very good … and he was a very prestigious man [威信很高].”12 Initially, I was dubious of these accounts of doctors treating acute diseases that contemporary practitioners would never dare to treat with Chinese medicine alone. I even wondered if these doctors thought of me as a gullible foreigner who could be easily swayed by their confident boasting. But as the anecdotes piled up, I began to re-examine the medical literature from this period, only to realize that there were countless similar cases that had previously escaped my attention. For example, many of the famous physicians of the Menghe current, renown for a clinical style that emphasized “harmonization and gentleness,” and catering to a well-heeled clientele that preferred mild therapies, established their reputations by curing acute, infectious diseases with fast acting herbs. Chao Shaofang (巢少芳, 1896–1950) was famous for treating meningitis and other infectious diseases.13 Ding Ganren (丁甘仁), one of the best-known doctors and reformers of the early Republican period, struggled to establish himself as a young doctor in Shanghai, until he acquired fame for his successful treatments during a scarlet fever (烂喉痧) outbreak in 1896.14 With each successive interview, I began to discuss more explicitly the nature of clinical medicine in the Republican period. Zhang Qi (张琪), the senior physician from Harbin, summed up best the trend to which almost all my other interviewees were gesturing: doctors not only commonly treated acute conditions in the Republican period, but, as he stated, “the Chinese medicine doctors who became famous [in the Republican period] became famous treating acute diseases [中医成名的人都是治疗急性病成名的].” The recollections of this last generation of doctors to study and practice during the Republican period painted a picture of clinical practice that was dramatically different from what I observed just a half century later. With each successive interview, my questions gradually began to shift: from confirming the surprising finding that Chinese medicine therapies could deliver fast-acting results in critical clinical situations to exploring how it had become an impotent bystander in contemporary emergency medicine. My interviewees did not always have easy answers to this question, even though each one of them had become quite famous in his later career for the treatment of certain chronic conditions. Nonetheless, taken as a whole, these interviews confirmed that this shift could not only be attributed to the rapid advances of western medicine in emergency medicine. In their lifetime, my interviewees had witnessed some breathtaking developments in western medicine that had revolutionized the field of emergency medicine – from antibiotics to fight acute

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infections, to catecholamines to maintain blood pressure during shock, to ventilators to assist breathing, to CTs to make rapid diagnostic assessments. Rather, their reflections suggested that the slowness of contemporary Chinese medicine was in large part due to a failure in knowledge transmission. This loss of knowledge – and the collective amnesia it has produced regarding the treatment of acute conditions  – is captured most emphatically for me by a story told by one of my clinical teachers in my final year of medical school. In the fall of 1999, shortly before my stint in the Emergency Medicine Department and ten years before my oral history research project, I was doing a clerkship in the Gerontology Department at our teaching hospital. I noticed that all of our admitted patients were being treated with antibiotics for any sign of an infection. One day, I asked one of the attending physicians, Dr. Hu, whether it was possible to rely on Chinese medicine alone to handle these infections. She wasn’t sure, she told me, since department policy required the use antibiotics when indicated. But she mused that it might be and told me about one of her experiences, treating a family friend outside the hospital – an elderly woman who had contracted a case of bacterial pneumonia. This woman was desperately trying to avoid a stay in the hospital and asked Dr. Hu to write her a prescription. But when Dr. Hu presented her with a prescription for antibiotics, the woman refused it, demanding a Chinese medicine prescription. Dr. Hu was taken aback. Pneumonia is a serious condition in the elderly with a high mortality rate, not something to be trifled with. Her eyes widened as she continued the story. “This woman had lobar pneumonia [大叶性 肺炎] and refused to take antibiotics. I thought she had a death wish. But she insisted, and I had no choice but to write her a Chinese medicine prescription. To my surprise, she got better!” Dr. Hu had been shocked by her own success. At the time, neither she nor I saw her account as evidence that Chinese medicine might be useful for a whole array of “acute illnesses.” The collective amnesia highlighted by this story, along with the unknown stories of my interviewees – gestures to a deep epistemic shift in nature of contemporary Chinese medicine. That doctors, scholars, or laypersons are generally unaware of these changes is perhaps best understood through the work of Thomas Kuhn, Michel Foucault, and other scholars of historical epistemology, who have argued that rapid epistemic changes are not always recognizable, even to the actors that may help bring them about. For example, Kuhn’s work repeatedly shows that scientific revolutions, or what he also calls paradigm shifts, in numerous fields of scientific inquiry were recast in narratives of incremental, progressive knowledge accumulation – past mistakes have finally led to today’s correct understandings.15 In this chapter, I will draw primarily on the accounts of my interviewees to outline the social and political changes that have contributed to this epistemic shift and at the same time made it almost inconceivable to me, Dr.  Hu, and countless other doctors of Chinese medicine that one could cure a case of lobar pneumonia with

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Chinese medicine alone. But first, we must re-examine the dominant narrative through which medicine in the Republican period has been studied: as a clash between the rapidly growing, modernizing profession of western medicine and the traditional, out-of-step-with-the-times practitioners of Chinese medicine. Once we recognize the limitations of this narrative, we can explore the more powerful social and demographic forces that were transforming the field of medicine. Contested histories The history of medicine in Republican China has been primarily focused on the struggle between the western medicine and Chinese medicine professions.16 Conflict arose in this period because a critical mass of Chinese nationals became doctors of western medicine, often by attending foreign medical schools. During this period of expanding imperialist encroachments on Chinese territory, these doctors were often aligned with reformist forces in Chinese society through their knowledge of a western scientific discipline, giving them significant political power despite their small numbers. Some of these doctors, together with many leading reformers, were hostile to Chinese medicine. The anxiety of the Chinese medicine community about the political might of their new rivals is palpable in the journals of Chinese medicine that proliferated during the 1920s and 1930s. Polemical pieces defending the value of Chinese medicine, reports on the discrimination against the Chinese medicine profession by government officials, etc., are a regular feature of these journals. For historians, the climactic moment of this politically charged period was the 1929 Bill proposed by Yu Yunxiu (余云岫), member of the Ministry of Health in the newly formed Nationalist government, to ban the practice of Chinese medicine. Although this bill failed to become law, it has come to symbolize the prejudice that has confronted the profession for most of the twentieth century. Historians have generally studied two features of the Republican period clash. First, scholars such as Ralph Croizier and Zhao Hongjun have examined the intellectual debate about the value of Chinese medicine. Fueled by the radicalism of the May Fourth Movement, many Chinese intellectuals beginning in the 1920s called for the urgent dissemination of science. They perceived Chinese medicine as an obstacle to their aspirations for the modernization of Chinese society and attacked it as a remnant of the old society, an unscientific practice that perpetuated superstitious beliefs. Writers, such as Lu Xun, Ba Jin, Lao She, and Zhou Zuoren mocked the ignorance of old-style doctors.17 Liang Qichao famously lamented: “Yinyang and Five Phases doctrines have been the general headquarters for more than the two thousand years of superstition … The very medicine upon which the lives of our generation depend is the product

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of this type of concept.”18 Some of the most influential critiques were made by Yu Yunxiu, who been a doctor of Chinese medicine before traveling to Japan to study western medicine. In 1916, he published a monograph, Deliberations on the Divine Pivot and Simple Questions(灵素商兑), which attacked the oldest and most revered of medical canons, The Yellow Emperor’s Inner Canon, charging that it was “filled with innumerable mistakes” and based on “a crude anatomy, vague and empty discourse, and dim nothingness.”19 Second, scholars such as Sean Lei and Bridie Andrews have addressed some of the political struggles and institutional development that paralleled these intellectual debates. Both authors demonstrate that there was nothing natural or inevitable about the development of western medicine in China. With the formation of the Nationalist government in 1928 by the Kuomintang of China (KMT), the two medical camps became engaged in a bitter struggle for state resources and support. Doctors of western medicine were quite effective in aligning themselves with the biopolitical goals of the state and gaining political advantage.20 But the Chinese medicine profession effectively organized to stop the 1929 abolition Bill from becoming law and, through the recruitment of allies from within the KMT government, achieved a tenuous but formal legal parity with western medicine by the mid-1930s.21 Sean Lei has cogently argued that many important changes to the Chinese medicine profession were spurred by this “encounter with the State.” His argument about the key role of the state in the clash between the two medical professions helps to explain why biomedicine had been present in Chinese society for decades as part of western missionizing efforts from the 1830s on, with only minor impact on the practice of Chinese medicine. One of the most surprising findings from my interviews with surviving doctors of this period is that many of them were indifferent toward or even unaware of what has been portrayed as a “life-and-death struggle” for the survival of Chinese medicine. Li Zhenhua (李振华) of Tianjin began studying medicine with his grandfather in his home village in Hebei Province as a teenager in the 1930s. “I was young at the time, I didn’t even know there were two types of medicine” – a discovery that he only made when he went to study at the Beijing College of National Medicine (北京国医学院) several years later after the death of his grandfather.22 Another well-known doctor of the same name, Li Zhenhua, from Luoning County (洛宁县) in Henan Province, told me that he only learned of the Republican era conflict after the establishment of the People’s Republic in 1949.23 He Ren (何任), the famous physician from Hangzhou who attended the Shanghai New China College of Medicine (上海 新中国医学院) in 1938, explained that he was the third generation to study medicine in his family. “We never thought about why we would study Chinese medicine. This is what my father did, so this is what I was going to do … At that time, [doctors of] Chinese medicine and western medicine were engaged in a furious debate, but we weren’t aware of it.”24

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Of the thirty-nine doctors that I interviewed, only two seemed to be aware of this clash. Deng Tietao (邓铁涛), who was born in 1916, remembered following debates in the Guangzhou newspapers as a young teenager, indignantly reading claims that ginseng had the clinical potency of a turnip. But his awareness of the struggle was sharpened considerably when he later became a student at the Guangzhou Technical College of Chinese Medicine (广州中医专门学 校) and first heard the stories of his teachers, some of whom had petitioned to stop the passage of the abolition bill.25 Deng Tietao has passionately defended the scientific value of Chinese medicine throughout his long career, so I was not surprised that he had followed these debates more closely than others. But I was astonished by the response of Gan Zuwang (干祖望), born in 1912 and a key figure in developing the ear, nose, and throat specialization within Chinese medicine. He told me of his great admiration for Yu Yunxiu and that he considered his book Deliberations on the Divine Pivot and Simple Questions – usually reviled in the Chinese medicine community as a tendentious, polemical attack against Chinese medicine – to be one of the most important books on Chinese medicine. Relishing the irony of his views, he told me that Yu Yunxiu “had insulted Chinese medicine, but he was right!”26 Since we know that the clash between the two medical professions, in particular the abolition proposal, produced a strong political response by the Chinese medicine community, why were so many of my interview subjects ambivalent toward or even unaware of these events? Although they would have been too young to participate in the heady events of 1929 and its immediate aftermath, I had fully expected them to all be like Deng Tietao, keenly aware of the politically charged environment in which they began their medical careers. The indifference or ignorance of my interviewees suggests that we need to undertake an important re-evaluation of the clash-of-medical-professions narrative that has dominated the medical history of the Republican era: these events were highly circumscribed, probably involving small numbers of elite practitioners in urban areas, and the overall impact on the Chinese medicine profession was small. Indeed, this may be why the irreverent Gan Zuwang could be so enamored with Yu Yunxiu. Yu Yunxiu was an insightful critic of Chinese medicine, but he never had the ability, and perhaps more importantly the Nationalist state never had the power, to carry out the “Medical Revolution” he preached. The work of historian Zhao Hongjun, who has discussed this conflict at length, seems to recognize this point implicitly. Zhao has pointed out that the conflict between the two professions was undoubtedly an urban phenomenon with its center in Shanghai. There were some sharp exchanges in Beijing and Tianjin, but many doctors in these cities on both sides advocated for the integration of the two medical systems.27 I cannot claim that my interviewees were ideal spokespersons for the sentiments of this era – they were the surviving few who were healthy enough and willing to be interviewed – but I suspect they do give a reasonable reflection of the urban parameters of this clash.28

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As we will see below, other recollections from my interview subjects will continue to displace the centrality of the clash-of-medical-professions narrative, at least as far as clinical practice is concerned. Their memories of the demographics, the clinical institutions, and the nature of medical transmission in the late Republican and early Communist era suggest an alternative history of this period that helps explain why this once fast-acting medical practice is now a slow one. The numbers One of the key facts of the Republican period, and perhaps the main reason that most doctors were unaffected by the clash between the two medical professions, is that doctors of Chinese medicine vastly outnumbered those of western medicine. Almost all of my interviewees reported that there were few, if any, doctors of western medicine working in their vicinity. Li Jiren (李济 仁), born in 1931 in She County (歙县) in Anhui Province said there were no doctors of western medicine near his home village when he was growing up. “In the countryside [at that time], you could say that 99 percent of the doctors were Chinese medicine doctors.”29 Guo Zhongyuan (郭中元), who was born in 1924 in Miyun County (密云县) outside Beijing, recalled that there were four doctors of Chinese medicine in his small village of Daxingzhuang but only a couple doctors of western medicine in the entire county. “They had worked as nurses for a bit in the army, then came home and started a clinic … Their technical skills weren’t good … and they didn’t have any equipment, not like modern hospitals. They would just listen with a stethoscope … They couldn’t treat much, much less than a Chinese medicine doctor.”30 In urban areas, doctors of western medicine would have been more numerous, but still considerably fewer than their Chinese medicine counterparts. Clustered in hospital facilities or running private clinics, their services and treatments were often beyond the financial reach of most people.31 Government documents estimate that there were approximately 9,000 registered physicians of western medicine in the country in 1937 at the outbreak of the SinoJapanese War, when most of my interviewees were just beginning their studies or their professional careers.32 About 22 percent of them were concentrated in Shanghai, making their numbers in other cities even more scarce.33 Zhang Xichun, a famous advocate for blending the two medical systems, sketched a similar picture of the relative strength of the two medical professions in an article that he wrote in response to the 1929 abolition proposal. I’ve recently learned about the Central Ministry of Health meeting, in which the leaders have favored the opinions of western medicine doctors to abolish Chinese medicine and Chinese herbs. [They made this decision] because the leaders are not members of the medical profession and don’t know the actual

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circumstances concerning Chinese medicine and western medicine. Looking at today’s situation, in big cities and commercial areas, no more than one out of ten patients sees a doctor of western medicine. In the average prefecture and county, no more than one or two out of a hundred patients visits a doctor of western medicine. Western medicine has been in China for many years. If it was so obviously superior to Chinese medicine, why are there so few believers? This is clear evidence. The Divine Farmer and the Yellow Emperor created Chinese medicine to protect our yellow race. Whenever there have been epidemics, there have also always been efficacious herbs and formulas to save lives. This is why the population of the yellow race is, in fact, greater than other races. The abolition of Chinese medicine would greatly affect the livelihood of the people and the wealth of the nation.34

Twenty years after the publication of this article on the eve of the Communist Revolution, Zhang Xichun’s summary of the state of the two medical professions was probably still fairly accurate. According to official statistics, the western medicine profession had grown more than fourfold to 38,000 doctors, although only 20,000 may have been graduates of medical school programs.35 Similar statistics are not available for Chinese medicine physicians at this time, but internal Communist Party documents from 1954 estimate that there were about 500,000 doctors, a figure that can probably be used as a rough guide to the number of doctors in the Republican era as well.36 Regardless of what the precise numbers were, it is perhaps more significant that my interviewees considered Chinese medicine to be the dominant form of medical practice in the Republican period. For example, Hangzhou had two major hospitals of western medicine during the Republican era: the French Shen’ai Hospital (神爱医院) and the British Guangji Hospital (广济医院). He Ren remembers them as being well run, but they were no competition for his father’s thriving clinic. “Most people held Chinese medicine in higher regard,” he told me.37 Deng Tietao remarked that in the age before antibiotics, the clinical efficacy of Chinese medicine in treating acute infectious diseases was respected even by doctors of western medicine. Deng recalled curing a young boy with a high fever, whose father had a clinic of western medicine right next to his own on Great Peace South Road (太平南路; now People’s South Road, 人民南路) in the late 1940s. That the doctor had turned to his Chinese medicine competitor for help was emblematic of the relative clinical strengths of the two professions, according to Deng.38 Zhang Jin (张缙), the well-known acupuncturist from Harbin, began his career as a doctor of western medicine, graduating from the Shenyang China Medical University (沈阳中国医科大 学) in 1951. But when he began working as a clinician, he discovered that: Western medicine had very few methods for curing disease. At the time, some people would joke that we were “three sector doctors” [三段大夫]. The head was one sector. If the head hurt, we used aspirin. The middle, the gastrointestinal tract, was the next sector. If the stomach hurt, we would use Stomach Powder

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[胃散, a compound probably containing calcium carbonate] … And last, if the legs and arms hurt, we would use phenylbutazone.39

Yang Zemin, the Marxist thinker and scholar of Chinese medicine from the Republican era, tried to give a more philosophical explanation to this situation: “Chinese medicine can cure illness and not know the patient’s disease. Western medicine may know the site of the disease and not have a therapy. This is why Chinese medicine disease names are chaotic and western medicine lacks therapies.”40 The private clinic The second key fact about medical practice in the Republican era is that the locus of clinical care was the private clinic. Almost all hospitals were hospitals of western medicine. They were relatively few in number and limited to urban areas. Some of the new colleges of Chinese medicine also established hospitals and used them as sites for clinical training.41 But many colleges were unable to resolve the finances of building and running a hospital.42 As a result, even those of my interviewees who attended colleges of Chinese medicine – about one-third of the total  – received their clinical training in the private clinics of their teachers rather than in a hospital of Chinese medicine. Most doctors had clinics in their home, although some doctors in urban areas rented a consultation space. Doctors in rural areas, where access to herbs might be more limited, were more likely to have a pharmacy attached to their clinic. Doctors in urban areas typically just offered consultation services but sometimes did acupuncture as well. Mornings were generally for walk-in consultations (门 诊), afternoons for house calls (出诊), either to those too infirm to visit the clinic or to those wealthy enough to pay an additional fee for the home visit. Because medical practice was private and patients paid for services out of their own pocket, economics played an important role in shaping clinical work. Many of my interviewees commented that the average patient could only afford to see a doctor for urgent medical issues. That meant that many nagging, chronic conditions, which would require a long course of treatment, or minor afflictions, which might get better on their own, went untreated. Only the wealthy had the resources to deal with these sorts of discomforts. The average patient therefore only sought medical help for acute illnesses and expected results in just a couple of doses. Jin Shiyuan (金世元), the well-known Chinese medicine pharmacist who apprenticed at the Fuyou Pharmacy (复有药庄) in Beijing in the early 1940s, recalled, “It was unheard of to fill a prescription for ten doses [like one often does today]. The biggest prescriptions that we filled were for two to three doses, and usually it was just one dose.”43 As a teenager, Lou Duofeng (娄多峰) of Yuanyang County (原阳县) in Henan studied with his grandfather, a specialist in Warm Illness therapies. “He never needed more

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than the three doses to cure a patient, and usually the problem was resolved in one or two doses.”44 Li Jinyong (李今庸), who grew up in Zaoyang County (枣 阳县), a mountainous region of Hubei Province, pointed out that the privations of war (caused by marauding Japanese and KMT armies) made it impossible for peasants to address anything but the most urgent problems, while at the same time creating the conditions for epidemic disease. “At the time, during the Sino-Japanese War, life in the countryside was so hard. Peasants could only [afford to] take one or two doses of medicine. We treated only acute diseases. If you didn’t get results in one or two doses, they didn’t come back.”45 A few of my interviewees, such as Li Bingnan (黎炳南), originally from Huizhou City (惠州市) in Guangdong, and Zhou Xinyou (周信有), originally from Andong (now Dandong, 丹东) in Liaoning, commented that they saw a considerable number of patients with chronic illnesses.46 It is possible that the first instance reflects the greater affluence of southern China, while the second instance was determined by Japanese colonial policy, which required acute, infectious illnesses to be treated at biomedical hospitals.47 Medical training The third key fact about medical practice in the Republican era was that medical training, in spite of the rapid spread of a modern, school-based educational system in China, remained centered on apprenticeships and the classics. Approximately two-thirds of my interviewees studied medicine through apprenticeships, usually with a relative or local teacher. The remaining onethird attended a school of Chinese medicine, one of the new developments of the Republican era.48 But almost all of these individuals later had an apprenticeship or similar relationship with a clinical teacher after they had finished their coursework. Yan Runming (阎润茗) graduated from Huabei College of Chinese Medicine in Beijing and then did a five-year apprenticeship with Zhao Shuping (赵树屏) while also studying acupuncture closely with a Buddhist monk, Li Chunxian (李春仙).49 For his final year of clinical training at the Shanghai New China Medical College, He Ren returned home to study with his father. There were some differences in the texts used by apprentices and students, but they were probably only minor when compared with the curriculum of contemporary students. For apprentices, the key texts remained relatively unchanged from the standards of the nineteenth century – a combination of introductory books (启蒙书), such as Drug Properties in Rhyme (药性赋), Essentials of Materia medica (本草备要), Formulary Verses (汤头歌), and the classics, with greater emphasis on the latter by the most literate teachers. The canonical text for most of my interviewees from northern China was the Qing Dynasty text, The Golden Mirror of Medical Orthodoxy (医宗金睷). In

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southern China, apprentices studied the “four classics” (四部经典), which meant a greater focus on the Warm Illness approach. Rote memorization of these texts was central to apprenticeship training, and my interviewees still had impressive recall of passages they had first memorized more than seventy years ago. In the new medical colleges, students used textbooks that were written by their teachers. Although the intricacies of textbook writing are beyond the scope of this chapter, we can broadly generalize that they were lightly edited, sometimes highly idiosyncratic interpretations, of the usual introductory texts and the classics. But they had more in common with each other than with the standardized textbooks that were collectively written in the early Communist period and became the foundation for the curriculum of today’s Chinese medicine universities.50 Perhaps most importantly, my interviewees had little or no training in western medicine at this time. This absence stands in sharp contrast to contemporary doctors of Chinese medicine, who have not only studied western medicine intensively but are quite competent practitioners of it as well. In the Republican period, knowledge of western medicine was valued by a small group of doctors, such as Zhang Xichun, Yun Tieqiao, Lu Yuanlei, and others, who were eager to reform Chinese medicine and make it more “scientific.” But its importance within these elite circles did not necessarily translate into educational reforms, although these authors were widely read and therefore did influence younger doctors. The recently established medical colleges all offered some courses in western medicine, but these usually did not go beyond the basics of anatomy and physiology. My interviewees who attended these private schools all agreed that these courses were very rudimentary. The rest of my interviewees, who learned medicine as apprentices, had almost no exposure to western medicine, except perhaps through the occasional encounter with the late Qing physician, Tang Zonghai, whose medical treatise incorporated some basic western anatomy. What these recollections demonstrate is that, in stark contrast to today’s doctors of Chinese medicine, the average doctor in the Republican era did not need to know western medicine. Here, the exceptions help prove the rule. With the start of the SinoJapanese War, Zhu Liangchun (朱良春) came to Shanghai to complete his medical training with Zhang Cigong (章次公). Zhu recalled that his teacher and respected clinician Zhang Cigong would send patients to get blood chemistries at a nearby laboratory and promoted the practice of “double diagnosis, single treatment” (双重诊断, 一重治疗), i.e., making a diagnosis in both Chinese medicine and western medicine but treating with Chinese medicine alone. Zhu Liangchun traces his own commitment to what is today called “integrated medicine” “中西医结合” back to his formative experience with Zhang Cigong. He fondly remembered the feeling of learning from a teacher at the cutting edge of a new trend in medicine. But he also recalled most doctors saw his teacher as a traitor to Chinese medicine. “It is not that I want to

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be a traitor to Chinese medicine,” Zhang Cigong would respond. “The times have made me be a traitor.”51 Xu Juqun (许济群), known for being one of the chief editors of the highly regarded fifth edition of the Chinese Medicine Formulary textbook, also wistfully remembered learning a little western medicine in his early days in Shanghai. He took a special course on the “three routine labs” (三常规) so he could incorporate blood-, urine-, and phlegmanalysis into his practice in the 1940s. He proudly told me how he had once used these skills to diagnose a case of malignant malaria and successfully treat it with quinine. I asked him if he felt as if he was “betraying” Chinese medicine with this use of western medicine. He dismissed that notion with a wave of his hand. The Shanghai medical market was extremely competitive at that time, he recalled, and it was important to stay one step ahead.52 The widespread incorporation of western medicine into one’s clinical practice was to become routine in the Communist period, but at this moment in history it was remarkable for its infrequency. Encountering the State The three aspects of Chinese medicine practice in the Republican era summarized above  – the numerical preponderance of Chinese medicine doctors, the small number of hospitals (and near absence of Chinese medicine hospitals), and the minimal exposure to western medicine – changed rapidly during the Communist era as the state began building a national healthcare infrastructure. As these social conditions changed so did the nature of clinical work in Chinese medicine. In the 1950s, doctors of Chinese medicine did play a prominent role in the control of some epidemics, most notably two outbreaks of Japanese B encephalitis, in Shijiazhuang in 1955 and in Beijing in 1956.53 Indeed, the second outbreak helped establish Pu Fuzhou (蒲辅周) as one of the leading Chinese medicine physicians of his times. Recognizing that treatment strategies for the Shijiazhuang outbreak were not working as effectively in Beijing, Pu quickly drafted a brief treatise on eight different strategies and sixty-six formulas for treating Japanese B encephalitis that not only improved clinical outcomes but also seamlessly blended approaches from the Cold Damage and the Warm Illness currents, two camps that had been bitterly opposed to each other in the Republican period.54 But despite these accomplishments, prejudice against Chinese medicine was hardening, and Lu Zhizheng (路志正) recalls it was soon common to hear the claim that “Chinese medicine cannot treat infectious diseases.”55 According to Deng Tietao, by the end of the 1950s, just ten years after the revolution, doctors of Chinese medicine had begun turning their attention away from acute disease toward the treatment of chronic illnesses.56 One of the surprising aspects of this new direction in Chinese medicine is that it happened at a moment when state investment in Chinese medicine was

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greater than it had ever been. The Communist Party has often portrayed its policies toward the Chinese medicine profession as a reversal of the repressive policies of the KMT. Today the Communist Party can boast that it has established thirty colleges of Chinese medicine, built 2,500 hospitals of Chinese medicine, and trained hundreds of thousands of Chinese medicine doctors.57 Compared to the Nationalist era, when private individuals, not the State, took almost all the initiatives to develop modern institutions of Chinese medicine, these sound like impressive achievements. Yet since the 1950s, the status of Chinese medicine doctors has declined, and the range of their clinical work has eroded. How can we explain these developments? To borrow a phrase from Sean Lei, I would like to argue that the 1950s was the moment when Chinese medicine encountered the State: not as political actors struggling for access to state resources, as Lei has shown for the Republican era, but as participants in a larger drama to create the infrastructure of a national healthcare system. Perhaps Zhou Xinyou’s comments about the difference between his life as a doctor in Japanese-controlled Manchukuo (a state that strongly privileged western medicine) and in Communist-controlled Liaoning Province might also be applied to all of China. “[Before Liberation] there was no meddling between doctors of Chinese medicine and western medicine. Even though the state didn’t support Chinese medicine, it allowed you to run a practice. Later [after Liberation], there was meddling. Western medicine was ‘exercising leadership’ over Chinese medicine.”58 This “exercise of leadership” took several forms. First, in the early years of the People’s Republic, far greater resources were devoted to building western medicine institutions. According to official Ministry of Health statistics, the number of doctors of western medicine grew very quickly after the establishment of the People’s Republic in 1949. Starting at 38,000 doctors in 1949, this workforce nearly doubled in eight years to 73,600 in 1957, and then grew by two-and-a-half times over the next eight years to 188,700 in 1965.59 The cost of this remarkable growth may have been lower-quality doctors, as some observers noted that medical school classes had as many as 400 to 600 students.60 By comparison, the official number of Chinese medicine doctors was 337,000 in 1957. This drop from the earlier estimate of 500,000 was probably due to the new licencing requirements.61 In 1957, the pharmacist Jin Shiyuan also participated in one of the licencing exams. He recalled that of the more than 1,900 people who took the licencing exam in 1957 only 150 passed. He saw this high failure rate as a more or less accurate reflection of the skill levels of the participants and not as an attempt to curtail the profession. In the early 1950s, educated laypersons could still try to make a living through the study of Chinese. You could read a few ancient medical texts and pass yourself off as a doctor.62 Regardless of the political motivations behind the exams, the end result was that professional development in western medicine was racing ahead while a winnowing process was still going on within the Chinese medicine community.

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At the same time, institution building for the Chinese medicine profession proceeded far more cautiously, especially in the early 1950s. Up to 1954, policy toward Chinese medicine focused on “scientizing Chinese medicine” (中 医科学化), which meant retraining doctors, not developing new institutions. Beginning in 1950 and continuing until the late 1950s, doctors were strongly encouraged to attend “Chinese medicine improvement classes” (中医进修 班), which focused on providing a foundation in western medicine.63 Classes were usually held in the afternoons or evenings to accommodate doctors’ work schedule and lasted for six months to a year. In addition to this western medicine training, doctors were also encouraged to study Marxism and Maoist thought, sometimes in formal classes. Although most of my interviewees complained about the prejudicial attitudes of bureaucrats toward Chinese medicine during this period, they were generally appreciative of the opportunities to study western medicine and Marxism. Li Zhenhua of Henan studied dialectical materialism on his own and told me, “It was the key to understanding the Inner Canon.”64 During this period, doctors of Chinese medicine did not work in hospitals but they were encouraged to form “union clinics” (联合诊 所), creating small group practices with usually fewer than a dozen doctors. Most of my interviewees found this situation to be professionally rewarding, because it encouraged intellectual exchange and reduced the financial stress of working on one’s own. Beginning in 1954, after the purges of some high-ranking officials in the Ministry of Health, government policy shifted and institution-building for Chinese medicine began in earnest.65 But the emphasis on scientizing Chinese medicine continued in new forms. One new approach was to “integrate Chinese medicine and Western medicine” (中西医结合) by training doctors of western medicine in Chinese medicine (西医学习中医) to create doctors with expertise in both medical systems and capable of finding their points of integration. Three-year training courses were inaugurated in 1955 and programs of integrated medicine continue in some form to the present day (although they have languished in recent years). Although some western medicine physicians were reluctant participants in these experimental courses, many went on to become leading figures in the Chinese medicine community. A second approach to reforming Chinese medicine was adopted by the new colleges of Chinese medicine. All but one of the original private schools opened in the Republican era had failed to survive the financial challenges of operating during the Sino-Japanese War and the reinvigorated KMT opposition to Chinese medicine immediately after it. In 1956, the central government established four colleges in Beijing, Shanghai, Guangzhou, and Chengdu, rapidly expanding to other major provincial capitals, until there were twenty-one colleges in 1965. Training in western medicine became a central component of the curriculum for these new colleges, making up nearly 50 percent of the required (medicine-related) course hours. Although most educators accepted the

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necessity of some western medicine training, the proper proportion of Chinese medicine courses to western medicine courses was an important area of debate that prompted a famous letter to the Ministry of Health by five leading professors at the new colleges of Chinese medicine. The five authors complained that the one-to-one ratio of Chinese medicine to western medicine courses was causing a major pedagogical problem. In trying to master two types of medicine, the students had not achieved proficiency in either.66 Coinciding with the development of these medical schools was the creation of Chinese medicine hospitals. Building on the “union clinic” experience of the early 1950s and drawing on the operational model of the biomedical hospital, these institutions differed from their Republican era predecessors by incorporating a significant amount of western medicine expertise into standard hospital work. As Deng Tietao recalled, all patients had to receive a western medicine diagnosis in those early days. A small number of western medicine physicians assigned to these hospitals assisted with this task.67 The presence of western medicine in the new Chinese medicine hospitals continued to grow in other ways, as Zhu Fangshou (诸方受), a well-known Chinese medicine orthopedic specialist, explained to me. Zhu Fangshou had been a participant in a one-time experiment at the Beijing Medical College (1952–57) to give Chinese medicine doctors comprehensive training in western medicine. These students brought additional western medicine skills to these new hospitals upon completion of their degrees in 1957. The following year, the first graduates of the “doctors of western medicine studying Chinese medicine programs” (西医学习中医班) arrived, followed by new graduates each year. In 1962, the first class of students from the new colleges of Chinese medicine began to work in these hospitals, bringing with them their considerable knowledge in western medicine.68 The creation of Chinese medicine colleges and hospitals during the Communist era was an important achievement for the Chinese medicine profession – an accomplishment that might have been unimaginable for Republican era doctors. But these institutional gains also brought western medicine into everyday clinical practice in ways that ultimately led to the hybrid blending of medical systems that has become the hallmark of contemporary Chinese medicine.69 As Xiaoping Fang has shown, a similar push to bring western medicine to rural areas led to disastrous results, profoundly undermining the practice of Chinese medicine in the countryside. In the early years of the Revolution, the state relied heavily on Chinese medicine doctors in the countryside organized into union clinics. But union clinics struggled to find new doctors, in part because the traditional practice of medical apprenticeships was hard to maintain under the changed social conditions of the Communist era. Prior to 1949, wealthy rural families had the means to educate their children and might encourage them to pursue a medical apprenticeship. In the 1950s, these families were typically the objects of Chinese Communist Party class struggle campaigns and might not have been in a position to finance a

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medical apprenticeship for their children.70 Because of limited success in training new doctors of Chinese medicine, union clinics gradually brought in new members with some professional training in western medicine. Xiaoping Fang reports that for Hangzhou Prefecture, this trend meant that the number of Chinese medicine doctors in union clinics was less than 50 percent of the total by the early 1960s.71 With the advent of the Cultural Revolution (1966–76), this trend was accelerated by the barefoot doctor program. This new program, intended to address the general scarcity of medical services in the countryside, required the recruitment of large numbers of participants. Contrary to the propaganda about this program, Xiaoping Fang argues that most barefoot doctors in Hangzhou Prefecture were trained primarily in western medicine, usually outside their local communities, and saw themselves as practitioners of western medicine first and foremost.72 These new training procedures together with the increasing availability of pharmaceuticals in the countryside meant that by the end of the Cultural Revolution, western medicine had become the dominant form of medical practice in the Chinese countryside. The end of the Cultural Revolution may have represented the nadir of the Chinese medicine profession, eroded by three decades of policy that supported Chinese medicine in name but curtailed the practice or shoe-horned it into the integrated medicine model at the institutional level. Historians have yet to understand fully what this “encounter with the State” really meant for the Chinese medicine profession. But perhaps Lu Bingkui (吕炳奎), a doctor of Chinese medicine and a high-ranking government official, who passionately advocated for the profession throughout his political career, can help us sense the impact of the social and political changes of the Maoist period on the practice of Chinese medicine. Writing shortly after the fall of the Gang of Four when it became possible to make critical statements about the Cultural Revolution – the period he refers to as the “ten lost years” – Lu Bingkui paints a bleak picture of the field. At the end of the “ten lost years,” there were only 240,000 [doctors of Chinese medicine], and today there are 250,000. Compared to Liberation, this is a loss of about one half. Western medicine has grown by more than a factor of 10; Chinese medicine has shrunk in half. This “half ” is according to official statistics, but the reality is worse. According to our surveys, only 20%–30% of these 200,000 plus doctors have systematically studied Chinese medicine … With this dearth of Chinese medicine personnel, Chinese medicine institutions are also pathetically few. There are almost 2 million hospital beds in the entire country. Chinese medicine has only 50,000 beds. But of these 50,000 beds, there are no more than 5,000 that are being managed with Chinese medicine … Chinese medicine doctors can now only do a little outpatient work, treating a few common illnesses. Under these conditions … how can the profession advance? It’s impossible.73

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Despite Lu’s bleak account, there was a significant rejuvenation of the Chinese medicine ranks from the 1980s. Indeed, many of my interviewees in the 2000s felt that the prospects for the profession were brighter than they could ever remember. Nonetheless, the Chinese medicine profession that has rebuilt itself since the 1980s is a significantly different form of medical practice. One of the most significant aspects of that transformation is that it has become “slow medicine.” Why exactly did the social and political changes of the Maoist period push Chinese medicine doctors toward the treatment of chronic illnesses? According to Deng Tietao, the overall effect was to “take away the stage” for Chinese medicine doctors to treat acute diseases. He pointed out that the rapid growth of western medicine hospitals in the early 1950s and the inauguration of a new health insurance system in 1951, which only provided reimbursement for hospital services, pulled patients with insurance coverage into the hospitals. Impressed with hospital technology – the laboratory exams, X-rays, and other medical devices – these new visitors gradually developed a preference for western medicine in the management of acute illnesses.74 Li Jinyong pointed out that hospital administrators played a central role in pushing this transition in Wuhan. Because administrators usually had a background in western medicine and were sensitive (and probably quite sympathetic) to the western medicine bias of their superiors in the Ministry of Health, they were in a position to curtail the work of Chinese medicine doctors according to their own prejudices. We can see precisely this same complaint being voiced during the Japanese B encephalitis outbreak in the 1950s, when Chinese medicine doctors were demonstrating the ability to contribute to urgent state matters of public health. In the introduction to a brief manual published in 1956 by the Hebei Province Association of Public Health Work about the Chinese medicine treatments for this disease, Duan Huixuan (段慧轩), the head of the association and Director of the Hebei Bureau of Public Health, praised the contributions of Chinese medicine doctors to the treatment of encephalitis and complained about the obstruction of their work by western medicine hospitals. One aspect of the problem is publicizing the experience of Chinese medicine therapies, but an even more important aspect is the close cooperation with [western medicine] hospitals, which will allow a better implementation of the successful experience of Chinese medicine doctors … Some hospitals have not cooperated enough, affecting the use of Chinese medicine therapies. Some hospitals have over-emphasized the primacy of western medicine diagnosis before allowing Chinese medicine treatments, causing unnecessary delays [in patient care]. This is inappropriate. Now that it has been shown that Chinese medicine has superb results in the treatment of encephalitis, I hope that all localities will act in accordance with the spirit of revolutionary humanism, putting the lives of the patients first, working together as closely as possible, to help Chinese medicine doctors be as efficacious as possible.75

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Unfortunately, countervailing social and political forces overwhelmed this optimism about the potential contribution of Chinese medicine to the treatment of acute infectious diseases in the Communist era. As Li Jinyong explained, the clinical virtuosity demonstrated so strikingly in the Japanese B encephalitis outbreaks was never passed on to the next generations of doctors. Why do the clinical skills [of younger doctors] today not match those of the old doctors? The old doctors accumulated years of experience, coming from the old society where they saw a lot. But … beginning with the very first class of college graduates that went to the hospitals to work, whenever there was a patient with an acute febrile disease, the patient was immediately sent for western medicine care. Chinese medicine doctors were not allowed to participate … As a result, the old doctors couldn’t use their skills in treating acute diseases, and young doctors couldn’t learn them.76

Coda In early 2003, the SARS epidemic swept across China and many parts of the globe. As healthcare institutions in China struggled to treat patients who had contracted this unknown, highly contagious, and virulent disease, the role of Chinese medicine in the treatment of acute illnesses was raised in the most pressing of national affairs. Marta Hanson has noted the positive role Chinese medicine doctors played in managing this epidemic, a fact that almost entirely escaped the attention of the western media.77 But at the beginning of the crisis, it was far from clear to Chinese officials that Chinese medicine could make any contribution to the control of this epidemic. Li Jinyong told me the leading officials at the affiliated hospital of the Hubei University of Chinese Medicine were desperate not to admit a single SARS patient for fear that the hospital couldn’t handle it.78 In Beijing, one of the major outbreak areas, officials established six treatment centers, all of them western medicine hospitals, and closed down Dongzhimen Hospital of Chinese Medicine entirely because it was the site of some of the earliest cases in the city.79 That doctors of Chinese medicine became involved in the treatment of SARS at all may be due to the happenstance of the origins of the epidemic in Guangdong Province. Chinese medicine is generally thought to be more popular in this province today than anywhere else in China. Perhaps this is why doctors of Chinese medicine in the provincial capital of Guangzhou were involved in the treatment of SARS patients from the beginning. Deng Tietao, one of the most revered doctors in the city, proudly told me that the mortality rate for SARS was lower in Guangzhou than the rest of the country precisely because of the contribution of Chinese medicine. In a review of the 103 SARS patients admitted to the Guangdong Provincial Hospital of Chinese Medicine from January to April 2003, researchers found that 7 had died, a mortality rate

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of 6.79 percent that compares quite favorably to other epidemic areas where the rate was as high as 15 percent.80 Deng Tietao insisted that these statistics, although notable, do not tell the whole story, because they omit all the patients with high fevers who were cured by timely herbal medicine treatments before the disease progressed to a stage where it could be positively identified. They also fail to recognize that there were no cases of SARS among hospital staff, who all took Chinese herbal medicine prophylactically, thus highlighting another presumed advantage of Chinese medicine – its preventive emphasis.81 The treatments at Guangdong Provincial Hospital of Chinese Medicine used a combination of western medicine and Chinese medicine therapies. But the main western medicine therapy (in addition to standard emergency and critical care inventions) was massive doses of corticosteroids, which proved to be of only limited benefit and sometimes resulted in devastating side effects. In the absence of effective western medicine therapies, doctors rediscovered that Chinese medicine already contained a sophisticated theoretical apparatus for diagnosing and treating acute illness. The successes of Chinese medicine doctors in Guangzhou were eventually recognized in other outbreak areas. On May 3 local officials in Hong Kong invited Chinese medicine doctors from Guangdong to assist in their own epidemic management efforts. The positive role of Chinese medicine in Guangzhou eventually attracted the attention of the central government in Beijing, and several research institutions were mobilized to study their treatment outcomes further. On May 8, Chinese medicine doctors became full participants in the struggle against SARS, when Premier Wen Jiabao announced that “Chinese medicine should play a full role in the prevention and treatment of SARS.”82 For Deng Tietao, one of Guangzhou’s last representatives of a forgotten era when doctors of Chinese medicine built their reputations on one’s ability to handle acute illnesses, the SARS crisis was a long awaited reawakening. As he told me, doctors of Chinese medicine had “finally learned they could treat acute illnesses again.”83 We will have to see if young doctors can live up to his expectations. Acknowledgments The research for this chapter was made possible by the generous support of the American Council of Learned Societies and their American Research in the Humanities in China Fellowship. Notes 1 People’s Republic of China Ministry of Health (中国卫生部), 2011 Yearbook of China Health Statistics (2011 中国卫生统计年鉴), People’s Medical Publishing House, www.moh.gov.cn/htmlfiles/zwgkzt/ptjnj/year2011/index2011.html (accessed June 27, 2014).

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2 Guangzhou University of Chinese Medicine (广州中医药大学), “First affiliated hospital of the Guangzhou University of Chinese Medicine” (“广州中医药大学 第一附属医院”), Guangzhou University of Chinese Medicine, www.gztcm.com. cn/Default.aspx?tabid=99 (accessed July 2, 2014). 3 Eric I. Karchmer, “Chinese medicine in action: On the postcoloniality of medicine in China,” Medical Anthropology 29.3 (2010): 226–52. 4 Editorial Committee of the China Medical Yearbook (中国卫生年鉴编辑委员会), China Medical Yearbook 2001 (中国卫生年鉴 2001)  (Beijing: People’s Medical Press, 2001). See Editorial Committee of the China Medical Yearbook (中国卫生 年鉴编辑委员会), China Medical Yearbook 2002 (中国卫生年鉴 2002) (Beijing: People’s Medical Press, 2002), 454–5, 499. 5 Huang Xingyuan originally trained as a doctor of western medicine and later enrolled in the experimental “integrated medicine” (中西医结合) classes to train biomedical physicians in Chinese medicine. He was well respected among his Chinese medicine colleagues, and his dual training made him an ideal figure to advance Chinese emergency medicine. Huang Xingyuan (黄星垣), ed., Emergency Care in Chinese Internal Medicine (中医内科急症证治) (Beijing: People’s Medical Publishing House, 1985). 6 There were a handful of doctors of western medicine working at the hospital at this time. Their seemingly anomalous presence actually has a history that goes back to the founding of Chinese medicine hospitals in the early Communist era. Doctors of western medicine were originally brought into these new institutions to assist their Chinese medicine colleagues unfamiliar with institutionalized medical care. 7 State Administration of Traditional Chinese Medicine Department of Politics (国 家中医药管理局医政司), Application Guide to the National Essential Chinese Patent Medicines for Emergency Medicine at Chinese Medicine Hospitals (全国中 医医院急诊必备中成药应用指南) (Beijing: State Administration of Traditional Chinese Medicine Department of Politics, 1997), 1–2. 8 Personal interview with Zhou Zhongying, Nanjing, January 16, 2009. 9 Wang Zhiying (王志英) et al., eds., Getting to Know the Great Chinese Medicine Master Zhou Zhongying (走近中医大家周仲英), Medical Life Series (医学人生 丛书) (Beijing: Chinese Medicine Press of China, 2008), 16–18. 10 Personal interview with Zhu Liangchun, Nantong, December 22, 2008. 11 Cao Dongyi (曹东义), ed., Getting to Know the Great Chinese Medicine Master Zhu Liangchun (走近中医大家朱良春), Medical Life Series (医学人生丛书) (Beijing: Chinese Medicine Press of China, 2008), 92–7. 12 Personal interview with Shen Fengge, Nanjing, March 15, 2009. 13 Volker Scheid, Currents of Tradition in Chinese Medicine: 1626–2006 (Seattle: Eastland Press, 2007), 150. 14 Ibid., 228. 15 Thomas S. Kuhn, The Structure of Scientific Revolutions, 2nd edn. (Chicago: University of Chicago Press, 1970); Michel Foucault, The Order of Things: An Archaeology of the Human Sciences, 1st American edn. (New York: Pantheon Books, 1971); Arnold Davidson, The Emergence of Sexuality: Historical Epistemology and the Formation of Concepts (Cambridge, MA: Harvard University Press, 2001).

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16 Deng Tietao (邓铁涛), ed., The Early Modern History of Chinese Medicine (中医 近代史) (Guangzhou: Guangdong Higher Education Publishing House, 1999); Ralph C. Croizier, Traditional Medicine in Modern China: Science, Nationalism, and the Tensions of Cultural Change (Cambridge, MA: Harvard University Press, 1968); Zhao Hongjun (赵洪钧), The History of the Early Modern Controversy between Chinese Medicine and Western Medicine (近代中西医论 争史) (Shijiazhuang: Hebei Branch of the Integrated Medicine Research Center, 1982); Sean Hsiang-Lin Lei, “When Chinese medicine encountered the State: 1910–1949” (Ph.D. dissertation, University of Chicago, 1999); Bridie Andrews, “The making of modern Chinese medicine, 1895–1937” (Ph.D. dissertation, University of Cambridge, 1996). 17 Croizier, Traditional Medicine, 72–77. 18 Zhao, The History of the Early Modern Controversy, 225. 19 Yu Yunxiu (余云岫), Collected Essays on the Medical Revolution (医学革命论集) (Shanghai: Great East Publishing House, 1932 [1928]), 1. 20 Lei, “When Chinese medicine encountered the State”; Andrews, “The making of modern Chinese medicine.” 21 Deng, The Early Modern History, 177. 22 Personal interview with Li Zhenhua, Tianjin, December 15, 2008. 23 Personal interview with Li Zhenhua, Zhengzhou, March 30, 2009. 24 Personal interview with He Ren, Hangzhou, April 2, 2009. 25 Personal interview with Deng Tietao, Guangzhou, March 19, 2009 and June 16, 2011. 26 Personal interview with Gan Zuwang, Nanjing, January 17, 2009. 27 Zhao, The History of the Early Modern Controversy, 98–101. 28 Because only a small number of doctors from this era are still alive, I traveled to many of the major geographic regions of China, including northern China, the north-east provinces, the lower Yangtze delta, central China, Sichuan, and Guangdong to conduct these interviews. Some doctors grew up in large cities, but many began their careers in the countryside. 29 Personal interview with Li Jiren, Beijing, April 4, 2009. 30 Personal interview with Guo Zhongyuan, Baoding, December 28, 2008. 31 Deng, The Early Modern History, 15; Croizier, Traditional Medicine, 52. 32 Croizier, Traditional Medicine, 54–55. 33 Scheid, Currents of Tradition, 182. 34 Zhang Xichun (张锡纯), “A true comparison of the therapies of Chinese medicine and Western medicine” (“中西医治疗上之真实的比较”), The Annals of Medicine (医界春秋) 35 (1929), 7–8. 35 Cui Yueli (崔月犁), ed., Founder of the Chinese Medicine Profession in New China: The Collected Writings of Lu Bingkui’s Sixty Years in Medicine (新中国中医事业奠 基人: 吕炳奎从医六十年文集) (Beijing: Huaxia Press, 1993). 36 Editorial Department for the Compilation of Chinese Medicine Work Documents (中医工作文件汇编编辑部), Compilation of Chinese Medicine Work Documents 1949–1983 (中医工作文件汇编 [1949–1983年]) (Beijing: People’s Republic of China Ministry of Health, Chinese Medicine Division, 1985).

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37 Personal interview with He Ren, Hangzhou, April 2, 2009. 38 Personal interview with Deng Tietao, Guangzhou, March 19, 2009. 39 Personal interview with Zhang Jin, Harbin, March 25, 2009. 40 Yang Zemin (杨则民), ed., Medical Discourses of the Hidden Hut (潜厂医话) (Beijing: People’s Medical Publishing House, 1985); Zhao, The History of the Early Modern Controversy, 239–40. 41 Scheid, Currents of Tradition, 196. 42 Deng, The Early Modern History, 175. 43 Personal interview with Jin Shiyuan, Beijing, April 3, 2009. 44 Personal interview with Luo Duofeng, Zhengzhou, March 31, 2009. 45 Personal interview with Li Jinyong, Wuhan, April 1, 2009. 46 Personal interview with Li Bingnan, Guangzhou, March 19, 2009; personal interview with Zhou Xinyou, Lanzhou, March 29, 2009. 47 See Michael Shiyung Liu, Prescribing Colonization: The Role of Medical Practice and Policy in Japan-Ruled Taiwan (Ann Arbor: Association for Asian Studies, 2009). 48 This 2:1 ratio should not be seen as a reflection of the population of doctors as a whole. School-trained doctors were probably a much smaller percentage of the total. 49 Personal interview with Yan Runming, December 16, 2008. 50 Eric Karchmer, “Orientalizing the body: Postcolonial transformations in Chinese medicine” (post-doctoral dissertation, University of North Carolina, 2005). 51 Personal interview with Zhu Liangchun, Nantong, December 22, 2008. 52 Personal interview with Xu Jiqun, Nanjing, January 18, 2009. 53 China Academy of Chinese Medicine (中国中医研究院), Research on the Prevention and Treatment of SARS with Chinese Medicine (II) (中医药防治非典型肺炎(SARS)研 究 [二]) (Beijing: Chinese Medicine Ancient Texts Press, 2003), 43, 48, 59. 54 See Pu Fuzhou (蒲辅周) and Gao Huiyuan (高辉远), The Pattern Recognition and Treatment Determination for the Chinese Medicine Treatment of Several Acute Infectious Diseases (中医对几种急性传染病的辨证论治) (Beijing: People’s Medical Press, 1960), 51–64; Eric I. Karchmer, “The excitations and suppressions of the times: Locating the emotions in the liver in modern Chinese medicine,” Culture, Medicine, and Psychiatry 37.1 (2013): 8–29. 55 China Academy of Chinese Medicine, Research on the Prevention and Treatment of SARS (II), 43. 56 Personal interview with Deng Tietao, Guangzhou, March 19, 2009. 57 Editorial Committee of the China Medical Yearbook, China Medical Yearbook 2001, 454–5, 99; ibid. 58 Personal interview with Zhou Xinyou, Lanzhou, March 29, 2009. 59 Editorial Committee of the China Medical Yearbook, China Medical Yearbook 2001, 455. 60 Victor W. Sidel, “Medical personnel and their training,” in Medicine and Public Health in the People’s Republic of China, ed. Joseph R. Quinn (Washington, DC: National Institutes of Health, 1973), 156.

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61 Kim Taylor, Chinese Medicine in Early Communist China, 1945–1963: A Medicine of Revolution, Needham Research Institute Studies Series (London: RoutledgeCurzon, 2004), 37–41. 62 Personal interview with Jin Shiyuan, Beijing, April 3, 2009 63 Taylor, Chinese Medicine in Early Communist China, 38–41; ibid. 64 Personal interview with Li Zhenhua, Zhengzhou, March 30, 2009. 65 Taylor, Chinese Medicine in Early Communist China; David M. Lampton, The Politics of Medicine in China: The Policy Process, 1949–1977, Westview Special Studies on China and East Asia (Boulder: Westview Press, 1977). 66 Ren Yingqiu (任应秋), Collected Medical Writings of Ren Yingqiu (任应秋论医 集) (Beijing: People’s Medical Publishing House, 1984), 3. 67 Personal interview with Deng Tietao, Guangzhou, March 19, 2009. 68 Personal interview with Zhu Fangzhou, Nanjing, December 21, 2008. 69 Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis, ed. Barbara Herrnstein Smith and E. Roy Weintraub, Science and Cultural Theory (Durham, NC: Duke University Press, 2002); Karchmer, “Chinese medicine in action.” 70 The precise role of the union clinics in the transmission of Chinese knowledge remains unclear. Xiaoping Fang also reports that potential disciples in Jiang Village in suburban Hangzhou had less patience or interest to withstand the hardships of this kind of training. See Xiaoping Fang, Barefoot Doctors and Western Medicine in China (Rochester, NY: University of Rochester Press, 2012), 44, 49. Anecdotally, my interviewees also corroborate this finding. For example, Li Jinyong reported that many of his father’s disciples in rural Hubei also quit before finishing their apprenticeships; personal interview with Li Jinyong, Wuhan, April 1, 2009. 71 Ibid., 63. 72 Ibid., 53–66. 73 Cui, Founder of the Chinese Medicine Profession, 67. 74 Personal interview with Deng Tietao, Guangzhou, March 19, 2009. 75 Hebei Province Association of Public Health Work (河北省卫生工作者协会), Chinese Medicine Treatment Methods for Japanese B Encephalitis (流行性乙型脑 炎) (Baoding: Hebei People’s Medical Press, 1956), 3. 76 Personal interview with Li Jinyong, Wuhan, April 1, 2009. 77 Marta Hanson, “Conceptual blind spots, media blindfolds: The case of SARS and traditional Chinese medicine,” in Health and Hygiene in Chinese East Asia: Publics and Policies in the Long Twentieth Century, ed. Angela Ki-Che Leung and Charlotte Furth (Chapel Hill: Duke University Press, 2010). 78 Personal interview with Li Jinyong, Wuhan, April 1, 2009. 79 Deng Tietao (邓铁涛) et al., eds., The History of Epidemic Prevention in China (中 国防疫史) (Nanjing: Guangxi Science and Technology Press, 2006), 702. 80 Lin Lin (林琳), Yang Zhimin (杨志敏), and Deng Tietao (邓铁涛), “Clinical research on the Chinese medicine treatment of SARS” (“中医药治疗SARS的临 床研究”), in Research on the Academic Thought of Deng Tietao (II) (邓铁涛学术

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思想研究 [II]), ed. Xu Zhiwei (徐志伟), Peng Wei (彭炜), and Zhang Xiaojuan (张孝娟) (Beijing: Huaxia Press, 2004). 81 Personal interview with Deng Tietao, Guangzhou, August 13, 2005. 82 Deng et al., The History of Epidemic Prevention in China, 703. 83 Personal interview with Deng Tietao, Guangzhou, March 19, 2009.

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Metaphysics at the bedside Judith Farquhar

Metaphysics … What is metaphysics, for western philosophy? There are many senses of the term, but here I adopt a notion of metaphysics that has an Aristotelian, Cartesian, and Kantian genealogy. This tradition, always combative but often ignored, sets metaphysics against the sciences (or beneath them as foundation, or above them as the most general result of reasoning); assumptions about the metaphysical differ from positive knowledge of the empirical. Aristotle’s “first philosophy,” classified with his Metaphysics, stands in contrast to his more empirical Physics. Francis Bacon’s “natural philosophy” gave a name to the (non-metaphysical) scientific disciplines (including magic and cosmology) he sought to advance. Bacon sorted the final and formal causes identified by Aristotle into the domain of metaphysics, and considered the study of efficient and material causes to be the concern of natural philosophy, i.e., science. Descartes located the central matter of metaphysical concern in the conditions of knowledge, thus translating metaphysics into epistemology. And Kant characterized metaphysics as the unavoidable tendency for reason to presume an unconditioned form of Being. The metaphysical imagination after Descartes and Kant, then, was seen to concern itself with totalities that cannot be known as such because they transcend all the categories through which we know. Thus, in a scientific age, one would think that metaphysics could be finally superseded. Yet we cannot quite banish metaphysics, even from our philosophy departments. Some modern philosophers have argued that even an anti-metaphysics in philosophy must make metaphysical assertions.1 And a post-Kuhnian philosophy and sociology of science has decentered scientific reason itself to rediscover the collective speculative interests in the domain of the a priori, what Kant called the unconditioned.2 Thus, the theories articulated in any scientific paradigm or thought-collective may be proposed as much for their aesthetic value as for their rigorous verifiability or falsifiability.3 At the same time, many of the elements of any theory or body of knowledge may go without saying,

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and thus not appear as conscious knowledge even as they contribute significantly to answering epistemological questions. Perhaps this is why historian of science Lorraine Daston introduces a book about scientific objects with the remark, “This is a book about applied metaphysics.”4 Indeed, as Daston and Peter Galison have amply shown, the constitution of both the objects known to science (gravity, proteins, the unconscious, etc.) and the objects among which we live (“the furniture”) is a profoundly historical process.5 Objects of all kinds come into being and disappear from the world in which scientists work; they become “densely woven into” historically specific arenas of scientific thought and practice: “If pure metaphysics treats the ethereal world of what is always and everywhere from a God’s-eye-viewpoint, then applied metaphysics studies the dynamic world of what emerges and disappears from the horizon of working scientists.”6 Metaphysical questions about the nature of (ultimate) Being are not separate from questions about the qualities and existence of (specific) beings; indeed, the latter concern has sometimes been called special metaphysics, and its topics seen as continuous with problems of the transcendent and unconditioned. The assertions of metaphysics, at least as they have been understood and debated in the philosophy of science, are both uncertain and foundational. The conceptual earth is always shaky under our feet. To think metaphysically is to be thrown into a state in which all premises are both precisely not true (because they cannot be demonstrated) and at the same time assumed to be actual (the unconditioned on which all knowable existence is necessarily founded). Impossible to demonstrate or even fully represent, the assumptions about Being taken up in ontology, imaginaries of the universe refined in cosmology, and even the grounds of knowing critiqued in epistemology make thought and action, thought as action, possible at all. We are all metaphysicians because we act, and we can only act – in the end – on unproven assumptions. Usually, however, we don’t think metaphysically, and we don’t face up to the conditioned quality, or the contingency, of our everyday knowledge. Indeed, by definition, it is almost impossible to think Being, universal form, and the premises of knowledge. Metaphysics eludes us especially when everything seems to be going according to a natural plan. Yet Daston proposes that historians of science deploy an applied metaphysics, attentive to the first principles that might be active in the objects perceived, manipulated, constructed, and superseded by scientists at work in early modern drawing rooms, at the laboratory bench, by the hospital bedside, and in the botanical and zoological fields of natural history. One such arena, in modernity proudly proclaiming its scientificity, is clinical medicine. The “traditional Chinese” institutionalization of the clinical has long been attentive to a certain first philosophy.7 However assiduously modern physicians and managers of “traditional Chinese medicine” (TCM) attempt to model in their practices and institutions the modern forms of hospitals and clinics, written case histories,

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disease classifications, and pharmaceutics, they nevertheless are witnesses to the daily emergence and disappearance of some objects that are not familiar to other modern sciences. In order to work at all, they must translate an ancient but changing metaphysics into modern rationalities, while seeking to lose none of the powers specific to their “traditional” specialty. This is a task that cannot succeed without an applied metaphysics. In this chapter I will consider a moment in the history of Chinese medicine when the metaphysical was not just underfoot but present-at-hand, on the agenda. I want thoroughly to entangle questions of Being, cosmos, and truth with the kind of action that medical people undertake on a daily basis. Along the way I will invoke some thinking by Bruno Latour and colleagues about things and assemblages; some powerful writing of the 1980s in China, at a time when “epistemology and methodology” (认识论, 方法论) were matters of great professional concern; and a bedside scene. We shall begin with the last. … at the bedside In 1983, while doing dissertation fieldwork on traditional Chinese medicine in Guangzhou, I visited a friend in hospital. My friend Xueran was a popular and brilliant younger scholar who taught in the department devoted to the “clinical classic,” the Shanghan Lun (Treatise on Cold Disorders). He had come down with a severe acute respiratory infection, showing a very high fever, and he was rapidly checked into the Guangzhou College’s attached hospital. By the time I saw him in his hospital room, he was a little better; treatment had been under way for about thirty-six hours by then. Knowing him as a critical intellect who always knew better than garden-variety doctors, I asked him if he was managing his own care. He wanly pointed out that he was far too exhausted to do that, and in any case he wouldn’t be allowed. His departmental supervisors, all senior resident clinicians in the hospital, had taken charge, and he would not be allowed to interfere. “But, how did they decide what is wrong with you, and what to do?,” I asked. “By arguing,” he replied. He humorously described some of the debates his seniors had had right at his bedside, and he explicitly reminded me that everything in this elite academic hospital of Chinese medicine  – with the college’s scholarly research centers just a short walk away – could be open to question. The nature of the pathological process, the stage of the illness, the visceral systems or circulation tracks most involved, the most responsive treatment principles, the exact herbal drugs, and the proportional dosages of the drugs  – all these things needed to be brought together to frame a strategic intervention. Even medical knowledge about the nature of the human body was challenged in this situation: as I will indicate below, whether the illness was ramifying through the

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Six Channels (liu jing) emphasized by the Cold Damage (Shang Han) School, or growing deeper in relation to the Four Aspects (wei qi ying xue) recognized by the contrasting Warm Illnesses (Wen Bing) school of thought, was a matter that was far from clear.8 Xueran’s doctors could not agree. When I saw him, neither biomedical diagnosis nor Chinese medical pattern determination had yet been agreed upon, though several elaborate descriptions of what was going on had been developed. Eventually one of the senior doctors won the initial argument and earned the right to prescribe a treatment for the first twenty-four hours. The next day, observing some improvement, the second debater took his agreedupon turn, tinkering with his colleague’s strategy and adding some fine points of his own. It helped that, though they disagreed, both of these senior practitioners belonged to the Cold Damage School to which Xueran was also committed; but not far off, in the same hospital, were senior physicians who would have preferred to treat this “Warm Illness” by logics developed in the Warm Illnesses School. In doing so, they would have observed the symptomaticity of different things: Four Aspects rather than Six Channels. Comforted that the situation was coming under control somehow or other, Xueran and I agreed that these two senior Chinese doctors would probably be revisiting his mysterious case in arguments for a long time to come. As time went on, Xueran developed his own account of what had happened, one that was quietly critical of the thinking of his seniors but equally indebted to the classical medical school of thought – that of Cold Damage analysis with its Six Channels, to which they all belonged.9 Perhaps it goes without saying that much is at stake in the clinical application of medical knowledge; it is routine to consider that lives and deaths, as well as a lot of inconvenience and discomfort, hinge on the correct use of therapies. The story I have just told is only a routine field report from a modern clinical situation with very standard aims: achieving a return to health from a markedly pathological condition. In a sense, it could be anywhere (though one wonders whether there would have been so much room for debate in a biomedical hospital at the same time). But the struggle that went on at Xueran’s bedside, and in his ailing body as he drank his custom-crafted herbal medicine, had particular historical and local characteristics. In the early 1980s, the modern field of Chinese medicine in China was aggressively and creatively reconstituting itself as both modern and ancient, at once scientific, clinically effective, and cultivated in a special relationship to the nation’s deep written heritage and archive of clinical experience.10 Many different positions on what Chinese medicine had been – in the Warring States period, during the late Han or Qing Dynasties, in the hands of barefoot doctors, in the paddies and forests of the folk – were being developed, both by traditionalists and modernizers. Historians and clinicians worked both separately and together to characterize the “essence” of Chinese medicine – often

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placed in over-simplified contrast to “western medicine” – in response to the Maoist injunction to “save the essence and discard the dross” of China’s scientific civilization. In the laboratories and clinics that were newly active in the early Reform period, from about 1978 forward, a “unify Chinese and western medicine” (zhongxiyi jiehe) movement received a lot of government funding to craft the integrated Chinese medicine of the future. Some researchers in this movement dared to hope that a unified medicine of China could become a new global standard, all local dross discarded and boasting a huge and valuable array of medicines and techniques “essential” to world medicine; such a new medicine of China would also include some key non-western conceptual objects, they hoped.11 In the early eighties, in keeping with this national push to unify and globalize, metaphysics was an explicit concern of a great many experts; the “epistemology” (renshilun) and “methodology” (fangfalun) of the field of Chinese medicine were developed as topics for professional symposia, journal articles, medical college courses, and even popular textbooks. To some extent these debates still rage, though their virulence and popular visibility varies from year to year, generation to generation. My friend Xueran, in 1983, found this applied metaphysics fascinating and important, though he always insisted on seeking clinical implications; by contrast, by the early 2000s, students of medicine I spoke with didn’t even know what the words epistemology and methodology meant. But in the early 1980s there were working scientists of traditional medicine, more and more of them as the Reform period advanced. Many hoped that science, especially in the form of clinical trials, chemical analysis, and research with animal models, would settle all matters of concern in the field by translating the things of Chinese medicine (the channels accessed at acupoints, the effective herbal drugs, the symptoms unrecognized by other forms of medicine, the Six Channels of Cold Damage medicine and the Four Aspects of Warm Illnesses medicine) into objects recognized in biomedicine. These transformed “traditional” entities, now spoken of as things like endorphins, vitamins, or immune response, could be retained in Chinese medicine as emissaries going back and forth between today’s hospital work and yesterday’s historical records. The rest? For this group of bench research scientists, all the “superstition”  – the Five Phases, the Six Channels, damp-oppression in the chest, visceral systems depletions – could be discarded as dross. This colonization of the knowledge of Chinese medicine by western biomedicine was not acceptable to everyone at the time. Many of the scholardoctors who became prominent as writers on epistemology and methodology in the 1980s realized that the programme to preserve and modernize a legitimate Chinese medicine on the grounds of experimental science was a losing battle, but Chinese medicine seen as a philosophy linked to an effective clinical practice might offer some hope. Some of these writers turned to what

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we might call metaphysics. Perhaps they felt, as clinicians and servants of the people, as post-imperial Chinese nationalists, and as thoughtful readers in their field, that nothing less than Being itself was at stake in the debates. The very language of modern science presumed an ontological distinction between real matter and ideal form, a Newtonian mechanical causation, a body–mind divide.12 However much any actual scientific fact overcame or betrayed these European metaphysical assumptions, it was deeply felt by well-trained Chinese doctors that a “western” objectivist metaphysics remained the starting point for thought and action in a world of thought that was alien to the field in which they had been trained. I rehearse this historical-intellectual situation in order to highlight the fact not just that metaphysics was tacitly at the bedside in places like the Guangzhou hospital in the 1980s, but that it was welcomed at least by some as an active partner in decision-making. But to understand this moment a little better, we must return to Xueran’s hospital room. At the time I was especially interested in the fine points of the several clinical visions and strategies being elaborated by his senior doctors: What Chinese medical school of thought or earlier authorities were most influential in which version? Given that these clinicians were teachers of Cold Damage medicine, though they were in the warm, damp South and facing a Warm Illness, did the Six Channels of Cold Damage Theory outrank and occlude the Four Sectors of Warm Illnesses Theory? How had each of the two debaters differently prioritized his intervention, such that the most actionable aspects of Xueran’s condition could be managed first, leaving the more chronic roots of the illness for a longer-term strategy? Though I wasn’t there for those arguments, I’m pretty sure that the two combatants confined their interests to distinctions that could be made in the rather purified domain they called Chinese medicine, or, even more specifically, studies of the Shang Han Lun, the Treatise on Cold Disorders. Why didn’t they consider the clinical options available in that (also rather purified) field they called “western medicine”? Why didn’t they just issue a prescription for antibiotics and worry about the fine points later, after the fever had come down? Why not adopt the clinical powers provided in the cosmopolitan and ontologically hybrid medical fields already typical in cosmopolitan hospitals like these? Well, there’s more to the story. Xueran and his teachers belonged to a group of scholars influential at that time in Guangzhou, and in Chinese medicine more generally, who were committed to showing that “traditional Chinese medicine” could effectively manage acute illnesses. The argument was developed in conversation with Ministry of Health policy and with many popular assumptions about the particular strengths of Chinese medicine and western medicine. Everyone knew (as we have so often heard) that Chinese medicine was good at managing and ameliorating chronic complaints, while western medicine, though risky, was better for treating acute illnesses.13

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This Guangzhou group worked in a Chinese medicine college that had an attached hospital serving a large catchment area in the city’s northern suburbs. Emergency medicine was an important element of the hospital’s mission. But the hospital’s academic experts in traditional medicine chafed under the necessity of using western biomedicine, which they considered “dangerous” and “invasive,” even for the acute conditions they treated in the emergency room. Further, many doctors who were senior residents at that time were veterans of an earlier period of medical mobilization under the leadership of the Communist Party. They often spoke of their histories of serving the people – acute ailments and all – in rural areas and in the absence of adequate biomedical services, using only their own heritage medical skills.14 Xueran himself had worked as a Chinese doctor in a rural area during the Cultural Revolution period; many of his patients had had no other access to medical services besides his kitchen-table treatments after hours, using needles and local herbs, and he thought of himself as an effective primary care doctor, able to intervene in a wide range of medical crises. When he himself fell ill, sick as he was, he refused western medical treatment. His doctors were not surprised. After all, they shared his commitment to using herbal medicine to treat acute illnesses. So, though the things that were gathered at Xueran’s bedside the evening he was hospitalized in 1983 were “purely” Chinese medical  – and heterogeneous, even conflictual within this purified space – there was another interlocutor present. That was western medicine in all its ontological modernism.15 (One could add more interlocutors, of course: the history of European technologies in imperialism, the global claims and authority of the European natural sciences, global images of weak and unmanly Chinese bodies, Maoist pragmatics and activism, the Cold Damage/Warm Illnesses contrast stemming from the regional intellectual lineages of those present  – one could go on and on; it was a crowded hospital room, tacitly at least.) We can imagine how those two senior doctors must have been feeling as they argued about what to do. Not only did they want to save their wonderful younger colleague from further misery – or chronic lung problems, or brain damage from the high fever – they wanted to do it well, persuasively, and fast. Even if they never published this case, even though the many cases published in the world of Chinese medicine are never read beyond local and expert publics, even though the things that concerned these debaters were quite incommensurate with any recognizable things in biomedicine  – they nevertheless wanted to prove a point to that looming Other: global biomedicine. “We too can do more than just palliate chronic symptoms,” they were saying, at the bedside of their sick colleague. The things we know and use – our herbs, our needles, our formulas, our archives of cases, our theory, our pedagogy, our diagnostic skills, our systematic classifications, our local and knowledgeable bodies, our forebears, even our Chinese “airs and waters” – these things have long made up a total medicine, ready to intervene in all kinds of illness.

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I have been using the word things in a rather awkward way. Actually, I have been trying to ease it into usage as a technical term, indebted to several authorities not yet discussed: Bruno Latour and Peter Weibel in their book Making Things Public; a philosopher, Huang Jitang, prominent in Guangzhou medical circles at the same time as Xueran’s illness took place; and Lu Guangxin, a Beijing medical thinker whose work I will also briefly introduce. There is even a bit of the Warring States era philosopher Zhuangzi lurking in my affection for the word “thing.” So things must be opened to more scrutiny. In 2005 Latour and Weibel assembled a lot of things together for an exhibition in Karlsruhe. In the introduction to the exhibition catalog, and gesturing to Heidegger (cited above), they engaged in an etymological exercise that would satisfy any Chinese philologist. A number of archaic European words for things (Ding, res, ens) involve not only materiality, not only object-being, but also a gathering, also a form of attention. In old German and Icelandic, a thing was a sort of parliament, an assembly to consider matters of shared concern. The thing-collective assembled, and it gathered together the strains of nature and culture that would constitute the focus of its attention, a sort of topic-thing, about which they might disagree, but the presence of which (the making present-at-hand) nevertheless made their political activity possible. This thing, this matter of concern, did not pre-exist the convening of this contentious parliament, or if it did, it didn’t matter that it did. Things in this political sense only came to matter as objects assembled for the purpose of debate, decision-making, action. Moreover, the thing is not actual apart from the debaters who gather it; people and their concerns are part but not all of these complex material assemblages called things. As Latour and Weibel say: For too long, objects have been wrongly portrayed as matters-of-fact. This is unfair to them, unfair to science, unfair to objectivity, unfair to experience. They are much more interesting, variegated, uncertain, complicated, far-reaching, heterogeneous, risky, historical, local, material and networky than the pathetic version offered for too long by philosophers. Rocks are not simply there to be kicked at, desks to be thumped at. “Facts are facts are facts”? Yes, but they are also a lot of other things in addition.16

Are you hearing echoes of our two Cold Damage scholar-doctors debating at Xueran’s bedside? I hope so. But the things they gathered there were nothing if not problematic in the view of certain larger collectives. The Taiyang and Shaoyang Channels (two of the Cold Damage Six) and their linkages with viscera, sense organs, case records, the properties of herbs, and so forth, were actual for them because they knew how to attend to changes in their channeling activity, how to act on them to alter their networked activity. But these experts acted within and over against a world of scientific facts in which

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medical things were supposed to be visible in microscopes, radiographs, or the cadaver; were supposed to be available for thumping or kicking, culturing, lancing, or excising.17 We have lots of evidence from the literature of the 1980s in Chinese medicine that the global culture of “facts are facts are facts” was a problem that needed to be addressed. Many investigators agreed the Taiyang Channel needed to be made into a thing, a fact, a matter of legitimate concern. And the only way to do this without scuttling everything clinicians had known in China for a very long time was to dip into metaphysics. Qi transformation Anxiety about the thing was one reason why all introductory training in Chinese medicine in the 1980s  – when the field was experiencing a post-Cultural Revolution renaissance – insisted on teaching “theoretical foundations.” This concern was one impetus for the demand that students and foreigners come to terms with yin–yang, the Five Phases, and the visceral systems, rather than discrete anatomical organs. Most of all, it was necessary to grasp the functional dynamics of qi.18 Looked at from the politics of thing-gathering, we can perhaps see more clearly now: Chinese clinicians and writers of the 1980s needed to loosen up, re-examine, and put in motion the metaphysical assumptions of modern science, if Chinese medical things were to be recognized as factual and actual. The elements that needed to be (re)gathered as matters of concern at the bedside could only be assembled in a plausible and practical way if the dynamic of natural forces and processes was more fluid than the causes and masses of Newtonian mechanics and Cartesian biology. One of my teachers at the Guangzhou College, Huang Jitang, went particularly far in this direction in the late 1980s in an Introduction to Chinese Medicine he wrote for a popular audience. As you can see from the extract below, he didn’t exactly condescend to make metaphysics easy for his readership. Rather, he wrote as if an attention to first principles was necessary to any proper understanding of Chinese medicine: Chinese medicine continues to uphold the doctrine that qi (qi-energy) is of one origin – qi is the original root of the world; heaven and earth and the myriad things [wanwu] are all formed from qi; and the life of the human body is generated from the movement and development of qi. [Classical quotations deleted] … So it is that we model research in medical questions on the developmental regularities of the natural world, in order better to mobilize life nurturance and disease prevention. Qi unceasingly moves and changes; this is called “qi transformation.” Qi transformation produces the myriad things including the human body. The Plain Questions [Suwen, juan 9] says, “Qi comes together so there is form” [Qi he er

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you xing]. Every thing [i.e., concern, shiwu] that has form comes into being from the gathering together [juhe] of the most minute qi. But the structured existence of things that have form is a relatively temporary state, material forms also disperse and lose form in accord with qi transformation, and change is itself a thing [shiwu] that changes. The Plain Questions [Suwen, juan 68] says: “Ascending and descending, inward and outward [movements of qi] are never without a thing [material object, also pronounced qi]. So the material object [qi] is the domain of living transformation; but when the object disperses, all falls into pieces, and [that instance of] living transformation ceases.” This “thing” [or object] is something that has material form; it is the site of the living transformations of qi [energy]. Ascending and descending, inward and outward movements are the manifest form of qi [energy] transformation. When the thing disperses, this is a scattering of the original gathered state of qi; its living transformation process is thus ended, and transformed into some other form of gathering qi. Thus it is said: “The life of things comes from transformation: when things reach an extreme they can only change, change is volatility itself, change is what both growth and decay come from.” The human body is also an object, also an instance of “qi coming together so there is form.” In the process of a life there is unceasing qi transformation, unceasing ascending and descending, inward and outward movement. Chinese medicine physiology is the study of this qi transformation process of ascending and descending, inward and outward in the human body. If the qi transformation of the physical body loses regularity, and ascending and descending, inward and outward become disordered; if a stable condition is damaged to the extent that a good equilibrium cannot be maintained; this is the onset of disease. The study of these irregular processes in the human body is Chinese medical pathology.19

In this dense discussion, which I have translated to highlight some fine distinctions among kinds of things, Professor Huang works his way from cosmogony – qi as the original root of the world – to physiology and pathology by way of the configurative nature of qi, the strategic logic of living in accord with the way, the character of the thing as a contingent gathering, and the foundation of all material reality in ceaseless change. An available vocabulary of thinghood  – involving the indiscriminate “myriad things” (wanwu), matters of concern (shiwu), and objects (qi) consisting of gatherings of qi (qienergy) – is very nicely deployed in this explanation. I have provided such a long extract, however, in order to show how integrally dependent every thing is on a dynamic of change, a spontaneous natural process that is always beyond the mastery of merely mortal hands. A vision of qi transformation at this rather general level actually helps us understand the debates at Xueran’s bedside: Was pathologically warm qi configuring or (de)forming in his body along the Six Channels or through the Four Aspects? Surely it was the Six Channels, given the theoretical commitments of the clinicians; but which of them? Could doctors catch the more

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violent forms of qi in the act of transforming inward or downward, and use medicine to reverse the flow, to drive the pathological qi transformation outward to regather as more harmless or superficial objects? The notion of gathering that Huang uses in this piece of modern writing is taken from the philosopher Zhuangzi (fl. fourth century BCE). Recall how he explains the importance of gathering: Qi comes together so there is form [qi he er you xing, 气合而有形]. Every thing [shiwu] that has form comes into being from the gathering together [juhe] of the most minute qi. But the structured existence of things that have form is a relatively temporary state, material forms [xingti] also accord with qi transformation to disperse and lose form, and change is itself a thing [shiwu] that changes … when the thing disperses all falls into pieces, and [that instance of] living transformation ceases.20

Zhuangzi – no doubt casually, and with a smile on his face – made the parallel, and earlier, observation: “the life of humans is a gathering of qi, where there is gathering there is life, when it disperses there is death.”21 Thinking of those human bodies and lives to which we are each so attached – a famous passage from Zhuangzi has him refusing to mourn the death of his wife – he is reminding us not to treat death as anything other than an expected transformation in the myriad forms of things. Moreover, if the thing is a gathering, it evokes all the same characteristics Latour has found in archaic European notions of the thing: The Cihai etymological dictionary tells us that the key term used here, ju, is, first, the gathering of people into villages; second, an assembly of a thing (“Places [方] are gathered from the [myriad] sorts, things [物]are carved out from the multitude”); and third, the collection and storage of things.22 Social, conceptual, and economic notions all rolled into one. Professor Huang is writing for medical novices, or laypeople interested in medicine, and his dip into the metaphysics of thinghood has a pro-life quality, turning from a very broad metaphysics of nature and the Way to our efforts to understand and treat physiology and pathology. It thus contrasts with Zhuangzi’s breezy relativism about human life and death. The final philosopher of thinghood I invoke in this discussion is, like Professor Huang, especially concerned with gathering and protecting human life. He is, after all, a doctor, so his pro-life stance comes with the territory. Learning from things At about the same time scenes like the one at Xueran’s bedside were playing out in Guangzhou’s world of professional Chinese medicine, and when Huang Jitang was writing his introduction to Chinese medicine, a scholar-doctor in

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Beijing was linking metaphysics and clinical judgement in his own powerful way. He was Lu Guangxin, and he worked until 2014 as a clinician, teacher, policy-maker, and philosopher in Beijing. With a gem-like brevity, and with a polemical style reminiscent of Mao Zedong, Lu helped to put a number of metaphysical questions on the table for doctors of traditional Chinese medicine. He discusses, for example, that thing-event called qi (qi-energy), insisting not only on its common-sense quality in Chinese language worlds, not only on its consistency with the insights of quantum physics, but also on its necessity as the material foundation of the whole field of Chinese medicine. Dr. Lu also discusses the epistemological character of the Chinese medical “illness pattern.” Relatively newly centered in the official practice and pedagogy of “traditional Chinese medicine,” the pattern (zhenghou) partly occupies the logical space of biomedical “disease.” But Dr. Lu argues that patterns are not ontological in the same way that diseases are taken to be, even though patterns are quite real. This is another fascinating area of debate and conceptual work that could easily be understood from the point of view of a new theorizing of thinghood in (at least) science and technology studies. But I am tempted to join my patriotic TCM colleagues in China to point out that Lu Guangxin (and his mid-twentieth-century philosopher colleagues in China, and Chinese metaphysicians from at least the Warring States Period with numerous revivals over 2,500 years) was there first.23 With the aim of even further opening up that bedside scene in Guangzhou, what I want to focus on today from Dr. Lu’s writings of the 1980s is his understanding of things. He is well aware, as he writes in the wake of massive systematizing and globalizing projects in his field, of literal-minded questioners who require for every technical term a clear and stable referent in nature. Doctors were asking themselves at the time, “What is qi? What is the pattern (if it is not a disease)?” The desired answers to such questions were delineations of an object in nature, a stable sort of thing that would not alter its form of being to fit human circumstances. Such an object could be discovered, but would not be contingent on any process of gathering.24 A signified must be supplied for the signifier, an object must come forward for every noun to make the technical term consistently meaningful to a large group of interlocutors. But Lu Guangxin insists that things are not so simple. In his usage, what is a thing? For Dr. Lu, it is a duixiang (对象). To see how he uses this very particular Chinese notion of a thing, we can turn to some comments he made in the important preface to his collected works in 2001, using the word duixiang, which I have here, invoking Latour, translated as “thing.” Here he is arguing that medicine is about people, a form of humanism in the broadest sense. (Humanism has been a very big term in Chinese letters since the 1980s.) In a paragraph that addresses the responsibility of the Chinese medicine researcher, for example, he says the following:

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The self-health and self-curing capacity of human-life-generating qi is the thing we serve and the thing we study; it is the thing through which Chinese medicine researchers must diligently become “great doctors of the masses.” Qi is that through which Chinese medicine researchers may or may not become touchstones of genuine Chinese medicine. If we depart from this human-life-generating qi, this “root” of life-generation that must be sought in the nurturing of life and in the treatment of illness, then we cannot expect any genuine Chinese medicine to survive. Hence the Way of Chinese medicine [advises] “the Way is not far from man, let the body/person [shenti] of the patient be your respected teacher.” The root of the Way of Chinese medicine is the study of the human: Learn from the things you serve [e.g., patients, students, bodies]; learn from the things on which medicine relies [e.g., drugs, symptoms]; learn from the things that develop medicine [e.g., scientific results, historical research]; learn from lifenurturance and disease treatment in practice, and seek development only out of practice. Medicine at root is humanism.25

This very general comment picks up on a number of themes that have been important throughout Dr. Lu’s career. Like the seasoned Maoist he is, he insists on learning from the practices of the collective.26 So what he means by humanism is a relational collectivism, a social regime through which all kinds of things play. Latour would call this a parliament of things. Though he is known as a theorist, Lu acknowledges no separate conceptual domain for theory or even for knowledge, no ideal realm in which the “real world” could be represented such that signifiers would correspond neatly to signifieds, and words would correspond without remainder to things. Instead he insists on learning from things as they gather and disperse in practice, becoming a great doctor through an engagement with things. The word he uses for thing has much clearer philosophical content in Chinese than in English. Duixiang (对象) is literally translatable as the image we face. It is a perceptible element of the manifest world, but not necessarily a massy object, and it is irreducibly relational. A duixiang exists only in relation to a perceiver or an actor – some common translations for the word are “target” or “partner”; translation as “interlocutor” or “objective” also works in some contexts.27 A duixiang is a complex entity that emerges from practice, but it does not do so merely as a product of the investigator’s imagination – if this thing were solely imagined, how could anyone learn from it (as Lu advises repeatedly)?28 Implicitly, a whole network of human and non-human agents is active in assembling contingent duixiang “things” for clinical and theoretical attention. Entities such as “the self-health and self-curing capacity of human-life-generating qi” are complex duixiang from which insights about natural processes can be gained. Heterogeneous entities like the body/person of the patient (bearing all his or her history) or the efficacies of an herbal medicine formula (made up of substances, each having its own regional, temporal,

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relational, and even literary character)  – these entities hold together for a while as unique and novel assemblages.29 The thing is thus a site at which specific processes (always more than one process, and never fully under the control of one actor) converge. Such a thing is by definition spatio-temporally unique and requires a situated perceiver if it is to exist at all. Duixiang things are our partners in perception, not the mere objects of our perception. From each such located conjuncture, Lu Guangxin says, we can learn something. This is especially the case if our learning from things is cumulative, collective, and oriented toward practical medical service. The local specificity of Chinese medical knowledge is not just found in a modern nation or linguistic community or set of institutions – it is found above all in a multitude of practitioners and researchers at work among, and learning from, other people and the things they gather, and are gathered into, where they are. The scholar-doctors arguing at Xueran’s bedside were accustomed to working with duixiang of the slippery and dynamic sort explained by Lu. (So was Xueran, and so was I as an anthropologist, although more naively and inarticulately.) They knew that it made a difference what things they chose to relate to, what things they gathered together as duixiang, for purposes of making an intervention. Was it one of the Taiyang Channels that was disordered, and if so, what affiliated systems were most affected? Had the external pathogen reached the Liver system (affiliated to the Taiyin or Shaoyin Channel) and affected all its interlinked sites and functions? Had internal Heat been turned up to the point that Heart system Fire (Shaoyin Channel?) should be targeted? Would a cooling prescription only aggravate the disorder, which might be rooted in a deep-seated depletion (e.g., in the Jueyin Channel) that was cold in character? The clinical dilemma was more than a matter of locating a site where the disorder might be rooted in a presumed a-priori bodily geography. It was not expected that there would be one correct vision of the little cosmos that was this disorder and this body at this time in Guangzhou. And, even though everyone concerned felt there could be a best approach to the things in question, the problem was more than finding a fixed protocol for treatment on which everyone could agree. That evening in Guangzhou, time was short, the stakes were high, things had to be gathered and quickly acted upon. The frightening and exhilarating activeness of the illness, of Xueran’s disordered body, and of its environment needed to be played upon, ridden along with, pushed into more wholesome tendencies. This required graceful footwork and firm hands in a cosmos where not even the furniture can be taken for granted. Notes 1 Karl Popper, Objective Knowledge: An Evolutionary Approach (Oxford: Clarendon Press, 1972); Peter van Inwagen, “Metaphysics,” in The Stanford Encyclopedia of Philosophy, winter 2012 edn., ed. Edward Zalta, available at http://plato.stanford. edu/archives/win2012/entries/metaphysics/.

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2 Graham Harman, Prince of Networks: Bruno Latour and Metaphysics (Melbourne: Re.Press, 2009). See also Howard Chiang’s introduction to this volume. 3 Ludwik Fleck, Genesis and Development of a Scientific Fact (Chicago: University of Chicago Press, 1981 [1979]); Karl Popper, The Logic of Scientific Discovery (London: Hutchinson, 1980). 4 Lorraine Daston, ed., Biographies of Scientific Objects (Chicago: University of Chicago Press, 2000), 1. 5 Ibid., 2–3; Lorraine Daston and Peter Galison, Objectivity (New York: Zone Books, 2007). 6 Daston, Biographies of Scientific Objects, 1. Recently, object-oriented and speculative realist philosophers – the new metaphysicians – have paid close attention to an important essay by Martin Heidegger, “The thing.” In this essay Heidegger distinguishes between things that are present-at-hand as objects of sometimes scientific attention, and things that are (merely) ready-to-hand – the furniture, in Daston’s metaphor  – which have a relatively independent and unnoticed existence as the contingent result of a broad process of “gathering” and “staying.” Importantly, the ready-to-hand can always shift into a role as present-at-hand for some actor or subject, and things that are at some time and in some place present-at-hand can recede into the unconsidered background of the ready-to-hand. See Martin Heidegger, “The thing,” in Poetry, Language, Thought, trans. Albert Hofstadter (New York: Harper and Row, 1971); Graham Harman, “Technology, objects and things in Heidegger,” Cambridge Journal of Economics 34 (2010): 17–25; Jane Bennett and William Connolley, “The crumpled handkerchief,” in Time and History in Deleuze and Serres, ed. Bernd Herzogenrath (New York: Continuum, 2012); Ian Bogost, Alien Phenomenology; or, What It’s Like to Be a Thing (Minneapolis: University of Minnesota Press, 2012). 7 The other chapters in this volume attest to this point. For earlier such arguments, see Judith Farquhar, Knowing Practice: The Clinical Encounter of Chinese Medicine (Boulder: Westview Press, 1994); Ted Kaptchuk, The Web that Has No Weaver: Understanding Chinese Medicine (Lincolnwood, IL: Contemporary Books, 2000); Manfred Porkert, The Theoretical Foundations of Chinese Medicine: Systems of Correspondence (Cambridge: MIT Press, 1974); Nathan Sivin, Traditional Medicine in Contemporary China (Ann Arbor: Center for Chinese Studies, University of Michigan, 1987); Geoffrey Lloyd and Nathan Sivin, The Way and the Word: Science and Medicine in Early China and Greece (New Haven: Yale University Press, 2002). 8 See the chapter by Yi-Li Wu in this volume; one of her chief sources, Wang Shixiong, was a founder of Warm Illnesses medicine. See also Marta Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China (New York: Routledge, 2011). 9 I will not attempt to explain why the Six Channels and the Four Aspects are different and incommensurate scientific objects in this chapter, though I am convinced that they are. The objects taken up below are somewhat easier to characterize as both common-sense objects and metaphysical problems than are these two vast paradigmatic systems governing physiology and pathology for two sometimes warring schools of thought.

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10 Farquhar, Knowing Practice. 11 David Palmer, Qigong Fever: Body, Science and Utopia in China (New York: Columbia University Press, 2007). 12 Philosopher Peter van Inwagen indicates that in the twentieth century the famous Cartesian body–spirit divide has been referred to as a physical–mental distinction, and that this distinction is one of the foundational ontological differences in metaphysics. 13 See Eric Karchmer’s chapter in this volume. 14 Shandong Zhongyixueyuan Xuebao (Newsletter of the Shandong College of Chinese Medicine), Ming laozhongyi zhi lu (Paths of Famous Senior Chinese Doctors), 3 vols. (Jinan: Shandong kexue jishu chubanshe, 1981). 15 In her classic article “Tenacious assumptions in western medicine,” in Biomedicine Examined, ed. Margaret Lock and Deborah R. Gordon (Boston, MA: Kluwer Academic, 1988), 19–42, Deborah R. Gordon, without using a vocabulary of metaphysics or ontology, has persuasively described certain first principles at work in everyday clinical biomedicine. Also see Michael T. Taussig, “Reification and the consciousness of the patient,” Social Science and Medicine 14B (1980): 3–13. In a sense the argument I am making here simply repeats the contribution of these studies, except that the metaphysics of biomedicine is seldom if ever acknowledged as a condition of bedside work in the European and American hospitals where Gordon and Taussig made their observations. 16 Bruno Latour and Peter Weibel, Making Things Public: Atmospheres of Democracy (Cambridge MA: MIT Press, 2005), 20–1. 17 As Heidegger argues in “The thing,” the modernist sciences proceed as if every thing were present-at-hand, in a “distanceless” objectivity that (I would add) resembles the metaphysical flattening of positivist empiricism. 18 For textbook material on Chinese medical “theoretical foundations,” see, e.g., Deng Tietao (邓铁涛), ed., Zhongyi jichu lilun (中医基础理论, Theoretical Foundations of Chinese Medicine) (Guangzhou: Guangdong Science and Technology Press, 1982); Liu Yanchi (刘燕池) et al., eds., Zhongyi jichu lilun wenda (中医基础理 论问答, Questions and Answers about Chinese Medicine’s Theoretical Foundations) (Shanghai: Shanghai Science and Technology Press, 1982); Yin Huihe (印会河) et  al., eds., Zhongyi jichu lilun (中医基础理论, Fundamental Theory of Chinese Medicine) (Shanghai: Shanghai Science and Technology Press, 1984); and Huang Jitang (黄吉堂), ed., Zhongyixue daolun (中医学导论, Introduction to Chinese Medicine) (Guangzhou: Guangdong Higher Education Press, 1988). Articles contributing to the “epistemology and methodology” debates that problematized entities and forces include Jin Guantao (金观涛) and Hua Guofan(华国凡), “Renshilunzhongde xinxi he fankui” (“认识论中的信息和反馈,” “Information and feedback in epistemology”), Ziran bianzhengfa tongxun (自然辩证法通讯) 4.3 (1983): 16–25; Lei Shunqun (雷顺群), “Du xitonglun yu zangxinagxueshuo” (“读系统论与脏象学说 [一－四],” “Reading systems theory and visceral systems imaging [1–4]”), Liaoning Journal of Chinese Medicine (辽宁中医杂志) 8 (1983): 15–17, 9 (1983): 9–11, 10 (1983): 10–11 and 17, and 11 (1983): 12–13; Qin Baolin

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(覃保霖) and Qin Zirong (覃自容), “Neijingde yunqilun xintan” (“内经)的运气 论新探,” “New explorations of qi transport in the Inner Canon”), Henan Chinese Medicine (河南中医) 2 (1983): 12–14; Lü Meixing (吕美行), “Xiandai renshilun yu zhongyi xiandaihua,” (“现代认识论与中医现代化,” “Modern epistemology and the modernization of Chinese medicine”), Yixue yu zhexue (医学与哲学, Medicine and Philosophy) 9 (1983): 45–6; and Lu Guangxin (陆广莘), Zhongyixue zhi Dao: Lu guangxin lun yi ji (中医学之道 陆广莘论医集, The Way of Chinese Medicine: Collected Medical Works of Lu Guangxin) (Beijing: Renmin weisheng chubanshe, 2001). The thinker who has authoritatively addressed metaphysical questions, perhaps at greatest length, is Liu Changlin (刘长林), Neijingde zhexue he zhongyixuede fangfa (内经的哲学和中医学的方法, Chinese Medicine’s Methods and the Philosophy of the “Nei jing”) (Beijing: Sciences Press, 1983); Liu Changlin, Zhongguo Xitong Siwei (中国系统思维, China’s Systems Thought) (Beijing: China Social Sciences Press, 1990). 19 Huang Jitang, “Qi shi shengmingde benyuan” (“气是生命的本原,” “Qi is the original root of human life”), in Zhongyixue daolun (中医学导论, Introduction to Chinese Medicine), ed. Huang (Guangzhou: Guangdong Higher Education Press, 1988), 43–4. 20 Ibid. 21 See Chinese Text Project, ctext.org/zhuangzi/knowledge-rambling-in-the-north (author’s translation). 22 Cihai Editorial Committee, eds., Cihai (Word Ocean Dictionary) (Shanghai: Cishu chubanshe, 1979), s.v. ju. 23 Other anthropologists have argued that it is under conditions of colonial contact  – like the situation faced by TCM in the twentieth century  – that ontology and metaphysics become an especially live issue. See Marisol de la Cadena, “Indigenous cosmopolitics in the Andes: Conceptual reflections beyond ‘politics,’” Cultural Anthropology 25.2 (2010): 334–70; Michael T. Taussig, “Fetishism: The Master Trope,” in The Devil and Commodity Fetishism in South America (Chapel Hill: University of North Carolina Press, 1980), 1–38; Eduardo Viveiros de Castro, “Exchanging perspectives: The transformation of objects into subjects in Amerindian ontologies,” Common Knowledge 10.3 (2004): 463–84. Closer to the metropolitan centers of medical science in the twentieth century, Ludwik Fleck was early (but neglected) in showing how objects are assembled by thoughtcollectives. 24 In science studies terms, this is a “splitting and inversion”: medical linguistic practice constructs presumed-to-be-already-existing natural objects that can be discovered and named by diagnosticians. See Bruno Latour and Steve Woolgar, Laboratory Life: The Construction of Scientific Facts (Princeton: Princeton University Press, 1986 [1979]); Steve Woolgar, Science, the Very Idea (London: Tavistock Publications, 1988). 25 Lu, Zhongyixue zhi Dao, 7. Emphasis mine. 26 Mao Zedong, “On practice (1936),” in Selected Readings from the Works of Mao Tsetung (Beijing: Foreign Languages Press, 1971).

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27 The perceiver or actor for this duixiang object need not be a modernist human subject. In the broadly vitalist world addressed by Chinese medicine practitioners, many non-human actors have intentions, perceptions, and orientations, and thus, duixiang. See François Jullien’s discussion of “propensity” in classical Chinese letters: François Jullien, The Propensity of Things: Toward a History of Efficacy in China (New York: Zone Books, 1995). 28 Hans-Jörg Rheinberger is particularly effective at making a similar point in his historical epistemology of the biosciences: Hans-Jörg Rheinberger, An Epistemology of the Concrete: Twentieth-Century Histories of Life (Durham, NC: Duke University Press, 2010); see especially Tim Lenoir’s foreword, “Epistemology historicized, making epistemic things,” xi–xix. 29 Hanson, Speaking of Epidemics; Carla Nappi, The Monkey and the Inkpot: Natural History and Its Transformations in Early Modern China (Cambridge, MA: Harvard University Press, 2009).

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How to make “acubabies” Leon Antonio Rocha

“These encounters, mundane and extraordinary”: the narratives of Chinese medicine Interactions with biomedical professionals, relations with patients who move back and forth between biomedicine and traditional Chinese medicine, negotiations with healthcare policies and legislatures are not just occasional incidents but rather are the everydayness of Chinese medicine. It is through these encounters, mundane and extraordinary at the same time, that the very “core” of traditional Chinese medicine takes on specific shapes.1

This chapter represents an initial step in a larger project investigating the narratives of Chinese medicine.2 I argue that we should pay attention to the study of “narratology” and the “narrative acts” in Chinese medicine as well as its epistemology. By foregrounding the issue of “narratives,” I suggest that not only is it important to grasp the construction of Chinese medical knowledge, it is crucial to investigate how such knowledge is framed by or presented via certain “stories” or “plots.” To label these narratives “stories” or “plots” is not to imply that they are somehow “fictional” or “untruthful,” nor is it to suggest that such narrative-making is unique to so-called “complementary and alternative medicine” (CAM). Rather, these stories give coherence to a body of knowledge like Chinese medicine; they make it portable, transmissible, comprehensible, identifiable, and attractive to its audiences. On this question of narratology, I am informed by seminal work on the history of the life sciences – particularly histories of nineteenth-century natural history, twentieth-century genetics and evolutionary science, primatology, and paleontology – in which scholars have argued that all kinds of “plots” are not “external” but integral to these sciences.3 “Emplotment” is just as important as fact-making. My outlook in this chapter is also inspired by anthropologist Mei Zhan’s Other-Worldly. She follows the long-range networks, stretching from Shanghai to the San Francisco Bay area, involving cosmopolitan practitioners and shrewd entrepreneurs who promoted Chinese medicine. Zhan conceptualizes the development of Chinese medicine as “worlding” instead

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of “globalization,” to move beyond the conventional spatiotemporal narrative, which assumes a coherent set of knowledge and practices that one could identify as “Chinese medicine” radiating from a definite point of origin or perceived centre (“China”), and then mutating into various forms in that process of transportation.4 Rather, a large number of entangled and entwined “worlds” of Chinese medicine co-emerge at multiple sites, with actors, texts, and artifacts circulating among them  – from State-regulated institutions in China, pharmacies in “sinophone” communities, private clinics across Europe and Africa, new training schools with accredited courses established in the United States and Australia, and so forth. Zhan pays careful attention to that thick and dense “everydayness of Chinese medicine” – a constellation of activities that actively shape Chinese medicine around the world.5 For instance, she sensitively unpacks the various conversations that Dr. Huang Jixian – a medical officer at Shanghai’s Shuguang Hospital – engages in with international students and local patients. Huang “crafts a distinctively traditional Chinese medicine through strategic and mobile positioning vis-à-vis biomedicine in everyday translational practices to form a kind of traditional Chinese medicine that is at once different from and familiar to biomedicine.”6 Zhan argues that it is through these “effervescent moments,” “mundane encounters,” and performative acts that Chinese medicine becomes “translated, reinterpreted, challenged, and performed – that is, worlded.”7 These moments and encounters are not “external” to but are rather constitutive to Chinese medicine: they are “everyday processes and practices by which the very knowledges and meanings of traditional Chinese medicine are relationally produced, negotiated, contested and legitimized.”8 Building on Zhan’s insights, I analyse those narratives in Chinese medicine that are embedded in some equally “mundane” objects of persuasion, namely, a small sample of popular manuals.9 These publications, which cover Chinese herbal formulae and materia medica, patent medicines and food therapy, acupuncture and acupressure, tuina massage and qigong exercises, have surprisingly received scant attention. Why use these manuals as a point of entry? Because I want to consider, or at least touch on, the perspective of the patients and consumers of CAM therapies. Over the last two decades, pioneering scholars have produced pathbreaking work on the constructions and disseminations of Chinese medicine in the twentieth and twenty-first centuries.10 All of these studies have intimately followed doctors and experts operating in private clinics, public hospitals, research institutions, and medical schools in China, Europe, North America, and elsewhere; and addressing anything from clinical decision-making, and instruction and transmission, to the movement of practitioners and personnel around the world. One noticeable gap in our understanding of Chinese medicine remains: the narratives, subjectivities, and experiences of patients. I am especially interested in how an individual becomes a patient of Chinese

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medicine: the multiple ways through which a patient encounters and comes to elect acupuncture and Chinese herbal medicine. Make no mistake, there is a tremendous diversity of patients in terms of ailments and expectations, wealth and access, gender and education, and so forth  – from the factory worker in Chongqing to white-collar professionals in a Massachusetts suburb. To investigate the subjectivities of patients and consumers clearly requires lengthy and laborious interviews and quantitative research with a wide range of individuals in a multitude of settings. The often-repeated demand for a “symmetric” account of medicine – one that gives equal attention to experts and patients – is tremendously challenging to fulfill. I suggest one launching pad for thinking about a specific demographic of Chinese medicine patients  – Anglo-American women from middle- to upper-class professional backgrounds with a high disposable income, who can afford the money and time to research and experiment with CAM  – is the collection of English-language popular manuals. To write in very general terms, these manuals invite readers, who often have not previously encountered Chinese medicine, to think differently about their health and to consider consulting a Chinese healer. They involve varying degrees of ideological and rhetorical labor, and project particular images of Chinese medicine that are often juxtaposed with negative portrayals and lengthy critique on the limitations of biomedical specialties. These guidebooks are a form of publicity for Chinese medical practitioners; the books are written to establish reputation and build cultural capital as well as compete for potential customers in the medical marketplace. These manuals cultivate potential patient-consumers by managing their expectations, often by endowing them with a certain vocabulary or framework with which they can talk about their bodies. In the process they may feel empowered and in control of their health. They are written with the intention to be part of that longer process of fact-gathering and experimentation, when individuals purchase and peruse popular guidebooks, survey the internet for information, discuss their medical decisions, seek testimonials, and exchange information from wider networks. They may try out simple, fast, and “non-invasive” procedures from Chinese medicine – like basic tuina massage, breathing exercises, diet modifications – which may be said to alleviate their symptoms or promote general well-being. In this sense, popular books on Chinese medicine may be different from, say, another subgenre of “self-help” publications on diet and nutrition, because the goal of the Chinese medicine books is to act as a “gateway” or “point of entry” and persuade readers to visit Chinese medicine clinics – often the clinic operated by the manual’s author – to seek further help. This contrasts with the more self-contained guides that contain diet regimens and exercise routines, which ordinary readers could follow without expert guidance. A face-to-face consultation between a Chinese medical practitioner and a patient may be in fact the culmination of a long

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process of continual negotiation and preparatory research. Popular manuals thus deserve more careful attention so that we can understand the many ways through which one comes to encounter and becomes part of a “world of Chinese medicine.”11 “This guy could get a cactus pregnant”: Chinese medicine and infertility BITSY: Can you believe it? Me, pregnant. It’s a girl … And I owe it all to Dr. Mao. Or as we call him, “Dr Wow.” Acupuncturist-slash-miracle-worker. Seriously, I couldn’t take it anymore with the IUIs and the IVFs and the “I-give-up.” Anyway, then I go to this guy and poof! I’m with child! … I don’t know how the hell it works, but this guy could get a cactus pregnant.12

Out of the many popular manuals, I choose one subset discussing Chinese medicine and acupuncture for female patients suffering from infertility or to complement these patients’ in vitro fertilization (hereinafter IVF) regimens. The three manuals I read in depth are all written in English and were published in the United States within the last decade. They include: (1) The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies by Randine Lewis (2004), (2) Fertility Wisdom: How Traditional Chinese Medicine Can Help Overcome Infertility by Angela Wu (2006), and (3) The Tao of Fertility: A Healing Chinese Medicine Program to Prepare Body, Mind, and Spirit for New Life by Ni Daoshing and Dana Herko (2008).13 Why these manuals? I have wanted to read closely the category of books that explore the way that Chinese medicine can deal with a specific problem – such as cancer, heart disease, respiratory illnesses and allergies, skin disorders, diabetes, infertility and menopause symptoms, and controversial conditions like fibromyalgia – and that are directed at the sufferers of these conditions. To paint with a broad brush, the persuasive labor carried out by books that explore Chinese medicine in general differs from those that target a particular disease. Some general guides, for example, are framed by Chinese cosmology and New Age philosophy, or prioritize general advice on health and diet. Others concentrate on meditation, exercises, or home remedies. Yet another subgenre contains lavish illustrations that appear to exoticise China and Chinese medicine.14 Unlike books that address specific conditions, the more general introductions on Chinese medicine do not necessarily contain explicit “translations” between biomedical and Chinese categories, or consistent labor in establishing equivalences between the two medical systems. I speculate that these general introductions may be perused by readers curious about Chinese medicine and perhaps Chinese culture in general, but in the current investigation I limit myself to manuals that address a specific medical condition and offer solutions to it. Neither am I considering specialist textbooks and training

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manuals on reproduction that are written specifically for current practitioners and clinical researchers.15 I am also drawn to these manuals on infertility, IVF, and Chinese medicine because women’s medicine has been crucial to the spread and survival of Chinese medicine in the global medical marketplace. Volker Scheid suggests that women with gynecological problems, which may have no straightforward “cure” in biomedicine, represent a sizeable clientele and a lucrative business for CAM. Scheid argues, “the ensuing demands for practices such as [Chinese medicine] may well have filtered back to China and influenced physicians there to design treatments specifically dealing with this problem.”16 This feedback loop between West and East ends up limiting Chinese medicine as just another CAM useful for treating a narrow set of conditions with an increasingly standardized, streamlined set of protocols. It is true that Chinese medicine has a long and rich history in dealing with reproductive problems through the specialism called “women’s medicine” (fuke).17 However, as Scheid observes, treatment strategies in Chinese medicine for problems like menopause and infertility were really invented from the 1960s and 1970s onwards. This consisted of the careful appropriation of older sources, repackaged and reconceptualized through the biomedical framework, and then re-presented globally as though current Chinese diagnoses and treatments of reproductive disorders are “systematic, coherent and nothing else than the logical extension of ideas contained in the earliest medical canons.”18 As such, I select a fertile area that needs urgent intervention: that intersection between Chinese medicine and assisted conception. I also hope to contribute to work on the cultures of assisted reproductive technologies (ART). Pioneers from medical anthropology and sociology have studied the users of ART, particularly the regimens, outlooks, and lifestyles they follow.19 In the Chinese context, Judith Farquhar and Jeanne Shea have analyzed menopause, ageing, and infertility in postsocialist China, while Lisa Handwerker has written specifically on Chinese women pejoratively labeled “hens that can’t lay eggs” (bu xiadan de muji).20 This whole body of literature on ART is too enormous to dissect here, but particularly pertinent for now is Sarah Franklin’s Embodied Progress (1997), which discusses in detail women’s IVF experiences as a “way of life,” an “obstacle course,” and a “sequence of obstacles that pose a constant challenge.”21 These women deploy “a range of strategies to cope, and [demonstrate] a sophisticated self-awareness in the process.”22 Franklin’s ethnography predates the rise in popularity of CAM as a supplement or adjunct to fertility programmes. I suggest Chinese therapies are being used precisely as one among a host of coping strategies or “accessories,” to “make sense” of things through another discourse. Karen Throsby’s When IVF Fails (2004) touches on the intersections of IVF and CAM. Throsby challenges the dominant representation of IVF as a “successful” technology. Her British informants say they have reached “unacceptable levels of desperation”

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when they try out CAM. Their doctors say they have an “unexplainable” infertility or abnormality; they are thus looking for a “miracle.” Some are IVF users, who feel the need to try everything to beat unfavorable odds – even if they never trust CAM’s efficacy.23 Throsby does not ask which CAM – they may have divergent levels of “scientific respectability,” carry different cultural meanings, and so forth – are chosen by which groups, what these therapies usually entail, and how these women discover information about them. I hope to open up consideration on the entanglements between infertility, ART, and CAM in the western medical marketplace. Isolated studies confirm that a substantial minority of infertile couples turn to CAM as either an alternative or adjunct to ART.24 Chinese medicine, particularly acupuncture, is one of the most popular CAM treatments used in this context. A prospective cohort study carried out in San Francisco followed 428 women for eighteen months. The majority of the subjects were “married (88%), white (70%), college graduates (72%)” and over half had “an annual household income of less than 100,000 [American] dollars (58%).”25 Over half of these women were using IVF during those eighteen months of observation, and “22% had used acupuncture” and “16% herbal therapy.”26 The use of Chinese medicine to supplement IVF has also become an interesting scientific “problem,” indicated by the increasing number, in the last fifteen-to-twenty years, of clinical trials and meta-analyses – statements from Euro-American professional bodies that either support or dismiss it. In mass media, there is also wide reportage on the use of Chinese medicine to treat infertility or as an adjunct to western treatments.27 Representations of “wonderworking” practitioners of Chinese medicine could also be found in popular culture. This section’s opening quotation comes from Sex and the City. One of the main characters, Charlotte York, is desperate to conceive after repeated failures with ART. Following a friend’s recommendation, Charlotte visits “Dr.  Mao”  – also known as “Dr.  Wow”  – played by Chinese medical practitioner Dr. Ni Maoshing (as himself).28 In the packed waiting room of “Wow”’s clinic, Charlotte is surrounded by patients who candidly share their own heartbreaks, as well as their triumphs after receiving “Dr. Wow’s needles.” Charlotte does not end up conceiving; instead her “miracle” is the adoption of a Chinese orphan girl. However, “Wow”’s treatments help Charlotte attain some sort of “inner peace” as she learns to “block out” the noises of Manhattan and Manhattanites. This is one of the first media portrayals of acupuncture used in the context of boosting fertility, and even though it is difficult to measure the impact of such filmic and journalistic representations, they do signify collectively that the combination of Chinese medicine and ART has entered into “mainstream” consciousness.29 The next sections discuss common motifs in the three popular guidebooks on Chinese medicine and fertility. These “plots” include: (1) the making of miracles, (2) the timelessness of Chinese “wisdom,” (3) the tensions between

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Chinese and western medicine. In tandem the manuals and their authors’ backgrounds are introduced. In the final section I address the dynamics between Chinese and western medicines, as well as the question surrounding the evaluation of the clinical effectiveness of Chinese treatments. “We call the little miracles ‘acubabies’”: defying odds and delivering life Step inside our clinic and you can’t miss a wall-size collage dedicated to the babies doctors thought would never be born. We call the little miracles in this photo collage “acubabies”: babies conceived and born, with support from acupuncture and other traditional Eastern therapies, often against tremendous odds.30

Angela Wu, the author of Fertility Wisdom, maintains a clinic in San Francisco and has practiced Chinese medicine “for nearly thirty years.”31 Her first American “acubaby”  – a baby conceived with the help of Chinese medicine (especially acupuncture) “working in partnership with Western fertility experts” – was born in 1982.32 Wu claims that in 2005 alone she has helped “seventy-nine fertility-challenged women become pregnant,” thirty-nine of whom used a combination of ART and Wu’s treatment.33 Many patients who come to Wu confess to being in a hopeless situation, wondering “if they would ever conceive at all.”34 Born in China, Wu explains that her first encounter with Chinese medicine was through her “Ama” (grandmother), who “constantly bombarded [Wu] with unsolicited healthcare advice: ‘Cover your head in winter!’ ‘No cold drinks!’ ‘Eat these special poached eggs after your period!’”35 Wu mentions that she has studied the art of “eight characters” (bazi) “developed more than 5,000 years ago and based on the same concepts as the I Ching.”36 Indeed, Fertility Wisdom contains extensive discussion on harmonizing one’s environment through fengshui to increase one’s chances of conception. Wu’s interest in Chinese medicine stems from her own difficulties. She had a miscarriage without having realized she was pregnant, and later gave birth to a girl who lived for only forty-odd days. She then successfully had two healthy children, but after she delivered her youngest daughter, her bleeding continued and she was hospitalized. It was during her recuperation that Wu began practicing meditation, feeling the “healing power of [her] own qi,” and developed “a deep sense of mission” to apply the wisdom of Chinese medicine to deal with all reproductive problems.37 Wu received training in acupuncture and Chinese medicine, and moved to San Francisco in the late 1970s. She “adapted ancient self-healing practices – meditation and acupressure – that for years were the exclusive domain of Taoist sages,” and challenged “preconceived notions,” reaping “unexpected benefits – among them, miracle babies – and [paved] the way for others on their own

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fertility journeys.”38 Wu states that if women use the “fertility wisdom” that she prescribes “in conjunction with Western technologies,” then: They find themselves better able to manage the physical discomforts and emotional stresses of these treatments. And when they do become pregnant, women who adhere to the concepts behind our Fertility Wisdom increase their chances of full-term pregnancy. They have more energy and vitality, less nausea, fewer mood swings, and a brighter outlook. When it comes time [sic] to deliver, labor often lasts 4 to 6 hours instead of days. Mothers bounce back without depression or fatigue and with better long-term reproductive health. Babies are calmer, with more regular sleep patterns and fewer health concerns. And none of the babies born to mothers who have followed my recommendations – even older mothers – has been born with Down’s syndrome.39

Wu claims her program has proven so successful that it has attracted the attention of western fertility experts, who invited her to participate in research at the University of California, San Francisco. She has been labeled a “fertility goddess,” comparable to “Quan [sic] Yin,” by her patients and associates.40 Ni Daoshing, author of The Tao of Fertility, is another “miracle-worker.”41 Compared to Wu, Dr. Ni devotes fewer pages to his background. What Ni does say is that his family “has been at this for a long time.”42 He claims to descend from “almost seventy-six generations of Taoists,” and his preferred moniker, “Dr Dao,” reflects his commitment to the “Taoist tradition.”43 Ni relates that he grew up immersed in Daoism and was “predestined to be a healer.”44 By the time he was in elementary school, he started learning taiji and qigong, and later on trained in Chinese medicine. Ni wants to “help people actualize their life and their potential.”45 He proposes that it is possible to give birth to miracles by following his simple twenty-eight-day fertility enhancement programme – the eponymous Tao of Fertility. Indeed, this manual is built upon Ni’s tips and the “miracles” from his case files. One such miracle he discusses in great detail concerns a thirty-year-old woman called Rita.46 Rita was diagnosed by her western doctors as “premenopausal”; she had very little ovarian tissue and extremely irregular periods. She had also been going through hormone replacement therapy to manage her premenopausal symptoms, and she had other ongoing health problems including asthma and allergies, and a family history of diabetes. When she visited a “big fertility expert,” she was prescribed oestrogen patches with the intention of using human menopausal gonadotropin shots later to stimulate the ovaries.47 Rita was highly critical of her doctors’ approach: “I think now they were just trying to pacify me. They knew it wasn’t going to work … And sure enough, it wasn’t long before they suggested a donor egg. The shots hadn’t worked and neither did the patch.”48 A donor was arranged who then backed out. Rita “started hoping again that there might be some other way for [her] to get pregnant without a donor egg,” but the doctors were adamant that this

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was not going to happen, “barring a miracle.”49 When Rita insisted, her doctors referred her to a psychotherapist. Later on she went to see another doctor, who introduced her to “Dr. Dao.” Rita was reluctant at first to visit Ni, because of her scepticism with regard to CAM’s efficacy in general and because she was “a complete needle phobic.”50 Her husband convinced her: “Why not try this one last thing?”51 Ni Daoshing recalls that Rita was “very sensitive and highly emotional.”52 His first strategy was to “reverse her ovarian aging.”53 Ni “told her there were no guarantees,” though Rita responded extremely well to the first acupuncture sessions.54 Ni then advised her to avoid refined sugar and to increase her protein intake, and to exercise every day. Soon after Rita “started to feel twinges in the ovary area,” and then an “actual twinge in her uterus.”55 She then began ovulating and her hot flashes had entirely stopped, and “with the blessing of her doctor, Rita went off all of the hormones she had been taking.”56 Dr. Dao continued acupuncture on a weekly basis and Rita was able to ovulate three times. She then discovered that she was pregnant and gave birth to a daughter with minimal complications. And here was the “miracle”: when Rita’s doctor performed a Cesarean section, he was “dumbfounded because he could not find any ovarian tissue.”57 Our third popular guide is Randine Lewis’ The Infertility Cure. Angela Wu used Chinese medicine for her postpartum recovery, and “Dr. Dao” boasts a family heritage in Daoism and Chinese medicine. Lewis, on the other hand, was trained first in western gynecology and midwifery, used ART without success, was helped by Chinese medicine to conceive, and then trained in Chinese medicine – a metamorphosis from patient to practitioner, from western doctor to Chinese healer. Lewis also emphasizes the “magical” and “miraculous” properties of Chinese medicine; it is something at once so simple yet so miraculously effective, or miraculously effective precisely because of its simplicity. Lewis’ book also contains elaborate case studies of women overcoming the odds and successfully bearing a child, despite being told by western experts to give up. One case involves Edith, who went through nine cycles of IVF: [Edith] had her fallopian tubes evaluated and her hormone levels … took (and passed) Clomid challenge tests; she had her uterus inspected hysteroscopically and had uterine biopsies and ultrasounds. She had no history of abnormal menstrual bleeding, ovarian cysts, endometriosis, fibroids, or any other menstrual disorder. Still she couldn’t conceive, and even with all the tests, her doctors could come no closer to explaining why she was unable to become pregnant. The only possible reason, they told her, was her age.58

As anthropologist Sarah Franklin points out, women undergoing a multitude of medical tests and failed cycles of IVF are often told by their doctors that, in the end, “there is nothing wrong.”59 This motivates women to reach out to CAM either for a sense of closure, or for a coherent narrative that can give

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them answers. By the time she came to visit Randine Lewis, Edith was already forty-five years old, and had “obviously come to the point of mistrusting her healthcare providers.”60 Lewis proceeded to see Edith twice a week for acupuncture and herbs.61 After five months of treatment, Edith enrolled in one more IVF and asked Lewis to “gear her up”; Lewis “stimulated her ovaries with acupuncture treatments to flood them with more energy and Blood.”62 Edith finally gave birth to a healthy son. Lewis frames this as a story of defiance  – Edith defied the fertility experts’ diagnosis, and Chinese medicine defied nature (though with the assistance of a final IVF cycle). In a telling passage, Lewis argues that Chinese medicine is all about “listening to our bodies,” and “miracles” could happen to anybody who does so: “When we’re willing to listen to our bodies and begin trusting ourselves as much as we trust outer authorities, all the rules change. And so does our biology. Statistics no longer apply to us. We enter the realm of miracles and undreamed-of possibilities.”63 In her ethnography, Mei Zhan also discusses in detail a cosmopolitan “miracle worker” called Li Fengyi.64 Like many Chinese medical practitioners, for Li, a specialist in cancer and liver diseases, “the ability to handle difficult clinical cases and, in particular, to achieve what mainstream biomedicine cannot is an unmistakable sign of professional accomplishment.”65 It is all about “playing [the western doctors’] game” and “get[ting] right at the centre of the game.”66 Indeed, Zhan shows that “everyday discourse and practice of traditional medicine [have] become intimately connected with the production of the extraordinary.”67 “Miracle-making” is also about strategic positioning and ultimate survival in the marketplace: “craft[ing] a niche of traditional Chinese medicine within the biomedicine-centered healthcare system.”68 Chinese practitioners often deal with the “leftover” cases – patients who have been “abandoned” by biomedicine – from tricky and controversial conditions (which biomedicine ignores) to chronic and debilitating diseases (for which biomedicine offers no cure). This also includes infertility: ART users who have exhausted all other avenues – and thus use Chinese medicine as a “desperate remedy.” Chinese medicine is therefore called on to defy death sentences or to overcome overwhelming odds to create life. These popular books present miraculous clinical events to persuade their readers, to showcase the efficacy or even superiority of Chinese medicine. Where biomedicine fails to bring life, Chinese medicine succeeds in helping women to become pregnant. As Zhan points out, this deployment of the discourse of the “extraordinary,” “improbable,” and “impossible” simultaneously challenges western medicine and reinscribes Chinese medicine’s marginality and Otherness vis-à-vis the “scientific” mainstream: This sense of the extraordinary … underscores the fact that instead of explaining or generalizing the mechanisms of [Chinese medicine], the conceptual framework and technologies of biomedicine affirm [Chinese medicine’s] efficacy only

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to the extent of confirming the result of [the] treatment in biomedical terms. The significance of [the] “miracle” making thus remains ambiguous: [Chinese medicine] has accomplished what biomedicine cannot, and yet the rationality of [its] success is not accounted for – let alone normalized – by authoritative biomedical means.69

Zhan argues “marginalization is much more than the simple act of excluding traditional Chinese medicine from the proper domain of science and biomedicine.”70 The mundane way that Wu, Ni, and Lewis weave their extraordinary clinical experiences into their narratives of medical practice and acts of persuasion performatively reiterates and reinforces the status of Chinese medicine as “complementary and alternative.” “Listen to and heed your body’s innate sense”: Chinese medicine and its timeless fertility wisdom Women understand the idea of the human body as an ecosystem because we ourselves are an “environment” within which (hopefully) a child can be conceived and grow to term. If you listen from the deepest part of your awareness, I believe you will experience the truth of this ancient and wise tradition of healing.71

How exactly does one make acubabies? All three guidebooks perform a delicate balance between the exotic and the familiar. Chinese medicine is “miraculous” but yet its “timeless wisdom” appeals to “common sense.” It is an elaborate system with a foreign origin that requires decades of dedicated training to master, yet the women’s “natural” and “innate” sense is the primary site of authoritative knowledge. Chinese medicine is something mysterious, not easily translatable into western science, yet it is simultaneously something that is always already “known.” To persuade their readers, Ni, Lewis, and Wu recruit the perspectives of former patients, as well as exhibiting elaborate case histories. Again, the plotlines of “timeless wisdom” and “women’s voices” in these guidebooks highlight the tensions and contradictions created by the global proliferation of Chinese medicine. The centerpiece of all three books is their set of instructions on increasing one’s “reproductive potential.” I start with Ni’s “Twenty-Eight Day Fertility Program.”72 It combines dietary regimens, “self-help acupressure,” and lifestyle adjustments to regulate menstruation. The program takes twenty-eight days because this represents “the length of the ideal menstrual cycle (which also roughly corresponds to the lunar cycle).”73 Ni maps the Chinese seasonal view of the female reproductive cycle onto the biomedical view, where “winter” corresponds to the menstrual phase and “summer” mirrors ovulation.74 The winter is akin to “resetting the clock,” as a woman is “gaining a new opportunity to conceive again,” and when spring (the follicular phase) arrives, “plants begin

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to sprout … the earth is filled with new life, with hope and beginnings,” and follicles are “like a bride ready to meet her groom.”75 This leads into the summer and the ovulation phase, “when life is at full bloom.”76 Ni elaborates his fertility programme via this trope of germination, nourishment and cultivation. His food menu, for the first fourteen days of the menstrual cycle from “winter” to “summer,” involves eating “a lot of wholesome grains as well as high-protein foods.”77 Everything must be consumed warm, and raw fruits and vegetables are to be avoided, because they are “harder to digest” and take away the body’s energy.78 If one suffers from menstrual cramps, it is “actually healthier to do more strenuous exercise,” though one should “avoid too much jumping or pounding” to prevent retrograde menstruation.79 If one feels weakened, it is “important to eat hot and warm foods and ‘bloody’ foods – beef bone soup, bone marrow soup, beef chili and hearty stews” as well as root vegetables.80 But above all, “[avoid] cold foods and definitely avoid icy ones – no ice cream and no ice in your water.”81 Ni lists some detailed menus, for instance: “organic whole-grain granola cereal mixed with one cup of organic low-fat plain soy yogurt” for breakfast; “one medium-sized chopped sweet potato or yam, and kale sautéed in chicken, vegetable or beef broth” for lunch or dinner.82 For the second fourteen days of the menstrual cycle, from “summer” to “winter,” the uterus is “like dough to which yeast has been added, the lining starts to rise and create spaces and crevices in which the egg might implant.”83 Ni recommends leafy green vegetables and berries.84 Heavy jumping and running  – or any “activity that would direct the blood flow away from the pelvic cavity”  – must be avoided, and “better bets” are Pilates, yoga, and qigong.85 Ni provides further menus and recipes, including scrambled soft tofu or poached egg for breakfast, and salmon, turkey breast, steamed-beet salad or lean sirloin steak for lunch and dinner. Dr.  Dao also briefly describes the culture of “medicinal foods” in China – cooking meals with the addition of certain medicinal herbs such as “jujube fruit (dazao), milk-vetch root (huangqi), Chinese angelica root (danggui), licorice (gancao), Chinese yam (shanyao).”86 If readers have difficulty acquiring these herbs, they “can substitute more common spices like fennel, cinnamon and ginger.”87 In addition to dietary changes, Ni Daoshing suggests that women selfadminister acupressure on a few acupoints – pressing them twice a day for general wellbeing.88 Of particular importance is the “Sea of Blood” (SP-10 xuehai on the Spleen Meridian of Foot-Taiyin), which has to do with “blood flow.”89 Ni suggests that our blood vessels “are like newly paved highways” when we are young, and as we age, bloodflow lessens and the “roads” become bumpier and narrower.90 The application of pressure on the “Sea of Blood” can “improve the microcirculation into your uterus, your fallopian tube area, your cervix, your vagina – all the areas of your reproductive system.”91 Finally Ni prescribes a set of “do’s and don’ts.”92 Do eat green vegetables, fruits, and legumes. Do eat fish and seafood but in limited quantity, because of the mercury content in fish. If

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in doubt, take fish oil supplements instead. Eat lean meats and eggs. Eat more cooked foods. Eat dark chocolate and drink green tea. Do increase intimacy with one’s partner, do “embrace nature,” and practice meditation. Further, recognition of “the power of imagery and affirmation” is essential: As part of your fertility program, start imagining. Daydream – come up with a mental picture that conjures up life and growth. Imagine a forest throwing off warmth and moistures … Everything grows there; everything gets fertilized and implanted. Now imagine that your pelvis or uterus is like the floor of that rain forest … The soil is full of nutrients, so any seed that drops on this floor will germinate and become alive … [The imageries] help a woman to focus and concentrate on bringing energy and blood circulation to a particular region.93

Here Ni recruits a “woman’s voice.” A former patient says that she “had heard about the mind/body connection, particularly how it relates to fertility.”94 It is about “getting centered and peaceful, and letting go of stress,” and through Chinese medicine she has come to understand “how the mind and the body interact,” which has “helped [her] to slow down” and improved her “egg quality.”95 A major feature of Ni’s The Tao of Fertility is the frequent appearance of a grey text box, separate from the main text, entitled “Women’s voices” – a point to which I return in the next section. The bulk of Wu’s Fertility Wisdom is a guide for boosting the chances of natural conception and success with ART, by preparing and nurturing a woman’s “internal environment.”96 In contrast to Ni, Wu prescribes a program that has to be followed for at least three to six months, consisting of the following components: “Feed the seed: eating and drinking wisdom,” “Nurture your organs: acupressure techniques,” “Smile and breathe: Taoist meditations,” “Move your body: Qigong exercises,” “Circulate your qi: using moxa,” and “Harmonize your environment: fengshui for fertility.”97 Wu’s dietary prescriptions are largely similar to Dr. Dao’s, particularly their shared, repeated emphasis on not taking food or beverages cooler than room temperature  – ice cream is strictly prohibited. Processed foods and refined sugar must be avoided; and all women should “[replace] junk food with real food”; stop smoking and drinking coffee; and lower the consumption of raw foods, including fruits.98 However, Wu describes a more elaborate classification of food according to the yin–yang and wuxing theories, whereby different foodstuffs contain different qi or affect its movements in the body. Depending on an individual’s bodily constitution (“internal weather”), which a reader can read off from Wu’s chart, certain foods are beneficial or harming.99 Wu provides details on how to “stock a fertility-friendly pantry” (fresh ginger and lowfat cottage cheese, among many items).100 Overall the aim is to “stop counting calories or assessing nutrient content” and instead “[strive] for balance and harmony – a diet that is neither too warm nor too cool and that samples the amazing variety of foods, beverages, herbs and spices nature provides.”101

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There is however no mention of Chinese herbal formulae, with the exception of a small two-page appendix at the end of the book on the familiar Xiaoyao san (“Rambling Powder”), Bazhen tang (“Eight-Treasure Decoction”), and Baochan wuyou fang (“Worry-Free Formula to Protect Birth”).102 The next four aspects of Wu’s program concern “bodywork”: acupressure, meditation, qigong, and moxa. Acupressure involves three techniques in turn: “Opening the Wind Gates,” “Uterus Lift,” and “Groin Pulse Acupressure.”103 The so-called “Wind Gates” in Wu’s scheme do not refer to the acupoint “Wind Gate” (BL-12 fengmen on the Bladder Meridian of Foot-Taiyang), but to Wu’s idiosyncratic method of “belly-breathing” and massaging various regions around the navel.104 “Uterus Lift” is an “important fertility enhancer,” Wu claims, “as old as Chinese medicine itself,” and “can be used by any woman … to lift and strengthen their uterus.”105 The first part of “uterus lifting” involves repeatedly relaxing and contracting the muscles in the pelvic floor during urination, similar to “Kegel exercises.”106 Then a woman should place her fingertips just above her pubic bone, pressing in toward her spine: “Your fingers will be under your uterus … gently lift your uterus up toward your navel … hold this position for 33 seconds, then release.”107 Finally, “Groin Pulse Acupressure” is “nature’s Viagra – an easy way to improve blood-flow to the genitals” by massaging the groin region and the inner thighs.108 Wu calls her meditation technique “Inner Smile.” Arguing that western medicine had only just begun “to acknowledge a correlation between health and happiness,” Wu claims that the “ancient Taoist sages” already understand the power of joyfulness: “You smile to your organs and thank them for a lifetime of hard work in keeping your body operating.”109 Further practices include “Microcosmic Orbit Meditation” – “touch[ing] your tongue to the roof of your mouth just behind your front teeth” to connect the major energy channels in the body – and “Six Healing Sounds” – healthy organs have “natural frequencies,” and it is possible to make the organs “resonate” by humming particular sounds.110 An extremely brief section on moxibustion is immediately followed by a discussion on fengshui: “Through the way we build on the land, place furniture and other objects in our homes, and choose colors for our décor and clothing, we can facilitate the flow of qi around us and bring good fortune, health, harmony – even a baby – into our lives.’111 Wu recommends her readers to place a Bagua mirror above the front door “to ensure balanced energy in your home”; arrange furniture with “maximum benefit and minimum effort” in mind; tidy up the bedroom, as “clutter blocks the flow of qi”; and use auspicious colors and “fertility symbols” (elephants, dragons, red paper lanterns, and fruit) to decorate the living space.112 Wu emphasizes that, in order to produce miracles, there has to be a total biological and environmental makeover. Randine Lewis’ “Ancient Chinese Program for Reproductive Wellness” comprises four steps: (1) preparing the reproductive system by “balancing opposing energies,” (2) “Taking care of your body gently and naturally” through diet and

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lifestyle changes (3) “Clearing your energy” with acupuncture and acupressure, (4) using herbal remedies to “promote vibrant reproductive health.”113 Out of the three guidebooks, Lewis’ contains the lengthiest instructions on acupuncture points and herbal remedies.114 Readers are invited to “come up with a program with which [they] are comfortable and to which [they] can adhere for perhaps months.”115 Whereas Ni and Wu describe around five acupoints, Lewis lists fifty, from those that “tonify the kidney” and “resolve liver qi stagnation,” to those that “regulate the hypothalamic–pituitary–ovarian axis” and “resolve grief and call to the soul of the unconceived child.”116 While Ni and Wu have little commentary on herbs, Lewis discusses around sixty formulae and patent medicines.117 There are also elaborate checklists, templates of charts, and tables with which readers are to monitor their reproductive cycles consistently.118 Despite these differences, Lewis’ advice is still largely similar to the other two authors’. Without sharing Ni and Wu’s fervent denunciation of ice cream, Lewis encourages her patients to: eat alkaline rather than acidic foods; have food with essential fatty acids from unprocessed plant sources and deep-sea fish; eat organic foods and hormone-free meats; avoid caffeine, nicotine, and alcohol; and so forth.119 Randine Lewis also prescribes various massage and qigong exercises that would help “literally breathe life into and through the uterus.”120 Ultimately the minutiae of the programs for making acubabies need not overly concern us. What really matters is the way that their Chinese medical knowledges are mediated and presented via the same narrative: Chinese medicine as a kind of “timeless wisdom.” For “Dr. Dao,” his source of authority was an exclusive pedigree  – seventy-six generations of Daoists.121 He de-­emphasizes his training and background and implies that his procedures are based on secret “wisdom” transmitted through generations of miracle workers. Out of the three manuals, Ni’s fertility program and therapies strike one as being the most general and simplistic. Angela Wu focuses on the “practicality” of her “fertility wisdom” and again emphasizes the “timeless advice” handed down from her ancestors, who in turn were endowed with the knowledge of the “Taoist sages from the Mountain” and the fertility goddess “Quan [sic] Yin.”122 Wu relates her teenage experiences, when she lived with her mother’s stepmother, who insisted that Wu eat a particular “post-period breakfast” with chicken and eggs poached in broth with fresh ginger, sesame oil, and rice wine – which Wu now prescribes regularly to her patients and readers. She states that, in East Asian cultures, elders are regarded as “a source of knowledge on how to live a healthy life,” and that China is “full of concerned grandmothers who tell their busy granddaughters never to leave the house with wet hair.”123 These everyday tips from nagging “amas” and long-winded “grannies” are regarded as something that encodes the principles of Chinese medicine, ignored or forgotten by modern

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men and women. Wu veers close to arguing that Chinese medicine is actually these “mundane” yet “miraculous” tips; it is something that is always already known by “us” (the Chinese). Wu’s mission is to recover this earthy advice for holistic health and begetting good offspring that has been distilled and refined through Chinese families, and to put this living wisdom back into wide circulation. The narrative that frames Randine Lewis’ acubabies program through Chinese medicine privileges the experiential. She portrays herself as a patientturned-practitioner, stating at the outset that her program “is not based on ideas about how to treat infertility; it is based on experience.”124 She frequently interjects her discussion on Chinese medicine with autobiography to add persuasive power: When faced with my own fertility challenges, like many other desperate women I was obsessed with making sure I did everything possible to help my body conceive and carry a child. I altered my diet, cut out all forms of animal products, and choked down a shot of wheatgrass every day … I also started incorporating elements of the Chinese medicine I was studying. Chinese medicine is based on the idea of balancing every aspect of the body, including diet and lifestyle.125 My first experience with Chinese herbs included trying every kind of natural fertility enhancement I could find in my desperate attempt to become pregnant … I brewed horrible-smelling concoctions of raw Chinese herbs on the stove, and they tasted no better than their aroma. Three months after I began my treatment with TCM [traditional Chinese medicine], my hormonal problems were resolved, and I became pregnant. My next experience was when I was in China interning at a TCM hospital, and I was in horrible physical shape. I was breastfeeding my baby, having terribly heavy periods, and feeling constantly fatigued. An internist felt my pulse and reported that I was rather depleted in both Qi and Blood. The next day, the hospital lunch consisted of mutton soup with the herbs Angelica (danggui) and Astragalus (Huangqi). Sounds horrible, right? … I had a bowl of the soup, and although it tasted unusual to my Western palate, after the first cup I began to crave more … And yes, I started feeling better.126

Lewis’ emphasis on the experiential, and the insertion of her own struggles and triumphs, dovetails a celebration of the “female spirit” and the “feminine mystique”: Mysterious and ancient, [the female spirit] is the mother of all creation, bringing forth both the heavens and the earth. Even if we sometimes feel this spirit is hidden, it is always within us. When facing the challenges of infertility, we can draw upon its life-giving potential. This spirit wants to give life, to be healthy, to harbor children; our job is simply to help our bodies to do what they were meant to do.127

Elsewhere, Lewis writes about the “Mysterious Female” that resides in all women, and how by “gently nurturing” it, all women could “reclaim the

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blessing of [their] fertility.”128 While biomedicine is “certainly valuable,” it loses “the sense of the whole, of the need for us to be in tune with our true nature to bring forth life.”129 If we use Chinese medicine, then we are “declaring our desire to be in alignment with nature,” and placing our trust in “our body’s innate wholeness and seeking ways to help the body remember what it was meant to do.”130 In a nutshell, Lewis places Chinese medicine on the side of “nature,” on the side of “women’s bodies,” and on the side of a mystical “female spirit” residing in all women  – and it is therefore “timeless.” The source of Chinese medicine’s efficacy is precisely all this – to use Chinese medicine is to “listen and to heed to the body’s innate sense,” and to believe in the body’s “natural” power, to “experience the ebb and flow” of cosmic energies.131 Chinese medicine, under Lewis’ scheme, operates at a different, spiritual dimension compared to “materialist” western medicine. Since Ni, Wu, and Lewis all project Chinese medicine as “timeless wisdom,” it is not surprising that their books convey little sense of the history and evolution of Chinese medicine. Out of the three, only Lewis explicitly names, in a cursory way, Chinese medical texts – the Yellow Emperor’s Inner Canon [Huangdi neijing] and the Book of Difficulties [Nanjing]. There is no discussion on historical figures or how particular therapies or formulae changed or developed. For example, in explaining acupuncture, Lewis’ historical narrative amounts to this: Thousands of years ago, sharpened stones and rudimentary needles made of flint were used to penetrate precise points on the skin, yielding consistently predictable results. These points were then charted into meridians, or energy pathways, which have complex and fascinating physiological effects on Organ system [sic].132

In sum, all three practitioners stress the “do-it-yourself ” nature of their fertility programs. It is about doing “work” on oneself and being in control of one’s fertility, contrasted with being “passive” and relying on ART. As Angela Wu writes, it is also about “getting to know yourself.”133 All three authors devote the final chapter to the way that Chinese medicine, even if it does not bring about the miracle of life, is nevertheless wisdom that will benefit everyone for life because it brings about total health.134 “Monkey King’s path”: cooperation and disenchantment with Western medicine When the Monkey King set off on his journey, he knew where he was going and what he had to do. How he was going to get there was an entirely different issue. When you’re taking a journey, it’s always a good idea to know where you are going. And if you’ve made it this far, you obviously do: you are heading in the direction of motherhood. That is why you have prepared your mind, your body,

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and your spirit. But how far are you willing to go to reach your goal? If motherhood is your ultimate goal, would you be willing to contemplate a donor egg or surrogacy if necessary? Are you willing to use assisted reproductive technology (ART) or are you adamant about pursuing a completely natural and drug-free pregnancy? And just how long are you willing to travel? All of these questions must be considered before you can determine the best route for you to take.135

I have read closely a small sample of popular manuals on Chinese medicine and fertility, and the analysis has focused on the level of language and rhetoric  – the similarities and differences of the messages that these books aim to transmit. I have argued that, to make Chinese medicine understandable and palatable, these popular manuals deploy a number of “plots” that we can identify. These books promise to “make miracles” and simultaneously manage readers’ expectations by stating that, even if Chinese medicine does not work, its timeless wisdom can result in new levels of holistic wellness. I suggest that these “plots,” as mundane as they may be, are important “narrative acts” and important processes in the continuous writing and rewriting of Chinese medicine. These books carry a tension between two positions with regard to the relationship between Chinese medicine and western medicine. On the one hand, they criticise western medicine and fashion Chinese medicine as a healthier, caring, more “natural” alternative to the physically exhausting and mentally grueling fertility programs to which women are subjected. On the other hand, they never seek to discredit the efficacy of western treatments, occasionally admitting that Chinese medicine functions ideally as a supplement or adjunct to western fertility programs. It appears that this is also how patients perceive Chinese medicine – as something that may increase the chances of conception but not necessarily as a replacement for ART. The move to critique western medicine and to establish Chinese medicine’s attractiveness always already entails a simultaneous reaffirmation of the power and authority of biomedicine and the ultimately “marginal” status of Chinese medicine, which is “parasitic” to the “failures” of biomedicine. On the question of power and authority, hitherto I have not considered the obvious problem of efficacy – do Chinese therapies work? Can one really make “acubabies”? That question of evaluating the clinical effectiveness of Chinese medicine is of course not the responsibility of researchers engaging in science studies or medical anthropology, and throughout the present chapter I have maintained an agnostic position. A lengthy discussion on the vast amount of scientific literature generated on Chinese medicine and the question of its efficacy (particularly as adjunct to ART), and the epistemological politics involved in “biomedicalizing” or falsifying CAM, will have to be a separate essay. In this section I offer a brief discussion based on the three popular manuals. Out of the three, only one explicitly mentions evidence-based research – Randine Lewis cites two clinical trials. Lewis states that in spring 2002  “a

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study by German researchers investigating the effects of acupuncture in women undergoing IVF” took place.136 Although Lewis does not explicitly name this research, it is a reference to Wolfgang Paulus and his collaborators at the Christian-Lauritzen-Institut in Ulm, Germany and the Tongji Medical University in Wuhan.137 According to Paulus et al., the research is based on 160 subjects (80 of whom had embryo transfer with acupuncture, 80 without acupuncture treatment acting as the experiment’s “control”). The acupuncture was performed 25 minutes before and after embryo transfer, and the rate of clinical pregnancy – defined as the presence of a fetal sac during an ultrasound scan six weeks after embryo transfer – was noted. Paulus et al. noted that clinical pregnancies were documented in 34 out of 80 patients in the acupuncture group, whereas the rate for the control was 21 out of 80. Thus the authors conclude that acupuncture “seems to be a useful tool for improving pregnancy rate after ART.”138 The second scientific article, which again is not explicitly named by Lewis, is the 2002 review by Raymond Chang and his collaborators at Cornell University.139 Chang et  al. suggested that “because acupuncture is nontoxic and relatively affordable,” its indication as an adjunct for or alternative to ART “deserves serious research and exploration.”140 For Lewis, “these results were not surprising.”141 She states that “all you really have to know is that acupuncture works” – that ultimately, such clinical trials were unimportant.142 Citations and discussions on scientific literature are conspicuously absent in Ni’s The Tao of Fertility and Wu’s Fertility Wisdom. Their bibliographies consist primarily of references to other popular guidebooks – Wu cites works by Mantak Chia and Deepak Chopra – or English-language textbooks, without any reference to the vast body of scientific literature on Chinese medicine and fertility. There may be a practical reason: since these guidebooks are written for a lay audience, they have avoided discussions on complicated research and trials. But there may also be an underlying “ideological” reason that illustrates the authors’ self-positioning vis-à-vis western medicine. Angela Wu’s Fertility Wisdom claims on its front cover that Chinese medicine is: CLINICALLY PROVEN TO • Support Natural Conception • Shorten Labor • Speed Postpartum Recovery[.]143

The book does not discuss recent clinical trials. Wu does recruit the help of Victor Fujimoto to write an endorsement; Fujimoto is a professor in obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco.144 Fujimoto suggests that he does not know “why [Chinese medicine] has a positive impact on infertility,” but that “there are things that Western science simply can’t explain,” and that he is “open to the idea that ‘spirit’ – though beyond the realm of Western medicine – plays a role in physical health.”145 Wu

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herself holds that “Eastern and Western professional partners” may have “dramatically different perspectives on fertility and use different tools to enhance it.”146 But the two medical systems “have one thing in common: they want you to succeed. They want you to have the baby you so desire.”147 Wu invites her readers to “empty their cups,” to forget about past failures with all sorts of treatments, and to “put those experiences behind [them].”148 This is because, Wu argues, “conception is the baby’s choice, not a product of your will or your professional partner’s skill. And you can improve your chances of being that choice by nurturing, encouraging and supporting the best partner you have: your body.”149 Wu’s book evades judgement on which medical approach is more effective, insisting instead that all partners should collaborate. She tells her readers that “whatever the direction of your path, you can choose to travel with an open mind and a smile on your face.”150 By contrast, Randine Lewis and Ni Daoshing are more critical of western medicine. Lewis’ language is very revealing. She asks her readers to start “changing your mind about infertility” and relates that when she first began studying TCM “it was difficult to believe what was presented to [her].”151 She recounts how she constantly argued with her TCM teachers, until “one of them told [her] to forget all the ideas of Western medicine that [she] had come to accept as the only truth,” because Chinese medicine is a “new paradigm.”152 Lewis continues to recount her own negative experiences with western fertility treatments: “my Western doctor’s only solution was to use drugs like Clomid.”153 She describes Western medicine and Chinese medicine as “two medical worldviews,” and aims to “correct the ‘conception misconceptions’ of Western medicine” and to expose its “bias.”154 Pointing out the “failures” and “fallacies” of western reproductive medicine, Lewis insists that there are two distinct, contrasting ways of thinking about health.155 East and West are not necessarily incommensurable or untranslatable – in fact Lewis displays a kind of syncretism or “bilingualism” as Chinese medicine and western diagnoses and disease categories are used to explain each other.156 But in Lewis’ view, there is no real need to subject Chinese medicine to the verification of western science to legitimize her practice. “Dr. Dao” Ni Daoshing states that he has “great respect for [western] diagnostic tests,” but: If you’ve been given information about your infertility that doesn’t feel quite right or is confusing, or even makes no sense at all to you, you are not alone. In Western society, we are taught to believe that the doctor is always right. It’s hard to speak up when you have questions or concerns. But that’s exactly what you must do. If you have a feeling about what’s happening or not happening in your body, it’s imperative to ask for the care you want. Don’t get swept up in fear or anxiety over your diagnosis and allow yourself to make a hasty or pressured decision about your case.157

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And in one of the “women’s voices” that Ni Daoshing incorporates with this argument: “You can do all the tests in the world, but you can’t do anything unless you accurately describe how you feel to someone who is willing to listen.”158 Enfolded within these passages are two critiques of western medicine. First, western medicine provides a diagnosis that can seem impersonal, even objectifying and disempowering. It does not endow patients with a vocabulary to “accurately describe” their subjective experiences. Ni encourages readers to challenge their western physicians, who are there to “serve.” Moreover, the suggestion in the second passage is that western doctors are not necessarily willing to listen to their patients’ concerns. From this critique, Ni returns to a trope he frequently uses in the book – that of a journey, a journey to conception with various obstacles and challenges to women. Ni describes the “Monkey King,” the protagonist from the sixteenth-century Chinese epic novel Journey to the West (Xiyou ji). The Monkey is “about to set off on his journey,” accompanying the sacred monk Xuanzang to retrieve Buddhist sutras from India and battling demons and ghosts along the way.159 Ni suggests that even though the Monkey King “knew where he was going and what he had to do[, h]ow he was going to get there was an entirely different issue.”160 Likewise, for Ni, there could be multiple paths toward the same destination, many methods for achieving conceptions. He implies that these possible pathways, from the IVF needle that injects sperm into an egg to the acupuncture needle that regulates qi circulation, are equally valid. In distancing himself from the “path” of western medicine, Ni highlights the experiences of former patients and incorporates a large number of case studies. Indeed, in the Prologue, Ni Daoshing opts to let former patient Dana Herko introduce the book. Ni explains: I have had the privilege of seeing thousands of women patients … They have taught me humility, compassion, and the strength of the human spirit. But for all I have learned – and regardless of how well I have come to appreciate and understand women – I can never be a woman living through the actual experience of her fertility challenges. I needed a woman’s voice to help me better communicate the wisdom passed on to me and what I have come to know.161

Wu’s Fertility Wisdom and Lewis’ The Infertility Cure also mobilize large samples of “women’s voices” to make Chinese medicine relatable, using their patients’ struggles to illustrate its miraculous effects – Angela Wu uses approximately fifteen such stories; Ni Daoshing and Randine Lewis both use around twentyfive cases to appeal to their readers. From these three popular manuals we could discern a number of different positions on the relationship between western and Chinese medicine. Wu recruits a western gynecology expert to write a testimonial, without mentioning ongoing clinical research, and generally subscribes to the position that western and Chinese medicine can cooperate, or that Chinese medicine qua

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“practical wisdom” can complement or integrate easily with a woman’s fertility regimens. Randine Lewis is the only author who explicitly discusses clinical research. Lewis and Ni Daoshing both point to “mainstream” biomedicine’s failures and weaknesses: the lack of sympathetic human exchange in western medicine, the inattention to the patients’ “total health,” the reduction of complex phenomena into statistics and incomprehensible terminologies that leave women feeling disenfranchised. These practitioners never explicitly dispute the power of western fertility medicine, nor do they construe Chinese medicine as an incommensurable, absolute “Other” resistant to all attempts at translation. Nevertheless, they do not believe that it is necessary to legitmize Chinese medicine through clinical trials or “scientization.” To adopt Ni’s metaphor: there are many paths available for conception, and some paths are just as good for taking one to the desired destination. Chinese medicine is thus fashioned as a “pathway”: as valuable as, or sometimes superior to, western counterparts. By way of closing, I want to go beyond the three popular manuals and turn to the “epistemological politics” and then the “narratological politics” of Chinese medicine. In 2010 five British researchers conducted a meta-analysis of the evidence on the effectiveness of acupuncture and herbal medicine on the treatment of female subfertility by ART, based on fourteen randomly controlled trials. The paper was published in March 2010 in Human Fertility, official journal of the British Fertility Society, which released in the same month a new set of guidelines to its members on Chinese therapies.162 The guidelines stated: “There is currently no evidence that having acupuncture or Chinese herbal medicine treatment around the time of assisted conception increases the likelihood of subsequent pregnancy.”163 In response, the British Acupuncture Council published its own statement, sayint it was “surprised at the findings especially as they seem to contradict a lot of the research previously published in this area.”164 The press release cited numerous studies that supported the use of acupucnture, as well as quoting the practitioner Zita West, who stated that “many women we see at [Zita West’s] clinic who have experienced IVF both with and without acupuncture frequently report that they are convinced that acupuncture made a difference”  – the argument moves quickly back to the experiences and testimonials of female patients.165 The response from the Association of Traditional Chinese Medicine and Acupuncture UK (ATCM) was more strident. It points out that, in the clinical trials assessed in the Human Fertility review, acupuncture is administered around the time of egg removal, on the day of embryo transfer, or two to three days after embryo transfer. This is not, in ATCM’s view, representative of a typical acupuncture program, which may be administered “once or twice a week for at least two to three months before and during IVF procedure.”166 It adds: “No wonder that in these trials, ‘acupuncture’ did not make any difference. You would not use 1/10 of normal dose of penicillin to treat pneumonia and then claim that penicillin is not effective for pneumonia.’167 The association

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also insists that the “acupuncture” used in clinical trials, in which the same acupoints were used across all research subjects, is “against the fundamental principle” of Chinese medicine: “There is no such thing existing that one or a few points can be effective to treat any kinds of infertility in all patients regardless of constitutional difference. Such tailor-made acupuncture treatment may make randomized controlled trial impossible.”168 As such, the “acupuncture” used, ATCM argues, “is not authentic.”169 Volker Scheid, in concluding his study on the globalization of menopause, echoes Vincanne Adams’ concern that “once traditional medicines allow themselves to be evaluated by biomedical research methods, the odds against receiving fair treatment are heavily stacked against them.”170 Chinese treatments are simplified so that they can be evaluated via biomedical research methodologies, and if negative results emerge from these studies then an entire field may be delegitimized, as if the simplified treatment protocols could stand in for all of Chinese medicine. The dispute discussed above between professional associations in western fertility medicine and Chinese medicine highlights questions concerning standardization and the slipperiness of “authenticity” – whether there could ever be a consensus on a standard protocol or a selection of procedures for all cases of infertility, whether there can be such a thing as an “authentic” acupuncture or “Chinese” medicine. These are the “epistemological politics” that have resulted in the worlding of Chinese medicine, and trials on IVF and acupuncture are just one of the many arenas in which this politics plays out. In this chapter I have discussed only three guidebooks or “objects of persuasion.” No matter how important or widespread these books are, they cannot be taken as representative of all popular books on Chinese medicine and fertility. More close reading is required on a range of publications on this subject, as well as more comparative work on books on fertility and CAM to see what kind of “stories” are being built around Chinese medicine. More ethnographical research is necessary too on the users of ART and Chinese medicine, and there is an enormous network of actors and institutions to be followed. Through the chapter I have wanted to draw out one key part from this vast enterprise – which I can perhaps call “narratological politics.” I suggest that the “narratological” is not so much to do with the “epistemological,” or with the verification or falsification of Chinese medicine via the research protocols of biomedicine. It has not so much to do with ways or styles of knowing either. Rather, to investigate the “narratological” is to pay attention to how Chinese medicine is framed by particular plotlines, how these stories are told, how certain signs and shorthand are mobilized to make Chinese medicine transmissible and understandable. These narratives are no less important to the survival of Chinese medicine in the West than clinical trials and metaanalyses – these narratives, mundane and ordinary as they often are, cultivate particular expectations, or reiterate Chinese medicine’s status in the western

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medical marketplace, or define and delimit the direction that Chinese medicine may take. Acknowledgments I am grateful to Carla Nappi, Volker Scheid, and Howard Chiang for their invitation to the 2010 conference “The (After)Life of Traditional Knowledge: The Cultural Politics and Historical Epistemology of East Asian Medicine.” I benefited enormously from conversations with Vincanne Adams, Bridie Andrews, Judith Farquhar, Eric Karchmer, David Luesink, Hugh Shapiro, Volker Scheid, and Yi-Li Wu at that event. As always I am indebted to Vivienne Lo and especially Elisabeth Hsu for their guidance on Chinese medicine. I express my appreciation for the “Generation to Reproduction” program – the Wellcome Trust Strategic Award awarded to the Department of History and Philosophy of Science, University of Cambridge  – especially its principal holders, Nick Hopwood, Martin Johnson, and Sarah Franklin, whose scholarship has continued to shape my thinking. Anna Kathryn Schoefert read through drafts of this chapter; all errors and inaccuracies remain my own. Notes I am not linked or affiliated in any way with the medical practitioners and their associated businesses or institutions discussed in this chapter. I do not endorse or oppose these practitioners or the medical services that they offer. 1 Mei Zhan, Other-Worldly: Making Chinese Medicine through Transnational Frames (Durham, NC: Duke University Press, 2009), 12. 2 I use the phrase “Chinese medicine” and refrain from using “traditional Chinese medicine” or “TCM” unless I am specifically referring to the “standardized” form of Chinese medicine taught in State-regulated institutions in the People’s Republic of China. “TCM” is only one of the many “Chinese medicines” that are practiced around the world – and it is not even the only form of Chinese medicine practiced in China. Kim Taylor, Chinese Medicine in Early Communist China, 1945–63 (London: RoutledgeCurzon, 2005); Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis (Durham, NC: Duke University Press, 2003); Elisabeth Hsu, “The history of Chinese medicine in the People’s Republic of China and its globalization,” East Asia Science, Technology and Society: An International Journal 2 (2008): 465–84. 3 E.g., Gillian Beer, Darwin’s Plots: Evolutionary Narrative in Darwin, George Eliot and Nineteenth-Century Fiction (Cambridge: Cambridge University Press, 1983); Donna Haraway, Primate Visions: Gender, Race, and Nature in the World of Modern Science (London: Routledge, 1989); Donna Haraway, Simians, Cyborgs, and Women: The Reinvention of Nature (London: Free Associate Books, 1991); William Clark, “Narratology and the history of science,” Studies in History and Philosophy of Science 26 (1995): 1–71.

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4 Zhan, Other-Worldly, 23–4, 195–201; Mei Zhan, “A doctor of the highest caliber treats an illness before it happens,” Medical Anthropology: Cross-Cultural Studies in Health and Illness 28 (2009): 166–88 (170–3); Mei Zhan, “Worlding oneness: Daoism, Heidegger, and possibilities for treating the human,” Social Text 29 (2011): 107–28. 5 See Zhan, Other-Worldly, 12, 27. 6 Ibid., 141. 7 Ibid. 8 Ibid., 141–2. 9 My use of “popular” here is to designate books on CAM that are accessible to a general, non-specialist audience  – readers with little prior contact and background knowledge. 10 E.g., Judith Farquhar, Knowing Practice: The Clinical Encounter of Chinese Medicine (Boulder: Westview Press, 1994); Elisabeth Hsu, The Transmission of Chinese Medicine (Cambridge: Cambridge University Press, 1999); Scheid, Chinese Medicine in Contemporary China; Linda Barnes, “The acupuncture wars: The professionalizing of American acupuncture; A view from Massachusetts,” in Medical Anthropology: Cross-Cultural Studies in Health and Illness 22 (2003): 261–301; Elisabeth Hsu, “Chinese propriety medicines: An ‘alternative modernity’? The case of the anti-malarial substance artemisinin in East Africa,” Medical Anthropology: Cross-Cultural Studies in Health and Illness 28 (2009): 111–40; Eric Karchmer, “Chinese medicine in action: On the postcoloniality of medical practice in China,” Medical Anthropology: Cross-Cultural Studies in Health and Illness 29 (2010): 226–52; Volker Scheid, “Globalizing Chinese medical understandings of menopause,” East Asian Science, Technology and Society: An International Journal 2 (2008): 485–506; Lena Springer, “Prekäre Identität und vielfältige Berufswege von Ärzten für chinesische Medizin in der VR China: Zur Geschichte des Arztes, der Nation und der Profession” (Ph.D. dissertation, University of Vienna, 2010); Lucia Candelise, “La médecine chinoise dans la pratique médicale en France et en Italie, de 1930 à nos jours: Représentations, réception, tentatives d’intégration” (Ph.D. dissertation, EHESS and Università degli Studi di Milano-Bicocca, 2008). 11 Scholarship has concentrated on the Anglo-American “self-help” lay medical texts. E.g., Charles Rosenberg, ed., Right Living: An Anglo-American Tradition of Self-Help Medicine and Hygiene (Baltimore: Johns Hopkins University Press, 2003); Thomas Horrocks, Popular Print and Popular Medicine: Almanacs and Health Advice in Early America (Amherst: University of Massachusetts Press, 2008); Guenter Risse, Ronald Numbers, and Judith Leavitt, eds., Medicine without Doctors: Home Health Care in American History (New York: Science History Publications, 1977). Critical work on the American “self-help impulse”: Sandra Dolby, Self-Help Books: Why Americans Keep Reading Them (Champaign: University of Illinois Press, 2005); Micki McGee, Self-Help, Inc.: Makeover Culture in American Life (Oxford: Oxford University Press, 2005). 12 Sex and the City, Season 6, Episode 11, “The domino effect,” broadcast by Home Box Office (HBO) on September 7, 2003. 13 Randine Lewis, The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies (New York: Little, Brown, and Co.,

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2004); Angela Wu, with Katherine Anttila and Betsy Brown, Fertility Wisdom: How Traditional Chinese Medicine Can Help Overcome Infertility (Emmaus, PA: Rodale, 2006); Ni Daoshing and Dana Herko, The Tao of Fertility: A Healing Chinese Medicine Program to Prepare Body, Mind, and Spirit for New Life (New York: Collins, 2008). 14 E.g., Gail Reichstein, Wood Becomes Water: Chinese Medicine in Everyday Life (New York: Kodansha, 1998); Harriet Beinfeld and Efrem Korngold, Between Heaven and Earth: A Guide to Chinese Medicine (New York: Ballatine, 1991). Bob Flaws, The Tao of Healthy Eating: Dietary Wisdom According to Traditional Chinese Medicine (Boulder: Blue Poppy Press, 1998); Angela Hicks, 88 Chinese Medicine Secrets: How to Cultivate Lifelong Health, Wisdom and Happiness (Oxford: How To Books, 2011). Roger Jahnke, The Healer Within: Using Traditional Chinese Techniques to Release Your Body (San Francisco: HarperCollins, 1999); Sandra Hill, Reclaiming the Wisdom of the Body: A Personal Guide to Chinese Medicine (London: Constable and Robinson, 1997). Penelope Ody, Chinese Medicine Bible: The Definitive Guide to Holistic Healing (London: Godsfield, 2010); Tom Williams, Complete Chinese Medicine: A Comprehensive System for Health and Fitness (London: Thorsons, 2003). 15 E.g., Ansgar Roemer, Medical Acupuncture in Pregnancy: A Textbook, trans. Ruth Gutberlet (Stuttgart: Thieme, 2002); Liang Lifang, Acupuncture and IVF: Increase IVF Success by 40–60% (Boulder: Blue Poppy Press, 2003); Jane Lyttleton, Treatment of Infertility with Chinese Medicine (London: Churchill Livingstone, 2004); Sharon Yelland, Acupuncture in Midwifery, 2nd edn. (Amsterdam: Elsevier, 2004); Debra Betts, The Essential Guide to Acupuncture in Pregnancy and Childbirth, ed. Peter Deadman and Inga Hesse (Hove: Journal of Chinese Medicine, 2006); Zita West, Acupuncture in Pregnancy and Childbirth, 2nd edn. (London: Churchill Livingstone, 2008); Andreas A. Noll and Sabine Wilms, Chinese Medicine in Fertility Disorders (Stuttgart: Thieme, 2010); Giovanni Maciocia, Obstetrics and Gynecology in Chinese Medicine, 2nd edn. (London: Churchill Livingstone, 2011). 16 Scheid, “Globalizing Chinese medical understandings of menopause,” 499. 17 Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History, 960–1665 (Berkeley: University of California Press, 1999); Yi-Li Wu, Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (Berkeley: University of California Press, 2010). 18 Scheid, “Globalizing Chinese medical understandings of menopause,” 494. 19 E.g., Marilyn Strathern, Reproducing the Future: Anthropology, Kinship, and the New Reproductive Technologies (Manchester: Manchester University Press, 1992); Jeanette Edwards, Sarah Franklin, Eric Hirsch, Frances Price, and Marilyn Strathern, Technologies of Procreation: Kinship in the Age of Assisted Conception, 2nd edn. (London: Routledge, 1999); Charis Thompson, Making Parents: The Ontological Choreography of Reproductive Technologies (Cambridge, MA: MIT Press, 2005); Faye Ginsburg and Rayna Rapp, eds., Conceiving the New World Order: The Global Politics of Reproduction (Berkeley: University of California Press, 1995); Carole Browner and Carolyn Sargent, eds., Reproduction, Globalization, and the State: New Theoretical and Ethnographic Perspectives (Durham, NC: Duke University

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Press, 2011); Marcia Inhorn, Local Babies, Global Science: Gender, Religion, and in vitro Fertilization in Egypt (London: Routledge, 2003); Elizabeth Roberts, God’s Laboratory: Assisted Reproduction in the Andes (Berkeley: University of California Press, 2012); Aditya Bharadwaj, Conceptions: Infertility and Procreative Modernity in India (Oxford: Berghahn Books, 2012); Monica Konrad, Nameless Relations: Anonymity, Melanesia and Reproductive Gift Exchange between British Ova Donors and Recipients (Oxford: Berghahn Books, 2005). 20 Judith Farquhar, “Objects, processes and female infertility in Chinese medicine,” Medical Anthropology Quarterly 5 (2009): 370–99; Jeanne Shea, “Chinese women’s symptoms: Relation to menopause, age and related attitudes,” Climacteric 9 (2006): 30–9; Lisa Handwerker, “The hen that can’t lay an egg (bu xiadan de muji): Conceptions of infertility in modern China,” in Deviant Bodies: Critical Perspectives on Difference in Science and Popular Culture, ed. Jennifer Terry and Jacqueline Urla (Bloomington: Indiana University Press, 1995), 358–86. 21 Sarah Franklin, Embodied Progress: A Cultural Account of Assisted Conception (London: Routledge, 1997), 165, 131–67. 22 Ibid., 166. 23 Karen Throsby, When IVF Fails: Feminism, Infertility and the Negotiation of Normality (Basingstoke: Palgrave Macmillan, 2004), 72. 24 James F. Smith, M. L. Eisenberg, S. G. Millstein, R. D. Nachtigall, A. W. Shindel, H. Wing, M. Cedars, et  al., “The use of complementary and alternative fertility treatment in couples seeking fertility care: Data from a prospective cohort in the United States,” Fertility and Sterility 93 (2010): 2169–74; Dana Weiss, C. R. Harris, and J. F. Smith, “The use of complementary and alternative fertility treatments,” Current Opinion in Obstetrics and Gynecology 23 (2011): 195–9; Catherine Coulson and Julian Jenkins, “Complementary and alternative medicine utilisation in NHS and private clinic settings: A United Kingdom survey of 400 infertility patients,” in Journal of Experimental and Clinical Assisted Reproduction 2 (2005): 5; Frank van Balen, J. Verdurmen, and E. Ketting, “Choices and motivations of infertile couples,” Patient Education and Counseling 31 (1997): 19–27; Marcin Stankiewicz, C. Smith, H. Alvino, and R. Norman, “The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: A prospective survey,” Australian and New Zealand Journal of Obstetrics and Gynecology 47 (2007): 145–9; Jo-Anne Rayner, H. L. McLachlan, D. A. Forster, and R. Cramer, “Australian women’s use of complementary and alternative medicines to enhance fertility: Exploring the experiences of women and practitioners,” BMC Complementary and Alternative Medicine 9 (2009): 52; Jo-Anne Rayner, K. Willis, and R. Burgess, “Women’s use of complementary and alternative medicine for fertility enhancement: A review of the literature,” Journal of Complementary and Alternative Medicine 17 (2011): 685–90; Sheryl de Lacey and Caroline Smith, “Traditional Chinese medicine,” in How to Improve Your ART Success Rates: An Evidence-Based Review of Adjuncts to IVF, ed. Gab Kovacs (Cambridge: Cambridge University Press, 2011), 208–12, as well as Tarek El-Toukhy and Sesh Kamal Sunkara, “The role of acupuncture in IVF,” in the same volume, 217–20. 25 Smith et al., “The use of complementary and alternative fertility treatment,” 2170.

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26 Ibid. 27 At the time of finalizing this chapter (August 2012), the UK’s Times Magazine ran a cover story entitled “What price a child? Because they’re worth it,” containing interviews with six mothers (July 21, 2012); available at www.thetimes.co.uk/tto/ magazine/article3477318.ece (accessed August 1, 2012). Portraits of happy children are juxtaposed to a “price tag” for each. Mothers described using CAM to complement their IVF programmes; one mother spent between £3,000 and £4,000 on acupuncture and hypnotherapy, even though she was “not into that sort of thing.” Young Liora “cost” four years and £100,000 from IVF, surgery, consultant appointments, and medication, as well as counseling, acupuncture, and vitamin tablets. Another example is Louise Carpenter, “The baby maker,” Observer Magazine, October 25, 2009, which profiles Dr. Xiao-Ping Zhai, available at www. guardian.co.uk/lifeandstyle/2009/oct/25/infertility-treatment-babies-doctor-zhai (accessed August 1, 2012). 28 Ni Maoshing is the brother of Ni Daoshing, co-author with Dana Herko of The Tao of Fertility, who will be discussed in this chapter. Whereas Daoshing specializes in fertility, Maoshing specializes in “Taoist anti-aging medicine.” Ni Maoshing, Second Spring: Dr. Mao’s Hundreds of Natural Secrets for Women to Revitalize and Regenerate at Any Age (New York: Simon and Schuster, 2009). 29 The most high-profile celebrity endorsement, often cited by Chinese medical practitioners, is that of Celine Dion, who in 2010 successfully gave birth to twins with the combination of acupuncture and IVF. 30 Wu, Fertility Wisdom, 2–3. 31 Ibid., 2. 32 Ibid., 3. 33 Ibid. 34 Ibid. 35 Ibid., 6. 36 Ibid. 37 Ibid., 8. 38 Ibid., 9. 39 Ibid., 4. 40 Ibid. 41 Daoshing and Herko, The Tao of Fertility, 165. 42 Ibid., 4. 43 Ibid., 5. 44 Ibid., 6. 45 Ibid. 46 Ibid., 147–51. 47 Ibid., 148. 48 Ibid. 49 Ibid., 149. 50 Ibid. 51 Ibid. 52 Ibid.

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53 Ibid. 54 Ibid., 150. 55 Ibid. 56 Ibid. 57 Ibid., 151. 58 Ibid., 187. 59 Franklin, Embodied Progress,145–8. 60 Lewis, The Infertility Cure, 187. 61 Ibid., 188. 62 Ibid. 63 Christiane Northup, “Foreword,” in Julia Indichova, Inconceivable: A Woman’s Triumph over Despair and Statistics (New York: Broadway Books, 1998), xiii–xv (xiv), quoted in Lewis, The Infertility Cure, 17. 64 Zhan, Other-Worldly, 91–117. 65 Ibid., 92. 66 Ibid., 114. 67 Ibid., 92. 68 Ibid., 93. 69 Ibid., 109. 70 Ibid., 101. 71 Lewis, The Infertility Cure, 20. 72 See Ni and Herko, The Tao of Fertility, 85–105. 73 Ibid., 85. 74 Ibid., 86–8. 75 Ibid., 86. 76 Ibid., 87. 77 Ibid. 78 Ibid., 88. 79 Ibid. 80 Ibid. 81 Ibid. 82 Ibid., 88–9. 83 Ibid., 91. 84 Ibid. 85 Ibid. 86 Ibid., 90. 87 Ibid. 88 Ibid., 92–7. 89 Ibid., 96. 90 Ibid., 95. 91 Ibid., 96. 92 Ibid., 98–105. 93 Ibid., 97–8. 94 Ibid., 98. 95 Ibid.

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96 Wu, Fertility Wisdom, 71. 97 See ibid., 77–172. 98 Ibid., 79–80. 99 Ibid., 83. 100 Ibid., 99–101. 101 Ibid., 88. 102 Ibid., 221–2. Volker Scheid, Dan Bensky, Andrew Ellis, and Randall Barolet, eds., Chinese Herbal Medicine: Formulas and Strategies, 2nd edn. (Seattle: Eastland Press, 2009): “Rambling Powder,” 120–5; “Eight-Treasure Decoction,” 346–50; “Worry-Free Formula to Protect Birth,” 360–2. 103 Wu, Fertility Wisdom, 103–16. 104 Ibid., 106. 105 Ibid., 110. 106 Ibid. 107 Ibid., 111. 108 Ibid., 112. 109 Ibid., 118. 110 Ibid., 123–9. 111 Ibid., 163. 112 Ibid., 168. 113 Lewis, The Infertility Cure, 55–77, 78–99, 100–29, 130–58. 114 Ibid., 109–29, 139–56. 115 Ibid., 157. 116 Ibid., 109–29. 117 Ibid., 139–56. 118 Ibid., 70–7. 119 Ibid., 81–3. 120 Ibid., 88–9. 121 Ni and Herko, The Tao of Fertility, 6. 122 Wu, Fertility Wisdom, 104–5. Wu refers to the “Quan Yin” (4–5), which is “Guanyin,” the bodhisattva associated with compassion. 123 Ibid., 70. 124 Lewis, The Infertility Cure, 52. 125 Ibid., 78–9. 126 Ibid., 130–1. 127 Ibid., 51–2. 128 Ibid., 54. 129 Ibid., 69. 130 Ibid. 131 Ibid., 138 and 69. See also 87. 132 Ibid., 101. 133 Ibid., 105. 134 Ibid., 277–83; Wu, Fertility Wisdom, 195–200; Ni, The Tao of Fertility, 227–38. 135 Ni, The Tao of Fertility, 122. 136 Lewis, The Infertility Cure, 100.

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137 Wolfgang Paulus, M. Zhang, E. Strehler, I. El-Dansouri, and K. Sterzik, “Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction,” Fertility and Sterility 77 (2002): 721–4. 138 Ibid., 724. 139 Lewis, The Infertility Cure, 101. Raymond Chang, P. H. Chung, and Z. Rosenwaks, “Role of acupuncture in the treatment of female infertility,” Fertility and Sterility 78 (2002): 1149–53. 140 Chang et  al., “Role of acupuncture,” 1153, quoted in Lewis, The Infertility Cure, 101. 141 Lewis, The Infertility Cure, 101. 142 Ibid., 102. 143 Wu, Fertility Wisdom, front cover. 144 Victor Fujimoto, “Preface: A word from a western doctor,” in ibid., ix–x. 145 Ibid., x. 146 Wu, Fertility Wisdom, 191. 147 Ibid. 148 Ibid., 16, 191. 149 Ibid., 191. 150 Ibid. 151 Lewis, The Infertility Cure, 1. 152 Ibid. 153 Ibid., 2. 154 See ibid., 10–18. 155 Ibid., 11. 156 See ibid., 285–91. 157 Ni and Herko, The Tao of Fertility, 120–1. 158 Ibid., 113. 159 Ibid., 122–3. 160 Ibid., 122. 161 Ibid., xi. 162 Ying Cheong, L. G. Nardo, T. Rutherford, and W. Ledger, “Acupuncture and herbal medicine in in vitro fertilisation: A review of the evidence for clinical practice,” Human Fertility 13 (2010): 3–12; Ying Cheong, Ng Ernest Hung Yu, and W. L. Ledger, “Acupuncture and assisted conception (review),” Cochrane Review 1 (2009): 1–50. 163 British Fertility Society, “Press release: British Fertility Society issues new guidelines on the use of acupuncture and herbal medicine in fertility treatment,” March 10, 2010, available at www.fertility.org.uk/news/pressrelease/10_03-Acupuncture.html (accessed August 1, 2012). 164 British Acupuncture Council, “Acupuncture and fertility: The British Acupuncture Council’s statement in regards to the British Fertility Society’s research announcement,” March 19, 2010, available at www.acupuncture.org. uk/index.php?option=com_k2&view=item&id=919:acupuncture-and-fertilitythe-british-acupuncture-councils-statement-in-regards-to-the-british-fertilitysocietyas-research-announcement (accessed August 1, 2012).

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165 Ibid. 166 Association of Traditional Chinese Medicine, “ATCM response to British Fertility Society’s press release regarding the use of acupuncture in fertility,” March 10, 2010. Available at www.atcm.co.uk/letter%20to%20British%20Fertility%20Society% 20Secretariat.pdf (accessed August 1, 2012). 167 Ibid. 168 Ibid. 169 Ibid. 170 Scheid, “Globalizing Chinese medical understandings of menopause,” 503; Vincanne Adams, “Randomized controlled crime: Postcolonial sciences in alternative medical research,” Social Studies of Science 32 (2002): 659–90; Vincanne Adams, “Establishing proof: Translating science and the state in Tibetan medicine,” in New Horizons in Medical Anthropology: Essays in Honor of Charles Leslie, ed. Mark Nichter and Margaret Lock (London: Routledge, 2002), 200–20.

Index

Note: ‘n.’ after a page reference indicates the number of a note on that page accuracy 18–19, 24, 89–90, 93, 95, 105, 123, 161–3, 180n.11, 181n.18, 200, 205, 257 acubaby 29, 30, 237–60 acupuncture 29–30, 72, 91, 105n.2, 119, 193, 200–2, 238–40, 242–6, 251–9 acute disease 26, 28, 70, 83, 95, 188–9, 193– 6, 200–2, 204, 209–11, 221, 224–5 agency 7, 192 alternative medicine (or complementary and alternative medicine) 29, 43, 72, 177, 237, 242, 247 Althusser, Louis 10 American Botanical Council 42 anatomy 12, 16, 18–20, 23, 24, 80–105, 117–24, 132, 139, 146–7, 150, 157n.41, 160–79, 182n.36, 184n.60, 197, 203, 227 anatomo-medicine 160, 163–7, 172, 176, 180n.2, 182n.26 ignorance (or inferiority or lack thereof) 18, 24, 25, 80–1, 162, 173 see also body; organ; viscera antibiotics 194–5, 200, 224 antiquity 9, 93, 97, 121 aorta 119 Archaeology of Knowledge 10–11 see also Michel Foucault Aristotle 27, 219 Army Medical College (Tianjin) 160

assisted reproduction 29–30, 241, 254, 258 Association of Chinese Scientists 176 Association of Traditional Chinese Medicine and Acupuncture 258 authority 4–6, 29–30, 69, 82, 225, 251, 254 of modern Chinese medicine 22–7, 137–216 Avoidance of Wrongs (Wuyuan lu) 143 Ba Jin 196 Bachelard, Gaston 6, 8–11, 14 see also epistemological obstacle backwardness 19, 25, 162, 173 Bacon, Francis 27, 219 Beijing Bar Association 22, 139 Beijing College of National Medicine 197 Beijing Medical College 207 Beijing University of Chinese Medicine 189–90 bile 99, 119 biomedicalization 254 biomedicine 15, 21, 24–5, 27–9, 71–2, 80, 161, 167, 176–8, 188, 190–3, 197, 202, 207, 222–5, 230, 237–41, 246–7, 253–4, 258–9 see also humoral medicine; western medicine

270

Index

Birth of the Clinic, The 12, 14 see also Michel Foucault blood 19–22, 25, 48, 51, 61, 68–72, 86, 89–91, 96–103, 113–36, 174–5, 185–6n.72, 193, 195, 203–4, 246, 248–50, 252 in Benjamin Hobson’s work 118–20 in canonical medical literature 113–15 circulation 114, 119, 123, 126 a literary symbol of degeneracy 126–7 in On the Origins and Symptoms of Ailments 115 parasites 124–5 in Social Darwinism 125–6 “static” 120 in Tang Zonghai’s work 120–4 tonics 127–32 “toxic” 98, 100–1 in Wang Qingren’s work 117–18 in Warm Diseases Theory 115–17 see also Benjamin Hobson; blood pressure; race; Social Darwinism; Tang Zonghai; Wang Qingren; Warm Diseases blood pressure 119, 195 body 4, 16–25, 29, 42–3, 46–8, 50, 53, 55, 60–1, 68–71, 80–136, 145–7, 150–2, 160–87, 219, 221–2, 224, 227–8, 231–2, 237, 241, 247–56 dead 22–3, 88, 95–6, 104, 124, 139, 142, 147 materiality 19, 80–105 structure and cholera 97–8 see also anatomy; corpse; epidemic; organ; viscera bone 63, 80, 85–6, 88, 91, 94–5, 105, 115–16, 126, 146–9, 158n.49, 248, 250 botany 42–3, 56–9, 61–5, 68, 71–2, 220 break 5–11, 15, 30, 32–3n.10 Canguilhem, Georges 6, 10–13 carbon dioxide 20, 102–3, 111–12n.84, 119–20

case 13, 19, 23, 29–30, 41, 45–6, 49, 55, 63, 70, 72, 80, 82–6, 91, 96, 100–1, 104–5, 113, 115, 125, 139, 146–7, 149–52, 163, 172, 189, 193–5, 204, 210–1, 220–2, 225–6, 232, 244–7, 256–7, 259 Chao Yuanfang 115, 121 Chen Duxiu 25, 168–9 China Medical Journal 127 Chinese Communist Party 21, 200, 205, 207, 225 Chinese emergency medicine 190, 193, 212n.5 see also Chinese Emergency Medicine Chinese Emergency Medicine 190 see also Chinese emergency medicine cholera 18, 26, 82, 97–103, 123, 125, 193 see also body; epidemic Chongwen Academy 85 chronic disease 26–8, 188–211, 224–5, 246 Cinnabar Field (dantian) 25, 169 Classic of Difficult Issues (Nanjing) 81, 90, 253 clinic 27–9, 179, 190, 199–202, 206–8, 220, 223, 238–9, 242–3, 258 Cold Damage (shanghan) 26, 28, 97, 115, 194, 204, 222–6 see also Shanghan lun Communist Revolution 189, 200 Conrad, Peter 12–14 see also medicalization contingency 5–6, 8, 220 Copernican Revolution 9–10, 35–6n.36, 176 coroner (wuzuo) 22–3, 139–42, 145–53, 153–4n.3 corpse 18, 24, 86, 88, 91, 92–7, 99, 104, 117–18, 140–1, 154n.11, 168, 173 see also body Croizier, Ralph 196 Crombie, Alistair 14 Cultural Revolution 208, 225, 227

Index Daston, Lorraine 3, 5–6, 28, 220 Davidson, Arnold 3, 5–6, 14–15 Derrida, Jacques 9–10 Descartes, René 9, 27–8, 219, 227, 234n.12 deterritorialization 172, 176 Ding Fubao 127 dissection 18, 20, 62, 81, 92, 96, 104, 117, 161–2, 167–9, 174 Doctrine of the Mean (Zhongyong) 165 Dr. Willmar Schwabe Company (DWSC) 17, 68–70 drug 42, 72, 123, 127, 130–1, 167, 178, 191–3, 202, 221, 223, 231, 254, 256 duixiang 230–2, 236n.27 see also object efficacy 26, 188–211, 231, 242, 245–6, 253–4 Elman, Benjamin 93, 103 emergency medicine 189–93 empiricism 7–9, 18, 22–3, 29, 72, 93, 97, 105, 141–5, 147, 152–3, 219, 234n.17 England 119, 165 English 29, 58, 63, 68, 87, 102, 115, 122, 165, 170, 178, 231, 239–40, 255 Enlightenment 62, 113 epidemic 20, 27, 82–3, 88, 97–100, 103, 115–19, 125, 171, 193, 200, 202, 204, 210–1 episteme 3, 5, 6, 8, 11, 13–15, 17, 21, 23, 25–6, 30, 195 see also Michel Foucault; Hans-Jörg Rheinberger epistemological obstacle 8, 14 see also Gaston Bachelard epistemology 3–30, 80–1, 93–5, 101, 104–5, 113, 121, 140, 142–4, 147, 149, 153, 161–2, 179, 189, 195, 219–21, 223, 230, 236n.28, 237, 254, 258–9 feminist 5 material 5 see also object; objectivity

271

moral 5 visual 5 existence 3–9, 12, 23–4, 58, 72 of modern Chinese medicine 27–30, 217–68 experience (including jingyan) 12, 14, 18, 22–3, 25, 44, 95, 113, 139–53, 166, 191, 194–5, 203, 207, 209–10, 222, 226, 238, 241, 247, 251–3, 256–8 experiment (including shiyan) 7, 14, 22–3, 29, 63, 142–5, 153, 157n.44, 166, 191–2, 206–7, 223, 239, 255 externalist history of science 7, 10 eugenics 21, 126, 133, 171, 174 Europe 12, 16–18, 23, 25, 30, 42, 55–6, 58–62, 64, 67–72, 80–1, 85, 92, 94, 104, 142, 153, 164–5, 172, 189, 224–6, 229, 238 evidential studies (kaozheng) 19, 82, 84–5, 93, 105 fact (including shishi) 6–8, 10, 23, 28, 63, 82, 143, 153, 224, 226–7, 237, 239 Fertility Wisdom 240–60 Feyerabend, Paul 9, 14 Five Phases 46–7, 50, 71, 196, 223, 227 Fleck, Ludwik 8–9, 14 see also thought collective; thought style forensic medicine 4, 22–3, 25, 88, 95, 140–59 see also legal medicine Foucault, Michel 6, 10–15, 26, 195 see also Archaeology of Knowledge; episteme; The Birth of the Clinic four classics 203 French theory 6 see also Louis Althusser; Georges Canguilhem; Jacques Derrida; Michel Foucault Galison, Peter 5, 220 genealogy 5, 6, 19, 22, 27, 219

272

Index

germ 124 theory 21, 82, 119, 124–5 Germany 42, 57, 59–60, 62–3, 67–9, 126, 167, 178–9, 226, 255 Ginkgo biloba 41–73 agricultural practice 52–5, 62, 72 applications in cookery 47–50 as a celebrity 62–70 as a dark and poisonous thing 50–5 effects on the brain 41–2, 55, 56–70, 72, 73n.6 effects on the lung 42, 45–7, 50, 54–5, 70, 71–2 as a living fossil 63, 65–6, 68, 70, 78n.90 medicalization 43, 45–50, 53, 55, 66, 68–9, 71–2 promote digestion 43, 59–62, 69–71 stomach vitality 48 symbol for motherhood 48, 50, 72 ginseng 41, 43, 68, 198 global medicine 164 globalization 19, 27, 30, 178, 238, 259 Goethe, Johann Wolfgang von 41–2, 72 Golden Mirror of the Medical Lineage (Yizong jinjian) 88, 91, 95, 152, 202 governmentality 25, 160–87 Gray, Asa 63–4 Great Learning (Daxue) 165 Greek medicine 61, 117, 123, 162 see also humoral medicine Guangdong Provincial Hospital of Chinese Medicine 210–1 Guangji Hospital 200 Guangzhou College 28, 221, 227 gynecology (or fuke) 113, 115, 191, 241, 245, 255, 257 Hacking, Ian 3, 5, 14–15, 29 Haraway, Donna 6 heart 21, 67–8, 70, 81, 86, 90, 102, 114, 117–19, 121, 123–4, 127, 174, 188, 232, 240 Heidegger, Martin 9, 226

historical ontology 3–5, 27, 80 see also ontology Hobson, Benjamin 20, 85, 87, 93–5, 98, 101–3, 118–21, 124 see also blood; Outline of Anatomy and Physiology homosexuality 12–14 Hong Kong 119, 125, 211 humoral medicine 162 see also biomedicine; Greek medicine; western medicine Hundred Days’ Reform 124, 173 in vitro fertilization (IVF) 29, 240–60 inference 92, 96 Infertility Cure, The 240–60 integrationist (or integrated medicine) 80, 166, 190–1, 198, 203, 206, 208, 212n.5 internal medicine 171, 191 internalist history of science 7, 8, 10 Japan 16–17, 23, 25, 42–3, 45–52, 55–66, 69, 71–2, 103, 125, 140–4, 150, 153, 163–79, 197, 199, 202–6, 209–10 Joint Terminology Committee 24, 164–5, 167, 169–71, 175–6 Jottings from the Hall of Repeated Celebrations (Chongqing tang suibi) 83–97 Chinese sources 87–9 contributors 84–91 “localistic” thinking 90–1 social history 83–4 structure and function in classical medicine 89–90 western sources 86–7 see also Wang Shixiong Kaempfer, Engelbert 57–61, 71 Kaibara Ekiken 47 Kangxi Dictionary 174 Kanpō 164, 167 Kant, Immanuel 27, 219

Index Koch, Robert 125 Koyré, Alexander 9 Kuhn, Thomas 8–11, 14, 26, 195, 219 see also paradigm; The Structure of Scientific Revolution Kuomingtang (KMT or Guomindang or Nationalist Party) 170, 196–8, 202, 205–6 Kuriyama, Shigehisa 61, 114 laboratory 10, 70, 142, 178, 203, 209, 220, 223 Lancet 42 language 5, 12, 14, 25, 29, 68, 87, 115, 120, 142, 165, 169, 173, 176, 178–9, 224, 230, 239, 254–6 Lao She 196 Latour, Bruno 5, 28, 221, 226, 229–31 legal medicine (fayixue) 22–3, 95, 139–40, 142–5, 149–50, 153 see also forensic medicine Lewis, Randine 240–60 Li Shizhen 16, 45–7, 50–1, 53–4, 61, 126 Liang Qichao 196 Linnaeus, Carl 56–8 Liu Ruiheng 164–5, 171, 176 liver 90, 114, 118, 121, 124, 232, 246, 251 Lu Xun 25, 126, 168–9, 196 Manson, Patrick 21, 125 Mao Zedong 126, 230 Maoism 206, 223, 225, 231 Maoist era 15, 177, 208, 209 Marxism 7, 201, 206 materiality 5, 28, 43, 72, 132, 226, 228–30 body 17, 18, 80–2, 93, 105 May Fourth 25, 196 medicalization 6, 11–15, 22, 43 of Ginkgo biloba 16–7, 45–50, 53, 55, 66, 68–9, 71–2 see also Ginkgo biloba; Peter Conrad metaphysics 3–4, 7, 27–8, 50, 219–36

273

methodology 5, 13, 42, 93, 221, 223, 234–5n.18, 259 Middle Ages 9 Ming Dynasty 16, 43, 45–50, 93, 116, 139 Ministry of Health 24, 27, 170–1, 188, 190, 196, 199, 205–7, 209, 224 missionaries 20–1, 80, 86–7, 118–19, 122–4, 126–8, 172–8 Nanjing government 170 narrative 4, 17, 18, 80–1, 104–5, 195–6, 198–9 acts 237 of Chinese medicine 29, 237–68 see also narratology narratology 237, 258–9 see also narrative National Board of Health 171 National Education Conference 170 National Medical Association (NMA) 24, 160, 164–5, 170, 178 see also National Medical Journal National Medical Journal 24, 160–2, 165 see also National Medical Association New Culture Movement 25 see also New Youth “new medicine” 129, 160–1, 164–6, 179 New Policies 142 New Youth 25, 168–9 see also New Culture Movement Ni Daoshing 240–60 object 4–10, 12, 14, 25, 27–30, 174, 177, 207, 220–1, 223–4, 226–32, 238, 250, 259 of modern Chinese medicine 15–22, 39–136 see also duixiang objectivity 4–6, 226 observation 8, 10, 16, 19–20, 23, 51, 72, 85, 88, 91–6, 98–9, 101, 113, 118, 120, 143, 146–7, 149, 151–3, 189, 229, 242 Okamoto Ippō 47 “old medicine” 160–1, 164, 166, 169–70

274

Index

ontology 3–7, 21, 27–9, 80, 220, 224–5, 230 see also historical ontology organ 16, 18–21, 25, 46, 61, 67, 80, 86–96, 101, 105, 115–20, 124–5, 149, 169, 226–7, 248–50, 253 see also anatomy, body, viscera outbreak 91, 97, 99, 194, 199, 204, 209–11 Outline of Anatomy and Physiology (Quanti xinlun) 20, 87, 119 see also Benjaming Hobson Ouyang Xiu 16, 43–5, 52 oxygen 20–1, 103, 119–20, 123–4 paradigm 5–6, 9–11, 14, 26, 195, 219, 256 see also Thomas Kuhn Pasteur, Louis 119, 124–5 patent medicine 192–3, 238, 251 persuasion 5, 238, 247, 259 pharmaceutical industry 16, 21, 68–70, 72, 127–8 pharmaceutics 22, 42, 71–2, 208, 221 phenomenology 113 phlegm 61, 119, 123, 204 physiology 18, 20, 62, 69–71, 118, 139, 144, 166, 171, 174, 203, 228–9, 253 politics 3, 148, 163, 166, 171, 227, 254, 258–9 Poovey, Mary 5 post-Mao era 4, 178 power 14, 18, 23–4, 62, 101, 104, 113, 160–79, 196, 198, 221, 224, 243, 249–50, 252–4, 257–8 proof 3, 23, 42, 65, 101, 144–5, 150, 177 propaganda 163, 208 Pure Food and Drug Act 127 qi 17–18, 20, 28, 46, 50, 53–5, 61, 80, 82, 86, 89–91, 96, 98–100, 114–19, 121, 123, 173, 231, 243, 249–52, 257 “charcoal” 101–3 transformation 227–9 Qianlong Emperor 146

qigong 72, 238, 244, 248–51 Qing Dynasty 17, 19–22, 27, 88, 93, 95, 97, 139, 142, 146, 148–9, 160, 173–4, 202–3, 222 quantum 7–8, 230 race 65, 94, 126, 162, 200 see also blood reclassification 163, 165, 170–7 Records on the Washing Away of Wrongs (Xiyuanlu) 22–3, 88, 95, 139–53 Republic of China MedicoPharmaceutical Association 167, 171, 178 Republican Journal of Medicine 144 reterritorialization 172 revolution 7, 9, 25, 69, 113, 165, 169–71, 173, 176, 189, 194–5, 198, 200, 204, 207–8, 225, 227 Rheinberger, Hans-Jörg 3, 6, 7, 10 rhubarb 43 SARS (severe acute respiratory syndrome) 27, 210–11 Scheid, Volker 4, 81, 179, 241, 259 Schreck, Johann 86–7, 95 science (kexue) 139, 153 scientific multiculturalism 7 scientization 170, 177–8, 206, 258 Sex and the City 242 Shanghai New China College of Medicine 197, 202 Shanghan lun 20, 81, 114, 116, 121, 221, 224 see also Cold Damage Shenbao 130 Shenyang China Medical University 200 Sino-Japanese War (1937–45) 199, 202–3, 206 Sivin, Nathan 114 Six Channels 28, 222–4, 228 skeleton 146–8, 150 slowness of Chinese medicine 26, 188–211

Index Social Darwinism 21, 125–6, 161 see also blood; Herbert Spencer Song Dynasty 16, 22, 43, 50, 92, 113, 139 Spencer, Herbert 125 see also Social Darwinism spirit 51–2, 55, 62, 95, 119, 121, 175, 209, 252–5, 257 spleen 96, 114, 121, 124 Staatsmedizin 167 standardization 9, 15, 25, 30, 132, 153, 203, 241, 259 medical terminology 24–5, 160–87 state 22, 24, 26–7, 142, 146, 153, 190, 192, 197–8, 204–10, 238 power 24, 160–87 State Administration of Traditional Chinese Medicine 192 Structure of Scientific Revolution, The 9 see also Thomas Kuhn style 5, 8, 14, 20, 24, 81, 104, 131, 160, 162, 170, 171, 173, 194, 196, 230, 259 see also Alistair Crombie; Arnold Davidson; Ian Hacking sublimation 164–9, 175 Tang Erhe 24–5, 162–5, 167–70, 173–6, 178–9 Tang Sitong 21 Tang Zonghai 20–1, 80–1, 91, 120–2, 132, 203 see also blood; Treatise on Blood Conditions Tao of Fertility, The 240–60 testimonial 239, 257–8 theory (including xueli) 5–9, 13, 15–16, 20–3, 25, 29, 47, 69, 82, 115–19, 124–5, 139–53, 160–1, 170, 211, 219, 225, 227–8, 230–1, 249 thought collective 8, 219 see also Ludwik Fleck; thought style thought style 8 see also Ludwik Fleck; thought collective

275

Tokugawa Japan 16 Tokyo Metropolitan Police 142 Toulmin, Stephen 9 traditional Chinese medicine (TCM) 15, 19, 21, 47, 55, 71, 81, 132, 166–7, 177–8, 191, 196, 220–5, 230, 237–8, 246–7, 252, 256, 258–9 translation 3, 25, 63, 87, 102, 118–20, 122–5, 140, 142–3, 162, 164, 172–8, 230–1, 238, 240, 247, 256, 258 Treatise on Blood Conditions 20, 121 see also Tang Zonghai Treatise on “Huoluan” (Huoluan lun) 82–4, 97, 99, 168–9, 172 see also Wang Shixiong triple burner (sanjiao) 25, 90–1, 98, 117, 121 tropical fevers 21, 125 tropical medicine 125 tuina 238–9 United States of America 4, 9, 13–14, 17, 23, 29–30, 41–3, 55–6, 58–9, 63, 65, 68–9, 71–2, 116, 127, 162, 164–5, 167, 172, 178–9, 189, 238–40, 242–3 Unschuld, Paul 91, 114 viscera 48, 54, 70, 85–6, 92, 126, 172, 221, 223, 226–7 see also anatomy; body; organ Wang Chichang 146, 149–52 Wang Jimin 165 Wang Qingren 19–20, 85, 88–9, 94–101, 103–5, 117–21, 124, 132 see also blood Wang Shixiong 18, 81–112 see also Jottings from the Hall of Repeated Celebrations; Treatise on “Huoluan” Wang Xuequan 83–5, 92, 96

276 Warm Diseases (wenbing) 18, 20, 28, 82, 97–8, 101, 115–17, 124, 201, 203–4, 222–5 see also blood Warring States 222, 226, 230 western medicine (xiyi) 18–19, 25–9, 72, 80, 82, 86–7, 96, 118–21, 124, 129, 132, 150, 160–6, 171, 177–8, 188–211, 223–5, 242–3, 246, 250–8 see also biomedicine; humoral medicine Wilson, Ernest Henry 59, 65–6 wisdom 29, 82, 93, 242–4, 247–54, 257–8 World War I 7–8 World War II 9 worlding 178, 237, 259 see also Mei Zhan Wu, Angela 240–60 Wu Liande 24, 165, 167

Index Xu Lian 146–50 Xu Ranshi 84–6, 89, 91, 96 Xueran 28, 221–32 Ye Gui 98, 116 Yellow Emperor’s Inner Classic (Huangdi neijing) 53, 87, 113, 147, 197, 253 yin and/or yang 20, 50, 52, 89, 91, 98, 115–16, 227, 249 Yu Fengbin 24, 162, 164–6, 170–2, 176, 179 Yu Yuan 22–3, 140–1, 145, 147, 149–53 Yu Yunxiu 24–5, 27, 162–5, 167, 169–73, 176, 178–9, 196–8 Yuan Shikai 24, 160–1, 163, 168, 171, 179 Zhan, Mei 177, 237, 246 see also worlding Zhou Zuoren 25, 169, 196 Zhuangzi 28, 92, 226, 229