Needham Research Institute Series. First paperback ed. London; New York: Routledge, 2013. xx, 265 pp. (Tables, maps, figures.) US$44.95, paper. ISBN 978-0-415-83535-0.
If you will read only one book in your lifetime about medicine in China, this should be it. For policy analysts, historians of (bio)medicine, or sinologists, this “biography of wenbing” (warm diseases) ties together past and present, and social, cultural and clinical histories to a sophisticated understanding of China’s regions and epidemiology. After reading this book you will have learned something new, connected disparate concepts, and clarified misconceptions. Hanson’s book is at once an introduction to the basics of Chinese medicine, an advanced course on its developments in late imperial China, and an explanation of its ongoing relevance seen through the application of wenbing theory and remedies to the SARS epidemic in 2003. Hanson demonstrates as clearly as anyone how Chinese medicine did not become “stagnant” in the Ming and Qing dynasties, as its modernizing opponents have declared. Instead, Chinese medicine continued (and continues) to create new nosologies that were (and are) clinically effective and flexible enough to take into account regional variation and even biomedical explanations of disease.
Although most Chinese today will tell you that shanghan is equivalent to typhoid, mafeng to leprosy, jiaoqi to beriberi, nüe to malaria, and huoluan to cholera, Hanson will have none of it: “[b]efore the nineteenth century, not one inhabitant of China suffered from plague, cholera, typhoid fever, tuberculosis, or malaria” (7). So what did they, in fact, die from? Hanson argues persuasively the historical anthropologist’s position that we need to understand pre-modern diseases with pre-modern categories. This “biography of disease” approach has become an important subfield in the history of medicine. Like Angela Leung’s work on li/lai/dafeng/mafeng/leprosy, this book traces a Chinese disease category through its history. But wenbing is particularly remarkable because it has not been displaced by biomedical nosology.
The book does not stop with merely a biography of wenbing, but uses this as “a heuristic device” to explore the Chinese geographical imagination of disease, and through these, epidemiology in late imperial and modern China. Although wenbing appears in the Basic Questions (half of the medical classic, the Inner Canon of the Yellow Emperor) and in Zhang Ji’s Treatise on Cold Damage Disorders, it did not emerge as a distinct disease category until a millennia and a half later during the epidemics associated with the fall of the Ming in 1642. At this time, Wu Youxing (c. 1582–1652) claimed that a regionally specific contagion was responsible for the epidemic, rather than a vague “unseasonable qi”(16–17). Wu began a school of thought that continues to this day that elevated wenbing from a mere variation of an underlying Cold Damage disorder (102). This process of doubting received interpretations of diseases and cures becomes for Hanson “Ming medical skepticism,” a massive and ongoing innovation in the late imperial period that has usually been characterized as “stagnant.”
The second theme is the connection between disease and geography. Hanson demonstrates how the early directional imagination of Chinese medicine stated in the Basic Questions was governed by the five directions (wufang)—the center and four cardinal directions. Each direction was associated with a particular form of climate, foods, diseases and therapies (26). Hanson’s discussion here of Chinese medical cosmology—of yin-yang, the five phases, the five climates—is one of the best I’ve seen (I do not know how Chinese medical concepts, usually presented as fully formed and unchanging, can be understood without such historicization). More specifically, the two major geographic divisions became the northwest (cradle of Chinese civilization) where “heaven is insufficient,” and the southeast (Jiangnan area), where “earth is incomplete.” Later, in the northern areas conquered by the Jurchens and Mongols, private physicians critiqued Song medical orthodoxy and innovated on the old formulas and nosologies. These medical innovations eventually became incorporated into southern medicine, but the north-south split in the Chinese medical imagination remained. Northern bodies, diseases and cures would be distinct from southern ones.
The geographical imagination of medicine became especially important in the Qing when the Qianlong emperor’s massive encyclopedia project, the Emperor’s Four Treasuries, elevated Wu Youxing’s book to the status of a medical classic. In the late nineteenth century, even some foreign physicians praised Wu’s work on disease nosology and epidemics, although this shifted to denunciation by the early twentieth century (150–151).
All of this becomes particularly interesting for students of contemporary China when Hanson demonstrates that wenbing has come to include what biomedicine now calls acute infectious diseases. The key example is SARS, which was not only prevented but also treated with wenbingnosology and drug formulas, depending on whether the patients were in the northern epidemic region in Beijing, or the southern in Guangzhou.
I am completely sympathetic with Hanson’s project, but the historical anthropology approach leads to a problem of consistency. The temptation to shorthand Chinese disease categories is too great, even for Hanson. So guangchuang, “literally Cantonese sores,” becomes unproblematically associated with “venereal diseases and syphilis” (70). Later Hanson again makes simplistic equivalencies between older Western disease conceptions and contemporary nosology “agues (shaking fits of malaria and other diseases) … [and] phthisis (various types of tuberculosis)” (149). To this inconsistency I have no solution to offer because even the historical anthropologist has to communicate using language and disease conceptions the reader can understand.
Despite this conundrum, this book sets a new bar for research on the history of medicine in China. This short review is hardly able to touch on all of Hanson’s main points connecting wenbing, the geographical imagination, and epidemiology. In 169 concise pages of text, Hanson demonstrates conclusively that “China’s wenbing remains a meaningful disease concept,” that Chinese medicine never became stagnant, and that it continues to be an effective and evolving therapeutic system today.
David Luesink
University of Pittsburgh, Pittsburgh, USA
pp. 850-852