Contemporary Chinese Studies. Vancouver: UBC Press, 2014. xvi, 294 pp. (Figures, tables.) US$35.95, paper. ISBN 978-0-7748-2433-0.
Chinese medicine may not be what you think it is. Americans may be forgiven for thinking acupuncture the most important part of China’s medical culture, yet in 1820 a popular slogan in China stated that acupuncture was “absolutely inappropriate to all gentlemen.” How then did needling become the representative practice for Traditional Chinese Medicine (TCM)? What happened, Bridie Andrews reveals, is that Chinese medicine became modern even as the conspicuous word “traditional” was added to its name.
In this long-awaited synthetic study examining the transformation of Chinese medical culture from a pluralistic and private affair in the mid-nineteenth century to a standardized and state-sponsored dual system by the mid-twentieth, Andrews offers the best account to date of how “Western” medicine (xiyi) and “Chinese” medicine (zhongyi) encountered each other and both became modern. The genius of this study is that it keeps its eye fully on both forms of medicine, rather than one or the other. In nine lean chapters, Andrews examines the transformation of the medical field in China that ranged from herbalists, shamans, bone-setters, midwives, priests and a few medical missionaries, to one in which two forms of medicine competed. There was an increasingly power-hungry xiyi that sought to dominate the medical field, and an increasingly rationalized Chinese medicine that (re-)incorporated acupuncture from Japan. Like other recent works on Chinese medicine, Andrews skewers the nationalist narrative of a TCM that was always, already complete. Likewise, xiyi was also in constant transformation. But this is no Whig history—neither form of medicine progressed according to an inevitable logic of progress—and so the end result is messy: a Chinese health-care field that promoted one form of medicine over another because it was sometimes popular, sometimes effective, and always subject to the politics of nationalism.
Following the introduction, Andrews establishes a baseline for a conversation about medicine and modernity in China. So we discover the complex field of health care in nineteenth-century China when on the street a foreign observer might witness Daoist medical peddlers, exorcists, and kung-fu masters, but an astute Chinese writer would observe that many health issues were handled within the household through religious practices and herbal medical prescriptions, but one could also consult itinerant “river-and-lake” doctors, street healers, tiger-skin merchants, or various female practitioners. There were also official and semi-official physicians, a category that might include military doctors, opium office doctors, and school and Red Cross doctors. But all of the above, for Qiu Jisheng in 1915 Shaoxing, were a separate category from Chinese-style doctors (zhongyi). The knowledge and practice of these specialists in wound treatment, eye and throat diseases, smallpox variolation, childbirth and pediatrics, and internal and external medicine was in a discrete class. For the poor, home and religious remedies were usually the only forms of medicine that were affordable, while the wealthy might get second and third opinions from established specialists.
We also see the birth of missionary medicine in China as hundreds of British and Americans physicians attempted to practice medicine as an aid to conversion. But rather than emphasize how different their medicine was, Andrews demonstrates how missionaries tried to reduce the “perception of alterity” by using Chinese drugs, making their clinics and hospitals accommodating to Chinese sensibilities, and taking the pulse at both wrists, as was common practice (55–61). In a fourth chapter, Japan becomes the focus as we see this nation as key to transforming both major forms of medicine. Japan had absorbed anatomically-based Western medicine along with other reforms well before China, and became a model for many modernizers from China due to its geographical and cultural proximity. In Japan, kanpō (Andrews calls this “Sino-Japanese medicine”) was regulated and starved while the government encouraged a vigorously expanding system of domestic medical education promoting anatomically-based medicine. A Chinese physician named Yu Yan, trained in the Japanese system, returned to China and tried to demolish Chinese medical theory through public debate, and then abolish its practice through legislation. But both kanpō in Japan and its counterpart in China survived and experienced resurgence in the 1930s.
Subsequent chapters focus on public health as a key component of state building, examples of medical lives in the unofficial hybrid field of medicine that emerged in the twentieth century, new medical institutions that changed both forms of medicine, and the development of new theories and new practices even as nationalism emphasized the “traditional” aspect of medicine. To illustrate these themes, I focus on acupuncture.
Andrews reveals how acupuncture was transformed into the marquee practice of modern Chinese medicine from its degraded position in the late Qing. The key was the Japanese grafting of acupuncture onto a Western view of the anatomical body. Modern filiform needles replaced previously much larger acupuncture tools. Acupuncture points were reduced and relocated by subsequent Chinese scholars like Cheng Dan’an, who studied both forms of medicine, and argued, “[e]ach acupoint must be elucidated anatomically,” to avoid blood vessels and arteries. And so it is ironic, the author argues, that Westerners now see this Japanese-influenced, anatomically reformed acupuncture as the symbol of a more holistic and ancient form of health now called Traditional Chinese Medicine (197–205).
The author ends her roughly chronological narrative of a long century of modern medicine in China with the official establishment of TCM in the 1950s. Although the analysis is often at its best in the final chapter of conclusions, the narrative becomes thin during the crucial war and early PRC years (1937–1960) as Andrews relies on recent secondary literature. Other readers may find the episodic nature of the chapter on three medical lives to be instructing, if not completely satisfying as the best examples of the trends she describes elsewhere. Yet these can hardly be major critiques of what was designed to be a century-long narrative history arguing that, against received understandings, modern Chinese medicine includes both xiyi practiced in China, and standardized and anatomized Traditional Chinese Medicine.
David Luesink
University of Pittsburgh, Pittsburgh, USA
pp. 700-702