- Email: [email protected]
Neither Donkey nor Horse
Studies in History and Philosophy of Science 49 (2015) 108e111
Contents lists available at ScienceDirect
Studies in History and Philosophy of Science journal homepage: www.elsevier.com/locate/shpsa
Essay Review
Emily Baum Department of History, University of California, Irvine, 200 Murray Krieger Hall, Irvine, CA 92697-3275, USA
When citing this paper, please use the full journal title Studies in History and Philosophy of Science
Neither Donkey nor Horse. Sean Hsiang-lin Lei; University of Chicago Press, Chicago, 2014, pp 382, Price US$35.00 hardback, ISBN 978-0-226-16988-0
Sean Hsiang-lin Lei begins Neither donkey nor horse by juxtaposing two seemingly unconnected episodes in the history of modern China: first, the death of the revolutionary Sun Yat-sen in 1925, and second, the successful appendectomy of the American journalist James Reston during his travels to China in 1971. To Lei, these two events can be understood as bookends to the convoluted history of traditional Chinese medicine in the twentieth century. In the first episode, Sun’s decision to forego biomedical treatment for liver cancer, and instead choose to manage the disease through Chinese drugs, was perceived as a “public betrayal” to China’s modernizing program. Half a century later, Reston’s successful appendectomy, which relied mainly upon acupuncture to relieve his postsurgical pain, appeared to vindicate the effectiveness of Chinese medical techniques. More than this, however, the case of James Reston was also a symbolic victory for Chinese medicine. At the time of Sun Yat-sen’s death, acupuncture and related practices had been dismissed as backward, unscientific, and (most damningly) anti-modern. By the time Reston’s postsurgical treatment had been publicized in the pages of the New York Times, Chinese medicine appeared to offer an alternative type of treatmentdand more importantly, an alternative form of medical modernitydto that of Western medical science. Framing these two events as endpoints in Chinese medicine’s modernizing journey, Lei asks the central question that informs his book: “How was Chinese medicine transformed from the antithesis of modernity to one of the most potent symbols for China’s exploration of its own modernity?” (p. 3). The answer is complex, and one that cannot rightfully be given justice within the narrow scope of a book review. In short, however, Lei argues that the twentieth-century confrontation between Chinese medicine (representing a backward Asian tradition) and biomedicine (representing Western scientific modernity) did not
E-mail address: [email protected]. http://dx.doi.org/10.1016/j.shpsa.2014.11.005 0039-3681/Ó 2014 Elsevier Ltd. All rights reserved.
simply evolve between the two styles of medicine directly. Rather, the confrontation took place between Chinese medicine and the modernizing state: a state that not only sought to impose its modernizing vision on the medical community, but one that was also influenced by medical practitioners from both camps. In this sense, practitioners of Chinese medicine were not simply the passive recipients of a state-mandated modernizing agenda, but actively worked with the state to shape the ideological, institutional, and epistemological context that would lead to the ultimate triumph of Chinese medicine as an alternative form of “modern” medical practice under the Chinese Communist Party (CCP). Lei skillfully traces this narrative across 10 chapters, eschewing a standard chronological account for one that is more thematically oriented. His decision to do so is deliberate. Arguing that most previous works of medical history in China have simply refashioned the well-worn divide between tradition and modernity, Lei instead proposes what he refers to as a “coevolutionary” history: that is, a tale that both interweaves and problematizes the clear-cut distinctions between the history of biomedicine on the one hand, and the history of traditional Chinese medicine on the other. The book thus cycles between different moments in the political history of these two forms of medical practice, showing how they interacted both with each other and with the newly triumphant Nationalist Party, whose uncertain ideological program allowed for a surprising amount of flexibility in its interactions with practitioners of Chinese medicine. As Lei succinctly states, Neither donkey nor horse can most aptly be characterized as “a political history of medicine and a medical history of the Chinese state” (p. 10). The inseparable relationship between medicine and politics in early twentieth-century China becomes strikingly apparent in Lei’s first substantive chapter, which centers on the Manchurian plague of 1910e1911. Despite the fact that neither biomedicine nor Chinese medicine was effective at treating those who fell victim to the mysterious scourge, biomedicine eventually emerged victorious in the confrontation between these two forms of medical theory. The reason for the victory, Lei contends, had to do largely with the sociopolitical context of Manchuria at the end of the Qing dynasty. Since Japan and Russia were both determined to extend their imperial reach into the Manchurian steppe, they sought to use the Qing government’s failure to contain the plague as an excuse for
E. Baum / Studies in History and Philosophy of Science 49 (2015) 108e111
their territorial ventures. The fear of losing further territory served as a necessary impetus for the Qing to take up the clarion call of biomedicine. Even if the latter was ineffective at treating plague victims, it nevertheless was able to identify the scourge (pneumonic plague), and subsequently recommend a strategy for containing it (through quarantine). The state, in this instance, stood as the arbiter of medical decision-making, even if its choice did not center specifically on the therapeutic efficacy of one form of medicine over the other. By the first few decades of the Republic (1911e1949), practitioners of Chinese medicine had become keenly aware of the power of politics in arbitrating which form of medicine would achieve dominance within the emerging Chinese nation-state. As a result, their claims to superiority and legitimacy were not strictly waged against biomedical doctors, but were mainly targeted at the government functionaries who held the power to either champion or deny the Chinese medical cause. Chapters three through five detail the ideological struggle that took place between supporters of both forms of medical practice. Champions of biomedicine, such as the Western medical practitioner Yu Yan (Yu Yunxiu), positioned the two forms of medical theory as being lodged in a zero-sum game. Believing that only one medical truth could exist in the ontological world, Yu argued that biomedicine had thoroughly and rightfully discredited the theoretical underpinnings of Chinese medicine. Chinese medical theory should thus be abandoned, he maintained, while Chinese drugs should be evaluated according to biomedical principles and held up to the scrutiny of Western science. Ultimately, Yu’s stance was adopted by the Nationalist government, which attempted to eradicate Chinese medicine once and for all in 1929. This attempted eradication, as the case of James Reston proves, was not a success. Instead, Chinese medicine practitioners launched a National Medicine Movement (guoyi yundong) in response to the challenge from reformers like Yu Yan. This movement encompassed two aspects. First, since Chinese medicine practitioners could not deny the ontological reality that appeared to legitimize Western science, they responded to the attack by “avoiding the place of confrontation”dthat is, they sought to position Chinese medicine as something wholly different from, and therefore not in competition with, biomedicine. This “defensive strategy,” as Lei puts it, resulted in a “distorted self-image” that was sculpted largely in reaction to “enemies” of Chinese medicine (p. 86). Second, and perhaps more importantly for Lei’s larger thesis, the National Medicine Movement sought to position Chinese medicine as an ally of the state. Here, Lei diverges from the standard narrative of Chinese medical history that was first laid out by the historian Ralph Croizier in his 1968 book, Traditional medicine in modern China. Croizier, and other historians who followed in his footsteps, argued that the impetus behind preserving Chinese medicine had to do with the fact that conservative elites upheld indigenous medical practices as a synecdoche for the cultural essence of Chinese intellectual tradition. To the contrary, Lei claims that the National Medicine Movement was not simply an appeal to cultural nationalism. Rather, “National Medicine” (guoyi) was a conscious strategy forwarded by Chinese medicine practitioners to align themselves with, and gain sanction from, the state. As Lei argues, it was not cultural nationalism, but rather political power, that paved the way for the preservation and future development of Chinese medicine. The next four chapters trace the changing contours of Chinese medicine as it was adapted to fit the needs and demands of the modernizing state. In spite of the fact that the first half of the book portrays “Chinese medicine” and “Western medicine” as two distinct and self-contained categories, chapter six foregrounds the “internal heterogeneity” of the two styles of medicine (p. 123). In
109
the 1920s, as Lei explains, Chinese medicine was not an internally coherent set of practices, but a range of religious, magical, and medical approaches to disease that did not necessarily have any inherent commonalities. This heterogeneity ended up working in Chinese medicine’s favor. When medical reformers, led in part by the Nationalist statesmen Chen Lifu and Chen Guofu, attempted to render Chinese medicine more “scientific,” they could preserve or eliminate different elements as they saw fit. As a result, certain practices (such as exorcism) were outright discarded, while others (such as acupuncture) were subjected to scientific testing and retained. Chinese medicine was thus remade in a completely new imagedone that had little semblance to the heterogeneous assortment of medical and religious practices that had been employed in the past. The act of “scientizing” (kexue hua) Chinese medicine experienced moments of failure and moments of success. On the one hand, because Chinese medical concepts like yin/yang and qi could not be confirmed using scientific methods, Chinese medical theory appeared less materially groundeddand thus less scientifically sanctioneddthan biomedical concepts that involved germs and pathogens. On the other hand, because certain Chinese drugs and medicinal remedies had been proven effective at treating specific ailments, the practice of Chinese medicinedas opposed to its theorydcontinued to be upheld as a viable alternative to biomedicine. As Lei relates, “The struggle between the two styles of medicine thus shifted from a competition over which medicine better represented the world of material reality to one over which provided more useful tools for the practical purpose of treating illness in the here and now” (pp. 189e190). This struggle was epitomized by research into the drug changshan, which had been used as a cheap alternative to quinine in the struggle against malaria, particularly in China’s wartime southwest. Although Chinese medicine practitioners could not explain, on biomedical grounds, why changshan was an efficacious antidote to malaria, years of accumulated experience marked the drug as both effective and safe. Even so, in the confrontation between Chinese and Western medicine, “experience” was not seen as valid grounds for confirming the therapeutic efficacy of Chinese pharmaceutics. Thus, it was not until changshan had been subjected to biomedical testing that Westerntrained practitioners were persuaded to accept the drug as legitimatedeven if it meant that anti-malarial drugs were withheld from the public for longer than they needed to be. The final substantive chapter focuses on similarities and divergences between Nationalist and Communist state-led rural medical policies. While both parties began to take an increased interest in rural healthcare in the 1930s and 1940s, the Nationalist government largely excluded Chinese medicine practitioners in their plans to expand health networks to the countryside. It was not until the 1950s, when the Communists had established state control, that Chinese medicine was effectively integrated into the national healthcare system. The reason for this later assimilation, Lei states in his conclusion, was that the Communists interpreted the relationship between medicine and modernity in a radically different fashion from that of their Nationalist predecessors. While the Nationalists viewed modernity as inextricable from Western science, the Communists actively strove to realize an alternative form of modernity that was not predicated on “bourgeois” science or the capitalist West. As a result, scientized Chinese medicine was salvaged from its earlier status as antithetical to modernity and was instead redeemed as a viable form of medical practice. Neither donkey nor horse makes a number of substantial contributions to the still emerging field of medical history in China. As Lei aptly summarizes in his introduction, most historiographical works on Chinese medicine have “reproduced a binary opposition between tradition and modernity” (p. 6), thereby focusing either on
110
E. Baum / Studies in History and Philosophy of Science 49 (2015) 108e111
the history of biomedicine in China or on the history of traditional Chinese medicine. Lei’s study, on the other hand, demonstrates how the two co-evolveddinstitutionally, technically, and epistemologicallydthrough the mediator of the state. This emphasis on “coproduction” is one of the ways that Lei sets his work apart from previous studies on the topic. From the time that Joseph Needham first began compiling his research on science and civilization in China in the 1950s, traditional Chinese medicine has consistently emerged as an ideological “other” to the dominating epistemological reach of Western science. Ralph Croizier’s (1968) pioneering study on Traditional medicine in modern China followed in the footsteps that Needham carved out. Arguing that medicine was the one epistemological preserve that resisted the encroachment of Western science, Croizier depicted Chinese medicine as a bastion of cultural nationalism and a mainstay of indigenous intellectual tradition. In Croizier’s analysis, Chinese medicine thus emerged as the binary opposite of science and modernity. To various degrees, the early scholars who built off of Croizier’s work continued to uphold the dichotomy between modernity and tradition as embodied by the seemingly oppositional epistemologies of biomedicine and Chinese medicine. Largely, this perspective was informed by the fact that most early historians of Chinese medicine either focused their inquiries on the perspectives of Western missionaries and physicians (Buck, 1980; Bullock, 1980) or on the attitudes of Chinese intellectuals who had internalized the Orientalist rhetoric of the West (Kwok, 1965). Indeed, it was not until Benjamin Elman’s On their own terms (2005) that scholars became increasingly concerned with the imperative to examine the validity and logic internal to the Chinese scientific traditiondoutside of mere comparisons to an apparent Western standard. More recently, the field of Chinese medical history has continued to be bifurcated along the exact lines that Lei has pointed out above: the history of traditional Chinese medicine and the history of biomedicine in China. With regard to the former, a small group of scholars has dedicated much of their careers to painstakingly translating and explicating ancient medical texts and practices. Ted Kaptchuk (1983) and Paul Unschuld (1985), most notably, are best known for their efforts to render Chinese medical theory and practice intelligible to a Western audience, while Volker Scheid (2007), in his rigorously detailed examination of one Chinese medical lineage, has demonstrated how disparate strands of medical practice were consciously unified over time in order to create a coherent medical “tradition.” With regard to the latter, histories of biomedicine in twentieth-century China have engaged with the ways in which elites and state reformers deployed Western science in order to transform the urban environment. Ruth Rogaski’s Hygienic modernity (2004), for example, details how public health concerns became central to the modernizing project of the late Qing and Republican regimes. Her monograph places turn-of-the-century China on the cusp of a changing medical landscape, wherein traditional notions of qi and Daoist “guarding life” exercises were slowly being discredited in favor of a discourse of cleanliness and purity based upon “modern” hygienic practices. Although Lei draws upon threads from both of these approaches, his own research adopts a different tack by interweaving the “co-produced” histories of biomedicine, Chinese medicine, and the state through which both practices were eventually legitimized and deployed. This perspective allows Lei to address the questiondthus far never askeddof why Chinese medicine was able to survive (and even thrive!) when faced with the constant stream of attacks from Western missionaries, biomedical physicians, and Chinese reformers. One of his most salient responses to this question centers on the agency of Chinese medical practitioners themselves. In contrast to PRC medical historian Kim Taylor (2005), who argues in no uncertain terms that the
development of Chinese medicine in the Maoist era was entirely a product of state policies, Lei frames its development in terms of an agential group of Chinese medicine doctors who recognized that their own occupational survival depended upon their ability to navigate the political waters of their time. Their goal was thus not simply to preserve Chinese medicine, but to adapt it to a changing sociopolitical context and evolving public health needs. The “new Chinese medicine” (xin zhongyi) that resulted from their efforts was one that did not shy away from an engagement with biomedicine, but one that actively sought to position itself as a viable alternative to Western science. The significant role that Chinese medicine practitioners played in the perpetuation of their practice is an important contribution that Lei makes to ongoing conversations within Chinese medical history. Rather than framing these practitioners as passive victims of the modern era, Lei showcases how traditional doctors consciously reframed their own ideological agendas in order to actively contribute to the development of Chinese modernity. These men and women, along with the scientized “new medicine” that they helped develop, would ultimately provide the foundation for later Communist efforts to transform indigenous pharmaceutics and techniques into the “Traditional Chinese Medicine” (TCM) familiar to Westerners today. Perhaps most crucially for Lei’s tale, moreover, the development of TCM also allowed the CCP to envision a new kind of medical modernity that could offer an alternative to that of the capitalist West. It is fitting that Lei ends his book with a meditation on science and technology studies, for the story that he so eloquently tells is not one that should be limited to the area studies scholarship of Chinese historians alone. Invoking the philosopher Bruno Latour (1993), Lei offers his own work as a way to concretely realize Latour’s proposal to “establish relations” between modern science and pre-modern (or non-Western) knowledge. As Lei shows, although “new Chinese medicine” was originally disparaged as “neither donkey nor horse”dan epithet used to signal that “scientized” Chinese medicine had no possible future in the modern eradby the second half of the twentieth century, TCM had proven itself to be a viable form of medical practice that not only reaped immediate benefits within China, but had also expanded globally as a form of homeopathic care. The ability for Chinese medicine to coexist alongside biomedicine is not a fluke. Instead, as Latour suggestsdand as Lei’s study convincingly provesdthis coexistence reaffirms the possibility for the nature-versus-culture divide to achieve “hybridity.” By offering a concrete example for Latour’s philosophical proposal, Lei’s research is well positioned to make a significant contribution to science studies writ large. For as far as the field has come, however, it is worth noting that histories of medicine in China remain largely centered on tope down interactions between elites and the state. Unlike the historiography of medicine in the Western world, which began to turn its attentions to the social histories of healing in the 1980s (e.g. Porter, 1987a, 1987b), the more nascent field of Chinese medical history is still in the midst of carving out a nuanced political narrative. Works like Lei’s, along with Bridie Andrews’ longawaited The Making of Modern Chinese Medicine (2014), have contributed much to this venture. These works, I imagine, will likely be considered foundational to the field in the future, particularly as Chinese medical history continues to develop along more socially-oriented lines. Overall, Neither donkey nor horse is thoroughly engaging, theoretically informed, and impeccably researched. This complex story, though acknowledging the intricacies and vagaries of history, does not get bogged down in its own detail. Instead, Lei’s skillful narrative hand remains positioned above the fray, ready to guide the reader across thematic and temporal divides. It is a fascinating
E. Baum / Studies in History and Philosophy of Science 49 (2015) 108e111
story, and one that will do much to advance the field of medical history in the non-West. References Andrews, B. (2014). The making of modern Chinese medicine, 1850e1960. Seattle: University of Washington Press. Buck, P. (1980). American science and modern China, 1876e1936. Cambridge: Cambridge University Press. Bullock, M. (1980). An American transplant. Berkeley: University of California Press. Croizier, R. (1968). Traditional medicine in modern China. Cambridge, MA: Harvard University Press. Elman, B. (2005). On their own terms. Cambridge, MA: Harvard University Press.
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Kaptchuk, T. (1983). The web that has no weaver. London: Rider. Kwok, D. (1965). Scientism in Chinese thought, 1900e1950. New Haven: Yale University Press. Latour, B. (1993). We have never been modern. Cambridge, MA: Harvard University Press. Porter, R. (1987a). Disease, medicine, and society in England, 1550e1860. London: Macmillan. Porter, R. (1987b). Mind forg’d manacles. Cambridge, MA: Harvard University Press. Rogaski, R. (2004). Hygienic modernity. Berkeley: University of California Press. Scheid, V. (2007). Currents of tradition in Chinese medicine, 1626e2006. Seattle: Eastland Press. Taylor, K. (2005). Chinese medicine in early communist China, 1945e63. New York: RoutledgeCurzon. Unschuld, P. (1985). Medicine in China. Berkeley: University of California Press.
Contents lists available at ScienceDirect
Studies in History and Philosophy of Science journal homepage: www.elsevier.com/locate/shpsa
Essay Review
Emily Baum Department of History, University of California, Irvine, 200 Murray Krieger Hall, Irvine, CA 92697-3275, USA
When citing this paper, please use the full journal title Studies in History and Philosophy of Science
Neither Donkey nor Horse. Sean Hsiang-lin Lei; University of Chicago Press, Chicago, 2014, pp 382, Price US$35.00 hardback, ISBN 978-0-226-16988-0
Sean Hsiang-lin Lei begins Neither donkey nor horse by juxtaposing two seemingly unconnected episodes in the history of modern China: first, the death of the revolutionary Sun Yat-sen in 1925, and second, the successful appendectomy of the American journalist James Reston during his travels to China in 1971. To Lei, these two events can be understood as bookends to the convoluted history of traditional Chinese medicine in the twentieth century. In the first episode, Sun’s decision to forego biomedical treatment for liver cancer, and instead choose to manage the disease through Chinese drugs, was perceived as a “public betrayal” to China’s modernizing program. Half a century later, Reston’s successful appendectomy, which relied mainly upon acupuncture to relieve his postsurgical pain, appeared to vindicate the effectiveness of Chinese medical techniques. More than this, however, the case of James Reston was also a symbolic victory for Chinese medicine. At the time of Sun Yat-sen’s death, acupuncture and related practices had been dismissed as backward, unscientific, and (most damningly) anti-modern. By the time Reston’s postsurgical treatment had been publicized in the pages of the New York Times, Chinese medicine appeared to offer an alternative type of treatmentdand more importantly, an alternative form of medical modernitydto that of Western medical science. Framing these two events as endpoints in Chinese medicine’s modernizing journey, Lei asks the central question that informs his book: “How was Chinese medicine transformed from the antithesis of modernity to one of the most potent symbols for China’s exploration of its own modernity?” (p. 3). The answer is complex, and one that cannot rightfully be given justice within the narrow scope of a book review. In short, however, Lei argues that the twentieth-century confrontation between Chinese medicine (representing a backward Asian tradition) and biomedicine (representing Western scientific modernity) did not
E-mail address: [email protected]. http://dx.doi.org/10.1016/j.shpsa.2014.11.005 0039-3681/Ó 2014 Elsevier Ltd. All rights reserved.
simply evolve between the two styles of medicine directly. Rather, the confrontation took place between Chinese medicine and the modernizing state: a state that not only sought to impose its modernizing vision on the medical community, but one that was also influenced by medical practitioners from both camps. In this sense, practitioners of Chinese medicine were not simply the passive recipients of a state-mandated modernizing agenda, but actively worked with the state to shape the ideological, institutional, and epistemological context that would lead to the ultimate triumph of Chinese medicine as an alternative form of “modern” medical practice under the Chinese Communist Party (CCP). Lei skillfully traces this narrative across 10 chapters, eschewing a standard chronological account for one that is more thematically oriented. His decision to do so is deliberate. Arguing that most previous works of medical history in China have simply refashioned the well-worn divide between tradition and modernity, Lei instead proposes what he refers to as a “coevolutionary” history: that is, a tale that both interweaves and problematizes the clear-cut distinctions between the history of biomedicine on the one hand, and the history of traditional Chinese medicine on the other. The book thus cycles between different moments in the political history of these two forms of medical practice, showing how they interacted both with each other and with the newly triumphant Nationalist Party, whose uncertain ideological program allowed for a surprising amount of flexibility in its interactions with practitioners of Chinese medicine. As Lei succinctly states, Neither donkey nor horse can most aptly be characterized as “a political history of medicine and a medical history of the Chinese state” (p. 10). The inseparable relationship between medicine and politics in early twentieth-century China becomes strikingly apparent in Lei’s first substantive chapter, which centers on the Manchurian plague of 1910e1911. Despite the fact that neither biomedicine nor Chinese medicine was effective at treating those who fell victim to the mysterious scourge, biomedicine eventually emerged victorious in the confrontation between these two forms of medical theory. The reason for the victory, Lei contends, had to do largely with the sociopolitical context of Manchuria at the end of the Qing dynasty. Since Japan and Russia were both determined to extend their imperial reach into the Manchurian steppe, they sought to use the Qing government’s failure to contain the plague as an excuse for
E. Baum / Studies in History and Philosophy of Science 49 (2015) 108e111
their territorial ventures. The fear of losing further territory served as a necessary impetus for the Qing to take up the clarion call of biomedicine. Even if the latter was ineffective at treating plague victims, it nevertheless was able to identify the scourge (pneumonic plague), and subsequently recommend a strategy for containing it (through quarantine). The state, in this instance, stood as the arbiter of medical decision-making, even if its choice did not center specifically on the therapeutic efficacy of one form of medicine over the other. By the first few decades of the Republic (1911e1949), practitioners of Chinese medicine had become keenly aware of the power of politics in arbitrating which form of medicine would achieve dominance within the emerging Chinese nation-state. As a result, their claims to superiority and legitimacy were not strictly waged against biomedical doctors, but were mainly targeted at the government functionaries who held the power to either champion or deny the Chinese medical cause. Chapters three through five detail the ideological struggle that took place between supporters of both forms of medical practice. Champions of biomedicine, such as the Western medical practitioner Yu Yan (Yu Yunxiu), positioned the two forms of medical theory as being lodged in a zero-sum game. Believing that only one medical truth could exist in the ontological world, Yu argued that biomedicine had thoroughly and rightfully discredited the theoretical underpinnings of Chinese medicine. Chinese medical theory should thus be abandoned, he maintained, while Chinese drugs should be evaluated according to biomedical principles and held up to the scrutiny of Western science. Ultimately, Yu’s stance was adopted by the Nationalist government, which attempted to eradicate Chinese medicine once and for all in 1929. This attempted eradication, as the case of James Reston proves, was not a success. Instead, Chinese medicine practitioners launched a National Medicine Movement (guoyi yundong) in response to the challenge from reformers like Yu Yan. This movement encompassed two aspects. First, since Chinese medicine practitioners could not deny the ontological reality that appeared to legitimize Western science, they responded to the attack by “avoiding the place of confrontation”dthat is, they sought to position Chinese medicine as something wholly different from, and therefore not in competition with, biomedicine. This “defensive strategy,” as Lei puts it, resulted in a “distorted self-image” that was sculpted largely in reaction to “enemies” of Chinese medicine (p. 86). Second, and perhaps more importantly for Lei’s larger thesis, the National Medicine Movement sought to position Chinese medicine as an ally of the state. Here, Lei diverges from the standard narrative of Chinese medical history that was first laid out by the historian Ralph Croizier in his 1968 book, Traditional medicine in modern China. Croizier, and other historians who followed in his footsteps, argued that the impetus behind preserving Chinese medicine had to do with the fact that conservative elites upheld indigenous medical practices as a synecdoche for the cultural essence of Chinese intellectual tradition. To the contrary, Lei claims that the National Medicine Movement was not simply an appeal to cultural nationalism. Rather, “National Medicine” (guoyi) was a conscious strategy forwarded by Chinese medicine practitioners to align themselves with, and gain sanction from, the state. As Lei argues, it was not cultural nationalism, but rather political power, that paved the way for the preservation and future development of Chinese medicine. The next four chapters trace the changing contours of Chinese medicine as it was adapted to fit the needs and demands of the modernizing state. In spite of the fact that the first half of the book portrays “Chinese medicine” and “Western medicine” as two distinct and self-contained categories, chapter six foregrounds the “internal heterogeneity” of the two styles of medicine (p. 123). In
109
the 1920s, as Lei explains, Chinese medicine was not an internally coherent set of practices, but a range of religious, magical, and medical approaches to disease that did not necessarily have any inherent commonalities. This heterogeneity ended up working in Chinese medicine’s favor. When medical reformers, led in part by the Nationalist statesmen Chen Lifu and Chen Guofu, attempted to render Chinese medicine more “scientific,” they could preserve or eliminate different elements as they saw fit. As a result, certain practices (such as exorcism) were outright discarded, while others (such as acupuncture) were subjected to scientific testing and retained. Chinese medicine was thus remade in a completely new imagedone that had little semblance to the heterogeneous assortment of medical and religious practices that had been employed in the past. The act of “scientizing” (kexue hua) Chinese medicine experienced moments of failure and moments of success. On the one hand, because Chinese medical concepts like yin/yang and qi could not be confirmed using scientific methods, Chinese medical theory appeared less materially groundeddand thus less scientifically sanctioneddthan biomedical concepts that involved germs and pathogens. On the other hand, because certain Chinese drugs and medicinal remedies had been proven effective at treating specific ailments, the practice of Chinese medicinedas opposed to its theorydcontinued to be upheld as a viable alternative to biomedicine. As Lei relates, “The struggle between the two styles of medicine thus shifted from a competition over which medicine better represented the world of material reality to one over which provided more useful tools for the practical purpose of treating illness in the here and now” (pp. 189e190). This struggle was epitomized by research into the drug changshan, which had been used as a cheap alternative to quinine in the struggle against malaria, particularly in China’s wartime southwest. Although Chinese medicine practitioners could not explain, on biomedical grounds, why changshan was an efficacious antidote to malaria, years of accumulated experience marked the drug as both effective and safe. Even so, in the confrontation between Chinese and Western medicine, “experience” was not seen as valid grounds for confirming the therapeutic efficacy of Chinese pharmaceutics. Thus, it was not until changshan had been subjected to biomedical testing that Westerntrained practitioners were persuaded to accept the drug as legitimatedeven if it meant that anti-malarial drugs were withheld from the public for longer than they needed to be. The final substantive chapter focuses on similarities and divergences between Nationalist and Communist state-led rural medical policies. While both parties began to take an increased interest in rural healthcare in the 1930s and 1940s, the Nationalist government largely excluded Chinese medicine practitioners in their plans to expand health networks to the countryside. It was not until the 1950s, when the Communists had established state control, that Chinese medicine was effectively integrated into the national healthcare system. The reason for this later assimilation, Lei states in his conclusion, was that the Communists interpreted the relationship between medicine and modernity in a radically different fashion from that of their Nationalist predecessors. While the Nationalists viewed modernity as inextricable from Western science, the Communists actively strove to realize an alternative form of modernity that was not predicated on “bourgeois” science or the capitalist West. As a result, scientized Chinese medicine was salvaged from its earlier status as antithetical to modernity and was instead redeemed as a viable form of medical practice. Neither donkey nor horse makes a number of substantial contributions to the still emerging field of medical history in China. As Lei aptly summarizes in his introduction, most historiographical works on Chinese medicine have “reproduced a binary opposition between tradition and modernity” (p. 6), thereby focusing either on
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the history of biomedicine in China or on the history of traditional Chinese medicine. Lei’s study, on the other hand, demonstrates how the two co-evolveddinstitutionally, technically, and epistemologicallydthrough the mediator of the state. This emphasis on “coproduction” is one of the ways that Lei sets his work apart from previous studies on the topic. From the time that Joseph Needham first began compiling his research on science and civilization in China in the 1950s, traditional Chinese medicine has consistently emerged as an ideological “other” to the dominating epistemological reach of Western science. Ralph Croizier’s (1968) pioneering study on Traditional medicine in modern China followed in the footsteps that Needham carved out. Arguing that medicine was the one epistemological preserve that resisted the encroachment of Western science, Croizier depicted Chinese medicine as a bastion of cultural nationalism and a mainstay of indigenous intellectual tradition. In Croizier’s analysis, Chinese medicine thus emerged as the binary opposite of science and modernity. To various degrees, the early scholars who built off of Croizier’s work continued to uphold the dichotomy between modernity and tradition as embodied by the seemingly oppositional epistemologies of biomedicine and Chinese medicine. Largely, this perspective was informed by the fact that most early historians of Chinese medicine either focused their inquiries on the perspectives of Western missionaries and physicians (Buck, 1980; Bullock, 1980) or on the attitudes of Chinese intellectuals who had internalized the Orientalist rhetoric of the West (Kwok, 1965). Indeed, it was not until Benjamin Elman’s On their own terms (2005) that scholars became increasingly concerned with the imperative to examine the validity and logic internal to the Chinese scientific traditiondoutside of mere comparisons to an apparent Western standard. More recently, the field of Chinese medical history has continued to be bifurcated along the exact lines that Lei has pointed out above: the history of traditional Chinese medicine and the history of biomedicine in China. With regard to the former, a small group of scholars has dedicated much of their careers to painstakingly translating and explicating ancient medical texts and practices. Ted Kaptchuk (1983) and Paul Unschuld (1985), most notably, are best known for their efforts to render Chinese medical theory and practice intelligible to a Western audience, while Volker Scheid (2007), in his rigorously detailed examination of one Chinese medical lineage, has demonstrated how disparate strands of medical practice were consciously unified over time in order to create a coherent medical “tradition.” With regard to the latter, histories of biomedicine in twentieth-century China have engaged with the ways in which elites and state reformers deployed Western science in order to transform the urban environment. Ruth Rogaski’s Hygienic modernity (2004), for example, details how public health concerns became central to the modernizing project of the late Qing and Republican regimes. Her monograph places turn-of-the-century China on the cusp of a changing medical landscape, wherein traditional notions of qi and Daoist “guarding life” exercises were slowly being discredited in favor of a discourse of cleanliness and purity based upon “modern” hygienic practices. Although Lei draws upon threads from both of these approaches, his own research adopts a different tack by interweaving the “co-produced” histories of biomedicine, Chinese medicine, and the state through which both practices were eventually legitimized and deployed. This perspective allows Lei to address the questiondthus far never askeddof why Chinese medicine was able to survive (and even thrive!) when faced with the constant stream of attacks from Western missionaries, biomedical physicians, and Chinese reformers. One of his most salient responses to this question centers on the agency of Chinese medical practitioners themselves. In contrast to PRC medical historian Kim Taylor (2005), who argues in no uncertain terms that the
development of Chinese medicine in the Maoist era was entirely a product of state policies, Lei frames its development in terms of an agential group of Chinese medicine doctors who recognized that their own occupational survival depended upon their ability to navigate the political waters of their time. Their goal was thus not simply to preserve Chinese medicine, but to adapt it to a changing sociopolitical context and evolving public health needs. The “new Chinese medicine” (xin zhongyi) that resulted from their efforts was one that did not shy away from an engagement with biomedicine, but one that actively sought to position itself as a viable alternative to Western science. The significant role that Chinese medicine practitioners played in the perpetuation of their practice is an important contribution that Lei makes to ongoing conversations within Chinese medical history. Rather than framing these practitioners as passive victims of the modern era, Lei showcases how traditional doctors consciously reframed their own ideological agendas in order to actively contribute to the development of Chinese modernity. These men and women, along with the scientized “new medicine” that they helped develop, would ultimately provide the foundation for later Communist efforts to transform indigenous pharmaceutics and techniques into the “Traditional Chinese Medicine” (TCM) familiar to Westerners today. Perhaps most crucially for Lei’s tale, moreover, the development of TCM also allowed the CCP to envision a new kind of medical modernity that could offer an alternative to that of the capitalist West. It is fitting that Lei ends his book with a meditation on science and technology studies, for the story that he so eloquently tells is not one that should be limited to the area studies scholarship of Chinese historians alone. Invoking the philosopher Bruno Latour (1993), Lei offers his own work as a way to concretely realize Latour’s proposal to “establish relations” between modern science and pre-modern (or non-Western) knowledge. As Lei shows, although “new Chinese medicine” was originally disparaged as “neither donkey nor horse”dan epithet used to signal that “scientized” Chinese medicine had no possible future in the modern eradby the second half of the twentieth century, TCM had proven itself to be a viable form of medical practice that not only reaped immediate benefits within China, but had also expanded globally as a form of homeopathic care. The ability for Chinese medicine to coexist alongside biomedicine is not a fluke. Instead, as Latour suggestsdand as Lei’s study convincingly provesdthis coexistence reaffirms the possibility for the nature-versus-culture divide to achieve “hybridity.” By offering a concrete example for Latour’s philosophical proposal, Lei’s research is well positioned to make a significant contribution to science studies writ large. For as far as the field has come, however, it is worth noting that histories of medicine in China remain largely centered on tope down interactions between elites and the state. Unlike the historiography of medicine in the Western world, which began to turn its attentions to the social histories of healing in the 1980s (e.g. Porter, 1987a, 1987b), the more nascent field of Chinese medical history is still in the midst of carving out a nuanced political narrative. Works like Lei’s, along with Bridie Andrews’ longawaited The Making of Modern Chinese Medicine (2014), have contributed much to this venture. These works, I imagine, will likely be considered foundational to the field in the future, particularly as Chinese medical history continues to develop along more socially-oriented lines. Overall, Neither donkey nor horse is thoroughly engaging, theoretically informed, and impeccably researched. This complex story, though acknowledging the intricacies and vagaries of history, does not get bogged down in its own detail. Instead, Lei’s skillful narrative hand remains positioned above the fray, ready to guide the reader across thematic and temporal divides. It is a fascinating
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story, and one that will do much to advance the field of medical history in the non-West. References Andrews, B. (2014). The making of modern Chinese medicine, 1850e1960. Seattle: University of Washington Press. Buck, P. (1980). American science and modern China, 1876e1936. Cambridge: Cambridge University Press. Bullock, M. (1980). An American transplant. Berkeley: University of California Press. Croizier, R. (1968). Traditional medicine in modern China. Cambridge, MA: Harvard University Press. Elman, B. (2005). On their own terms. Cambridge, MA: Harvard University Press.
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Kaptchuk, T. (1983). The web that has no weaver. London: Rider. Kwok, D. (1965). Scientism in Chinese thought, 1900e1950. New Haven: Yale University Press. Latour, B. (1993). We have never been modern. Cambridge, MA: Harvard University Press. Porter, R. (1987a). Disease, medicine, and society in England, 1550e1860. London: Macmillan. Porter, R. (1987b). Mind forg’d manacles. Cambridge, MA: Harvard University Press. Rogaski, R. (2004). Hygienic modernity. Berkeley: University of California Press. Scheid, V. (2007). Currents of tradition in Chinese medicine, 1626e2006. Seattle: Eastland Press. Taylor, K. (2005). Chinese medicine in early communist China, 1945e63. New York: RoutledgeCurzon. Unschuld, P. (1985). Medicine in China. Berkeley: University of California Press.