The state, the nation, and their limits: Recent publications on the history of Chinese medicine

Studies in History and Philosophy of Biological and Biomedical Sciences xxx (2014) xxx–xxx

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The state, the nation, and their limits: Recent publications on the history of Chinese medicine Jesse D. Sloane New Millennium Hall, Yonsei University, 262 Seongsan-no, Seodaemun-gu, Seoul 120-749, Republic of Korea

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Speaking of epidemics in Chinese medicine: Disease and the geographic imagination in Late Imperial China. Marta Hanson; Routledge, New York, 2013, p. 268, Price £24.99 paperback, ISBN 978-0-415-83535-0. Chinese medicine and healing: An illustrated history. T. J. Hinricks & L. Barnes (Eds.), Belknap Press, Cambridge, MA, 2013, p. 480, Price $45.00 hardcover, ISBN: 9780674047372. 1. Introduction The history of Chinese medicine in Western languages exhibits two interrelated tensions. The first is between the need on the one hand to demonstrate its object’s legitimate status as medicine, and on the other to engage with the history of medicine as a broader field. Examination of Chinese medicine within the same institutional and discursive spaces as Western medicine is only possible if the former discipline is seen to exhibit coherence, rationalism, empiricism, and innovation. At the same time, a responsible historical methodology necessitates skepticism regarding precisely these qualities: historians of science seek evidence that practices and their practitioners are less coherent and rational, their ideas less empirically grounded, and their ‘‘innovations’’ less novel than previously assumed. For many within the history of Chinese medicine, however, emphasis on contingency, politics, and the social context merely affirms a preconception that Chinese medicine would be more appropriately relegated to the areas of anthropology, religion, antiquarianism, and self-help. Such attitudes remain common, with philosophers of science continuing to work from the axiom that cultural factors in China precluded ‘‘scientific cognition’’ (Faucher et al., 2002). The same position is evident in influential survey works that group the entirety of Chinese medical history with that of pre-Renaissance Europe (Porter, 1997, pp. 147–162). The two recent publications discussed here represent a discipline investigating the history of Chinese medicine as rationally structured and

theoretically fecund, characterized by frequent innovation and vigorous debate. 1.1. Framing the field A second tension is between ‘‘Chinese medicine’’ and ‘‘medicine in China,’’ competing conceptions of the boundaries and goals of the discipline (Hsu, 1999, p. 6). ‘‘Chinese’’ or ‘‘East Asian medicine’’ focuses on a body of interrelated theories and practices, changing over time and in constant dialogue with its social context. This topic of inquiry extends beyond present-day China and particularly to Japan, Korea, and Vietnam, where distinct but interconnected innovations occurred, and where East Asian medicine holds a prominent role alongside biomedicine in modern health care systems. In contrast, ‘‘medicine in China’’ more strictly observes national borders, yet encompasses a far broader variety of ideas and practices within them. This division is represented by two recent publications. Containing contributions by over forty scholars, Chinese Medicine and Healing: An Illustrated History offers an eclectic panorama of healing practices in China, and displays an overarching emphasis on medical pluralism in China from prehistory to the present. As the content of its eight historical chapters may be newest to many readers, they form the focus of this discussion; two further chapters by Linda A. Barnes contribute accessible new insights on the recent globalization of Chinese medicine. In contrast, Speaking of Epidemics in Chinese Medicine is a monograph ‘‘biography’’ of a single medical concept from the first century BCE to the present day, focusing on theoretical developments in the late imperial period (ca. 1500–1911). 2. Historicizing medicine in China While introductions to Chinese medicine are numerous (see for example Kaptchuk, 2000; Unschuld, 1985, 1986), Chinese Medicine and Healing stands alone as a comprehensive, up-to-date

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Please cite this article in press as: Sloane, J. D. The state, the nation, and their limits: Recent publications on the history of Chinese medicine. Studies in History and Philosophy of Biological and Biomedical Sciences (2014), http://dx.doi.org/10.1016/j.shpsc.2014.01.001

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single-volume survey of medicine in China in historical and contemporary social context. Fifteen years ago it was still possible for a leading scholar to remark, ‘‘The history of East Asian medicine has never evolved a methodology to account for change’’ (Sivin, 1998). A proliferation of studies since has identified four major conceptual shifts in Chinese medicine. Each joined existing approaches rather than replacing them, and accompanied fundamental changes in state and society. 2.1. Naturalism and its alternatives The first shift occurred with the formation of philosophical systems in the first millennium B.C.E.: illness and treatment came to be understood in terms of predictable systems of correspondences and temporal cycles, providing an alternative to the earlier predominance of unseen conscious agents. Constance A. Cook’s chapter stretches from the earliest diagnostic records in the thirteenth century B.C.E. to the classical texts of the Warring States (fifth– third centuries B.C.E.). She notes that early diagnoses relied on divination, and treatment on exorcism, offerings, and communication with spirits and deities. By the Warring States period, what may be called naturalistic understandings of illness had emerged in elite medicine. The movement of qi and its processes came to rival malevolent demons and disaffected ancestors as a cause of illness (p. 15); similarly, astronomical observations and calendrical calculations became alternatives to direct communication with trans-empirical beings (pp. 7, 22). Many texts still central to Chinese medicine were authored or compiled in the Han period (206 B.C.E.–220 C.E.), particularly the Inner Canon of the Yellow Emperor and the later Treatise on Cold Damage Disorders. Vivienne Lo’s chapter on this period provides a thorough yet readable critical examination of the textual tradition, introducing texts that would later receive the greatest attention, underscoring their composite structure, and foreshadowing their reception in later eras (pp. 34–35 and 40). She notes that calculation from cycles and correspondences, including calendrical and Five Phases cycles, and Yin–Yang duality, dominated the cosmology or the period and gained increasing utilization in medicine (pp. 59–62). At the same time, she emphasizes, recently excavated texts attest to the continued importance of spirits and demons to understandings of illness and treatment; their absence from received sources illuminates the endeavors of redactors in later periods to purge the medical canon of ritual and religious elements (p. 55). Lo is particularly wary of attempts to locate a precise beginning for acupuncture, citing recently excavated texts to highlight variation within Han understandings and their differences from modern conventions. She allows that one excavated text (186 B.C.E.) may be considered the first extant mention of acupuncture, yet complicates the chronology by noting slightly later texts showing that the current standard Chinese medicine model of the body, in which qi circulates along twelve meridians, was then far from universal. Moreover, she notes, moxibustion—targeted application of heat— was considerably more frequent than acupuncture or related techniques for manipulating body qi through direct contact (p. 41). Fan Ka-Wai’s chapter relates developments during the ‘‘Period of Disunity’’ (220–581) and under the Sui (581–618) and Tang (618–907) dynasties. The chaotic centuries after the fall of the Han empire saw the spread of Buddhism through Chinese society and the maintenance of elite status by a small group of families (see respectively Johnson, 1977; Zürcher, 2007). Fan outlines how aristocratic families in the Period of Disunity pursued medical scholarship to maintain their ethical and physical integrity. Subsequently the geographic expanses of the Sui and especially Tang empires exposed their officials to new forms of illness, which spurred their interest in new treatments (p. 76).

Beyond introducing a new taxonomy of pharmaceuticals introduced in the early sixth century, Fan devotes little space to innovation within Chinese elite medicine. His focus is instead on new ideas and materials from abroad, particularly India and Central Asia (pp. 77–79). Indian texts brought the concept of past lives and karma as new causes of illness and health, as well as the four Indo-European elements (earth, water, fire, and wind). Readers seeking traces of Indian medical traditions in China will, however, find no examples of the integration of Indian or Western Eurasian concepts into Chinese medicine at this time (they may be found in Leung, 2009, pp. 54–55; Schafer, 1963, pp. 176–194). 2.2. Antiquarianism, standardization, and their discontents The second major conceptual shift in Chinese medicine came during an era of technological innovation peaking in the eleventh century C.E. This era saw the dominance of Cold Damage theory, tracing illness to infiltration by pathogenic qi linked to seasonal factors and treating it with a standardized repertoire of pharmaceuticals. The government of the Northern Song dynasty (960– 1127) reached a level of state activism never since equaled until the twentieth century, pursuing a broad range of economic, social, and intellectual initiatives (Hymes & Schirokauer, 1993). T.J. Hinrichs’ chapter notes that Song state medical programs were exceptional for their duration and impact; these programs remained active after the abandonment or rejection of other state initiatives in the twelfth century. She emphasizes the role that printing technology played in giving state-sponsored texts broad influence throughout society, establishing the versions of earlier classical texts that remain standard today and bringing uniformity to pharmaceutical formulae and acupuncture loci (pp. 104–106). As she points out, texts were only one facet of state intervention, which included also a network of medical schools and offices providing premixed medicines inexpensively or gratis (p. 101). Hinrichs highlights as well Song officials’ determination to change healing practices in southern territories more recently brought under Chinese settlement and administration, undertaking medical campaigns which served both to extend state authority and to propagate the cultural norms of the literate elite class (pp. 110–111). She questions state and elite claims to a superior medical repertoire, suggesting that such southern practices as isolating patients were consistent with modern biomedical understandings. Moreover, Hinrichs and contributors of shorter entries illustrate how ‘‘orthodox’’ elite healing encompassed the demonic etiologies of mainstream Daoism (pp. 119–122). The importance of religious healing in society even after the Northern Song promotion of standardized formulae—and perhaps as a reaction against it—is demonstrated by the practices of newly emerged northern Daoist movements, which while overtly downplaying ritual and thaumaturgy were nonetheless heavily involved in religious healing (Eskildsen, 2004; Leung, 2003). Like other Song state initiatives, the privileging of Cold Damage theory provoked resistance in the thirteenth century as elites reacted against attempts to standardize knowledge. Particularly in the Jin dynasty (1115–1234), which wrested northern China from Song control, many educated physicians came to favor treatments based on complex calculations specific to each case (Furth, 2006, pp. 428–431). Hinrichs draws due attention to the important changes in medicine during this period yet explains little concerning how state actions were understood and justified in medical terms, an unfortunate decision given the light shed on these questions by recent research (Despeux, 2001; Goldschmidt, 2009). In the succeeding chapter, Angela K.C. Leung addresses two periods which she connects by social trends spanning both. One is transnational integration; she finds the Ming state (1368– 1644) less isolationist than sometimes portrayed, with maritime

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links particularly important. As she acknowledges, however, the Ming nonetheless lacked the Eurasian connections the Yuan dynasty (1206–1368) rulers’ Mongol identity had conferred. In their treatment of transnational exchanges, Leung and the contributors of shorter entries on this period miss certain opportunities to link them to larger themes. While global interconnections can be fascinating, to transcend the status of trivia their role in secular change must be demonstrated; paradigmatic examples are, of course, the transformations of European medicine by contact with the Islamic world and subsequently by overseas colonies. At times scholarship on Chinese medicine offers comparable attention to transnational connections without corresponding demonstrations of their significance in broader trends. For example, Leung announces the arrival of ‘‘Arabic, Tibetan, and European Christian medical ideas’’ during the Yuan without further elaboration (p. 131), while Paul Buell’s related entry concludes only that ‘‘the long-term influence of Islamic medicine on Chinese medical theory is unclear’’ (p. 134). Entries by other contributors on medical texts from Vietnam (pp. 134–135) and Korea (pp. 137–139) frame both mainly as distinctive accomplishments of those two nations. However, the Korean Tongu˘i pogam (1610) in particular has been examined productively within the intellectual dialogue of its time in by a considerable body of Asian-language scholarship (Li & Li, 2008; Nukii, 2007; Yao, 2011; Yoshida, 2010; Korean scholarship is far more extensive). Similarly, the role of Chinese medicine in Persia and Central Asia under the Mongols was more evident than influence from West to East in the same period (Allsen, 2004, pp. 142– 151). Expanding the focus of historical chapters in this volume beyond ‘‘medicine in China’’ would have clarified the significance of these developments. In particular, examining the development of ‘‘Chinese’’ medicine outside ‘‘China’’ would have further illuminated both the coherence and changeability of its concepts and the role of contingency in their development. 2.3. Cartographies of illness The third shift in Chinese medicine occurred from the thirteenth through nineteenth centuries, when a new emphasis on local identity led by educated elites was accompanied by greater attention in medicine to environmental factors, especially those related to geography. Leung notes that the first major intellectual reaction to Song state activism was advanced by prominent physicians of the Jin and Yuan, whose critiques of hegemonic Cold Damage theory proved influential in subsequent scholarly medicine (explored in greater detail in Leung, 2003, pp. 377– 379). Medical occupations became increasingly accepted among an educated elite class whose size far exceeded available positions in the bureaucracy (Hymes, 1987), and within this group published collections of medical case histories systematized the transmission of knowledge (Cullen, 2001; Furth, Zeitlin, & Hsiung, 2007). Leung argues that these scholar-physicians demonstrated increasing signs of consciousness as a profession. Here and elsewhere Leung has argued that this period saw a shift in elite scholarly medicine toward reliance on pharmacology at the expense of acupuncture, with scholar-physicians’ academic proclivities and disdain for intensive bodily engagement ceding to non-elite practitioners the techniques of acupuncture, moxibustion, and smallpox variolation (pp. 156–157; Leung, 2003, pp. 383–384). Leung’s discussion of the Ming period successfully introduces key medical texts in relation to social trends without obscuring their understanding by contemporaries. She instructively distinguishes the influential Systematic Materia Medica of Li Shizhen (1596) by its connection to the maturing national market in pharmaceuticals (p. 149), although unfortunately omits recent findings on this text (Nappi, 2009). Confronting the common assumption that Chinese medicine lacked a concept of contagion, Leung draws

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attention to physicians’ observations on the spread of skin diseases in the far south of the Ming empire; for cases resembling leprosy in Western nosology, first Buddhist orders and then the state established quarantine facilities to contain infection (explored more fully in Leung, 2009, pp. 85–114). The Qing dynasty (1644–1911) saw greater social mobility, a resurgence of state activism, new scholarly rigor, and Western incursions. Yi-li Wu’s chapter on the period addresses these developments in turn. Many trends Wu identifies had been underway since the Song: the elites’ entry into the medical profession continued to grow, their efforts to circumscribe ‘‘legitimate’’ medicine against religious and lower-status practitioners still met with limited success, and commercially printed texts remained important in pedagogy (pp. 178–181). As in the Song, eighteenth century state medical texts served to project central government authority (pp. 174–176). Wu takes care, however, to note subtle changes belying these apparent continuities. From the sixteenth century commercial printing grew dramatically (Brokaw & Chow, 2005; McDermott, 2006), and Wu finds that higher literacy brought printed texts an unprecedented popular readership among both physicians and laypeople, testing the boundaries of professional medicine (pp. 180–181). Similarly, she points out that some Qing government printing reflected the rigorous philology of the new ‘‘evidential studies’’ movement, seeking direct understanding of the third century Treatise on Cold Damage and downplaying subsequent theoretical developments (treated in detail in Elman, 2005). Wu’s treatment of medical concepts focuses overwhelmingly on Western medicine; the one case of innovation within Chinese medicine she describes in detail, concerning nineteenth century physicians’ responses to the quintessentially colonial epidemic of cholera, is in fact drawn from Hanson’s Speaking of Epidemics (pp. 203–204). A strength of Wu’s account is its depiction of the integration of newly introduced Western anatomical learning into existing Chinese discourses (p. 197). Wu’s account of the introduction of Jennerian vaccination for smallpox, focusing on prescient early promoters (p. 196), is usefully complemented by Bridie J. Andrews’ emphasis on how Chinese skepticism was reinforced by Europeans’ importation of inert and contaminated vaccine batches (pp. 212–213). 2.4. Modern states and ‘‘traditional’’ medicine In accounts of modern developments, a ‘‘medicine in China’’ framework can find the country’s tumultuous political history seizing attention at the expense of other considerations. In her chapter on the Republic of China (1912–1949), Andrews foregrounds proposals to marginalize or abolish Chinese medicine advanced by the small but influential biomedical profession and government officials favoring radical modernization (pp. 225–226). No concerted attempt was made to realize them as the scale of such a transformation exceeded the weak and unstable Republican state’s capacities. Political support for the proposals was also far from universal, with scholars, physicians, pharmacists, and consumers of Chinese medicine representing a large constituency who strengthened their cause by appeals to nationalism (loc. cit.). Even so, she notes, the sense of crisis aroused by the abolition campaign produced dramatic and lasting changes in Chinese medicine; nationwide professional organizations and dedicated educational institutions on a modern structure were established for the first time (pp. 230–231). On the theoretical side, charges that the diversity within Chinese medical traditions harbored theoretical incoherence and contradiction prompted efforts at scholarly synthesis and standardization (pp. 222–224). One focus of Andrews’ account is the rebirth of acupuncture; she emphasizes that only under the Republic did it become the standardized, largely bloodless procedures now taught as

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‘‘traditional’’ (pp. 234–238). In her account, however, the transition is bewilderingly sudden: a society from which ‘‘acupuncture and moxibustion had virtually disappeared’’ seems to become over the course of the 1930s one where new forms of both were widely accepted by elite physicians. Andrews gives little sense of how so many minds—many conservative—were changed, mainly crediting a handful of promoters. Greater attention to the well-known importance of Japan as a model for Chinese modernizers might have helped readers make sense of the pace and direction of change in China Republican period; the role of exchanges with Japan in the modernization of ‘‘Chinese medicine’’ in the early 20th century was considerable (Mayanagi, 2006; Miyakawa, 2001), yet scarcely figures in Andrews’ account of the period. She provides scattered hints of these connections, mentioning the influence of  shin on the scientization Japanese medical theorist Yumoto Kyu of Chinese medicine (p. 231) and the study of modernized acupuncture in Japan by Cheng Dan’an, the chief reformer of Chinese acupuncture (p. 234). However, these transnational considerations remain peripheral to her account. Integration with biomedicine and modern scientific methods constituted a fourth and most recent shift in Chinese medicine, one which began from the nineteenth century but achieved sweeping transformation only with concerted state intervention under the People’s Republic of China (1949–present). In his chapter on this period, Volker Scheid notes that ‘‘the most noteworthy feature . . . is not the ongoing encounter with the West but rather the fact that, for the first time since the Song, the state now assumed direct and deliberate responsibility for regulating the field of medicine’’ (p. 242). Scheid finds that an early political impulse sought the removal of Chinese medicine as outmoded and ideologically reactionary (pp. 246–249). A subsequent policy shift is widely credited for giving new life to the discipline, however (Sivin, 1987; Taylor, 2005, pp. 18–19). In the mid-1950s, the biomedical profession came to be viewed as a potential rival to the authority of Mao and other Party leaders. Moreover, securing biomedical pharmaceuticals, personnel, and equipment would strain the resources of a new state emerging from civil war and committed to other initiatives. Consequently, Chinese medicine was granted its own institutional and discursive space with the creation of dedicated Chinese medical colleges and research institutes, and its practitioners integrated into the nation’s hospitals (pp. 251–255). Through the politically and socially turbulent decades until the liberalizing reforms beginning in the late 1970s, long-term trends were toward the simplification and standardization of Chinese medicine and the integration of biomedical concepts and technologies into diagnosis, treatment, and pedagogy (pp. 258–262). Although the minimally trained ‘‘barefoot doctors’’ dispatched to rural areas in the 1960–70s were celebrated for employing acupuncture as a costeffective remedy, Scheid points out that their frequent use of biomedicine in areas where its penetration had hitherto been limited had a greater impact on popular attitudes toward medicine (p. 262), an argument confirmed by new studies (Fang, 2012). Standardization, the imposition of biomedical frameworks, and a proportional reduction in institutions in comparison to biomedicine have continued to be prevailing trends since 1989 by Scheid’s account. On a smaller scale, he also identifies seemingly contrary currents: drives to generate ‘‘native’’ forms distinct from biomedicine, interest in medical lineages and regional traditions, and a recent state initiative to expand institutions of Chinese medicine (pp. 269–280). As he refrains from directly comparing the strength of present trends, however, readers here can only speculate as to the relative significance of his conflicting observations (for a fuller account see Scheid, 2012). While this volume provides a detailed account of the persistence—and transformations—of ‘‘traditional’’ medicine in China

since 1949, the restriction of the historical chapters to Chinese territory produces a narrative dominated by state ideology. Some discussion of how the modern health systems of other East Asian countries have incorporated native elements would add balance to the account. Two cases offer productive comparisons: one is the modernization of ‘‘Chinese medicine’’ (Kanpo¯) in Japan (mentioned above), while another is the well-studied construction of modern ‘‘Korean Medicine’’ (Hanbang) also utilizing Yin–Yang, Five Phases, and related concepts (Byun, 2012; Kim, 2007; Son, 1998). All stem from a common theoretical framework, and the reification of national categories removes the opportunity to examine contexts where the drama of Chinese political history does not overshadow other factors; this broader perspective would provide a more multifaceted understanding of how modern medicine in China cannot be reduced to a tug of war between Westernization and autocracy. 3. Visual evidence: Strengths and limitations Subtitled An Illustrated History, this volume demonstrates the varied effectiveness with which images can be employed. A notable success is Hinrichs’s use of Song dynasty paintings to show the penetration of state medical initiatives into society, from pharmacies advertising government formulae to physicians consulting a state-printed formulary. In later chapters, interior photographs of modern pharmacies convey the selection of pharmaceuticals and their manner of presentation. Pedagogical diagrams offer multiple views of the body: crossed by energy meridians, dotted with acupuncture loci, or enclosing bones susceptible to fracture. Images of medical treatment in painting, drawing, and sculpture—childbirth and village moxibustion in the Song, scholarly advising of an elite sufferer of food poisoning in the Yuan, and the home care of women in the Ming—reveal changing expectations for the context of treatment and doctor–patient relationships. Surprisingly, modernized ‘‘Traditional Chinese Medicine’’ is conveyed mainly through textual description, with images of treatment in modern settings richest for religious and ritual healing. The twentieth century is illustrated perhaps disproportionately by images produced for public relations purposes, from group portraits at newly built clinics to advertisements, political posters, and an unrepresentative portrayal of ‘‘barefoot doctor’’ acupuncture. While overall this volume achieves comprehensiveness, Daoist alchemy is never addressed with a thoroughness commensurate with its importance to Chinese medical history. Daoist ‘‘outer alchemy’’ (pharmaceuticals) and ‘‘inner alchemy’’ (self-cultivation practices) exhibit considerable theoretical and methodological overlap with scholarly medicine. Outer alchemy receives no systematic explanation in this volume despite considerable research on the topic (Ho, 2007; Needham, 1983; Pregadio, 2006). Despite several brief mentions, the book’s only detailed account of inner alchemy concerns a twentieth-century text (pp. 167–70); readers may be justifiably curious as to its precedents (for which see Kohn & Wang, 2009; Robinet, 1995). The neglect of Daoist alchemy is particularly puzzling since the coexistence, overlap, and interchange between ‘‘scholarly’’ and ‘‘religious’’ healing—particularly Daoism—are themes emphasized throughout the volume. 4. The case of warm diseases In keeping with the recent ‘‘Spatial Turn’’ in historiography, territorial expansion in the late imperial period is now regarded as a key transformation in Chinese history (Hostetler, 2001). One area of impact was medicine, as Chinese colonization and settlement to the south drew attention to the multiplicity of unfamiliar diseases encountered there by newcomers (Bello, 2005; Giersch,

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2006; Teng, 2004). In the north, ethnic Manchus who took control of China as a ruling minority in the seventeenth century were ravaged by smallpox when they moved from their northeastern homeland into densely populated regions. The emergence of new epidemics and other illness patterns in association with population movements spurred new understandings of relationships between geography and illness. The period from the thirteenth through nineteenth centuries saw a new—if never dominant—current in medical theory emphasizing spatial, rather than temporal, factors (Leung, 2003, p. 379). Another geographic trend playing a role in late imperial thought was the movement of the intellectual and cultural center southward to the Lower Yangtze region, where scholars regarded more critically the universalistic claims of older, North-centered medical theory. This trend is reflected in Marta Hanson’s Speaking of Epidemics. At one level, Hanson’s study illuminates the history of concepts within ‘‘Chinese medicine.’’ One is the concept of ‘‘Warm diseases,’’ which Hanson traces from a minor element in early Han canonical texts to later reinterpretations as a major nosological category; its employment to explain the SARS epidemic of 2003 demonstrates its contemporary role in understandings of epidemics (pp. 162– 168). Related is ‘‘Warm diseases’’ as a medical discipline, one of four disciplines within modern ‘‘Traditional Chinese Medicine’’ and the only one whose foundational texts date not from the third century or earlier, but rather from the seventeenth century onward (pp. 15–16). Prominent in Hanson’s account are doctrinal and therapeutic innovations by physicians in successive eras responding to the perceived ineffectiveness of received treatments against present epidemics; their observations drove scholars to offer new understandings of disease and innovations in treatment. This study’s emphasis on theoretical change on the basis of observation contrasts with the political and social focus of Chinese Medicine and Healing to provide a more balanced understanding of Chinese medical history. 4.1. Epidemics north and south Hanson describes how the Cold Damage theory promoted by the Northern Song state contained a subcategory of ‘‘Warmth factor disorders,’’ produced when pathogenic Cold qi underwent a latent period in the body and manifested as illness during the spring (p. 36). When physicians under the Jin and Yuan states formulated alternatives to this standardized approach, some argued for greater attention to geographic variation in illnesses, materia medica, and in some cases human constitutions (pp. 39–42). Their writings were succeeded by further competitors to the Cold Damage framework. Some skeptics argued that its focus on universalized seasonal etiology ignored the importance of geographic variation, particularly that between the cool, arid climate of the northwestern heartland of early China and the wetter, warmer southeastern areas that contained an increasing proportion of the population and physicians. This concern drew on observations of events in the far southern region of Lingnan—modern Guangdong and Guangxi provinces—in which both febrile disorders attributed to ‘‘miasmas’’ and sores recognized as contagious posed threats not observed farther north (pp. 85–89). Hanson’s account of these developments is echoed in Leung’s chapter in Chinese Medicine and Healing, which also highlights the role played by new skin disorders associated with the south—in Western nosology, syphilis and leprosy—in focusing physicians’ attention on infection in this period (pp. 155–156). A key turning point occurred during the 17th century, when the physician Wu Youxing argued in 1642 that febrile epidemics such as the one that had swept northern and central China the previous year—in which he observed the ineffectiveness of Cold Damage treatments—were not convincingly explained as seasonally varying

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manifestations of Cold qi. He suggested instead that variation in illnesses was often spatially conditioned, with geographic localities differentiated by the pathogenic ‘‘heterogeneous qi’’ each produced (pp. 90–99). Contagion was recognized by several scholars, yet no distinct division emerged between contagionism and consideration of environmental factors and individual constitutions (pp. 118–121). In the nineteenth century the theories articulated by Wu and others were combined into a discrete ‘‘current’’ of learning in Chinese medicine (pp. 126–131), whose southern practitioners used it to assert intellectual independence from—and superiority to—the weakening Beijing government (pp. 143–146). The Warm diseases emphasis on geographic distinctions between populations and illness patterns proved convincing to some nineteenth-century Western physicians, and served as a basis for the preservation of ‘‘Chinese medicine’’ against ‘‘Western’’ biomedicine through the twentieth century (pp. 152–154). The current was incorporated into modern ‘‘Traditional Chinese Medicine,’’ with its southern regionalist aspects suppressed for much of the century but partially revived in the 1980s (160–162). Contemporary Warm diseases medicine retains the current’s composite etiology of environment, individual, and contagion, the latter now represented by pathogenic microbiology. 5. Conclusions: Reconsidering knowledge and power As Nathan Sivin has convincingly argued, Chinese medical treatments emerge from a complex theoretical framework, without which they cannot be adequately understood (Sivin, 1987, pp. 11–12). Government intervention and social trends have demonstrably affected Chinese medicine, and due attention to these factors is necessary to address representations of the latter as a ‘‘tradition’’ or ‘‘wisdom’’ unaffected by worldly events. In Chinese Medicine and Healing, however, consistent attention to external factors may risk confirming other problematic views of China before the twentieth century held by readers today: a land of fossilized mandarins, absolute despots, and unquestioned superstition together rendering histories of medicine impossible. Here Hanson’s monograph serves as a valuable corrective by illustrating limits to the role of the imperial state: she details considerable innovation and change effected by scholar-physicians, writing in an unofficial capacity, who advanced alternatives to the ‘‘orthodox’’ Cold Damage theory without state interference. Taken together, the multiple perspectives these recent books provide on the contours of Chinese medicine in historical context reveal opportunities both for fruitful comparison to present findings and directions for productive future development of both content and methodology. References Allsen, T. T. (2004). Culture and conquest in mongol eurasia. Cambridge University Press. Bello, D. A. (2005). To go where no Han could go for long: malaria and the Qing construction of ethnic administrative space in frontier Yunnan. Modern China, 31(3), 283–317. Brokaw, C. J., & Chow, K. (Eds.). (2005). Printing and book culture in late imperial China. Berkeley: University of California Press. Byun, C.-W. (2012). The long, hard road to Korean medicine. Seoul: Bookland. Cullen, C. (2001). Yi’an (case statements): The origins of a genre of Chinese medical literature. In E. Hsu (Ed.), (pp. 297–323). Cambridge, UK: Cambridge University Press. Despeux, C. (2001). The system of the five circulatory phases and the six seasonal influences (wuyun liuqi), a source of innovation in medicine under the Song (960–1279). In E. Hsu (Ed.), Innovation in Chinese medicine (pp. 121–166). Cambridge, UK: Cambridge University Press. Elman, B. A. (2005). On their own terms: Science in China, 1550–1900. Cambridge, Mass.: Harvard University Press. Eskildsen, S. (2004). The teachings and practices of the early Quanzhen Taoist masters. Albany: State University of New York. Fang, X. (2012). Barefoot doctors and Western medicine in China. Rochester, NY: University of Rochester Press.

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Faucher, L., Nazer, D., Ruby, A., Nichols, S., Weinberg, J., Stich, S., et al. (2002). The baby in the lab-coat: Why child development is not an adequate model for understanding the development of science. In The cognitive basis of science. Cambridge University Press. Furth, C. (2006). The physician as philosopher of the way: Zhu Zhenheng (1282– 1358). Harvard Journal of Asiatic Studies, 66(2), 423–459. Furth, C., Zeitlin, J. T., & Hsiung, P. (Eds.). (2007). Thinking with cases: specialist knowledge in Chinese cultural history. University of Hawaii Press. Giersch, C. P. (2006). Asian borderlands: The transformation of Qing China’s Yunnan frontier. Cambridge, Mass.: Harvard University Press. Goldschmidt, A. (2009). The evolution of Chinese medicine: Song Dynasty, 960–1127. London: Routledge. Ho, P. Y. (2007). Explorations in Daoism: Medicine and alchemy in literature. London: Routledge. Hostetler, L. (2001). Qing colonial enterprise: Ethnography and cartography in early modern China. Chicago: University of Chicago Press. Hsu, E. (1999). The transmission of Chinese medicine. Cambridge, UK: Cambridge University Press. Hymes, R. P. (1987). Not quite gentlemen? Doctors in Sung and Yuan. Chinese Science, 8, 9–76. Hymes, R. P., & Schirokauer, C. (Eds.). (1993). Ordering the world: Approaches to state and society in Sung Dynasty China. Berkeley: University of California Press. Johnson, D. G. (1977). The medieval Chinese oligarchy. Boulder, Colo.: Westview Press. Kaptchuk, T. J. (2000). The web that has no weaver: Understanding Chinese medicine. New York: McGraw-Hill. Kim, J. (2007). Alternative medicine’s encounter with laboratory science: The scientific construction of Korean medicine in a global age. Social Studies of Science, 37(6), 855–880. Kohn, L., & Wang, R. (Eds.). (2009). Internal alchemy: Self, society, and the quest for immortality. Magdalena, N.M.: Three Pines Press. Leung, A. K. (2003). Medical learning from the Song to the Ming. In P. J. Smith & R. Von Glahn (Eds.), The Song–Yuan–Ming transition in Chinese history (pp. 374–398). Cambridge, Mass.: Harvard University Asia Center. Leung, A. K. (2009). Leprosy in China: A history. New York: Columbia University Press. Li, L., & Li, Z. (2008). Dongyi baojian de xingcheng yu xueshu tezheng de tantao. Zhongguo ziran yixue zazhi, 2008(1), 9–12. Li, S. (1596). Bencao gangmu 1998, Beijing: Huaxia chubanshe.  i shinkyu  gaku no keisei ni ataeta Nihon no ko¯ken. Mayanagi, M. (2006). Gendai Chu  gakkai zasshi, 56(4), 605–615. Zen nihon shinkyu McDermott, J. P. (2006). A social history of the Chinese book: Books and literati culture in late imperial China. Hong Kong: Hong Kong University Press.

 wo yunyu  shita Chu  goku Minkoku jidai Miyakawa, T. (2001). Nihon no sinkyu  igakuka: Sho¯ Tan’an no gyo¯seki ni tsuite. Nihon ishigaku zasshi, 47(3), shinkyu 538–539. Nappi, C. S. (2009). The monkey and the inkpot: Natural history and its transformations in early modern China. Cambridge, Mass.: Harvard University Press. Needham, J., & Lu, G.-d. (1983). Science and civilisation in China (Vol. 5). Part 5: Spagyrical discovery and invention: Physiological alchemy. Cambridge University Press.  : Kyo Shun sencho To¯i ho¯gan to Nihon Nukii, M. (2007). Higashi Ajia no bunka ko¯ryu no juyo¯. Nagoya gaikokugo daigaku gaikokugo gakubu kiyo¯, 33, 75–95. Porter, R. (1997). The greatest benefit to mankind: A medical history of humanity. New York: W. W. Norton. Pregadio, F. (2006). Great clarity: Daoism and alchemy in early medieval China. Stanford, Calif.: Stanford University Press. Robinet, I. (1995). Introduction à l’alchimie intérieure taoïste: de l’unité et de la multiplicité. Paris: Editions du Cerf. Schafer, E. H. (1963). The golden peaches of Samarkand: A study of T‘ang exotics. Berkeley: University of California Press. Scheid, V. (2012). Integrating east Asian medicine into contemporary healthcare. Edinburgh: Churchill Livingstone Elsevier. Sivin, N. (1987). Traditional medicine in contemporary China: A partial translation of revised outline of Chinese medicine (1972): With an introductory study on change in present day and early medicine (Vol. 2). Ann Arbor: Center for Chinese Studies, University of Michigan. Sivin, N. (1998). The history of Chinese medicine: Now and anon. Positions, 6(3), 731–761. Son, A. H. K. (1998). Modernisation of the system of traditional Korean medicine (1876–1990). Health Policy, 44(3), 261–281. Taylor, K. (2005). Chinese medicine in early communist China, 1945–1963: A medicine of revolution. London: RoutledgeCurzon. Teng, E. (2004). Taiwan’s imagined geography: Chinese colonial travel writing and pictures 1683–1895. Cambridge, Mass.: Harvard University Asia Center : Distributed by Harvard University Press. Unschuld, P. U. (1985). Medicine in China: A history of ideas. Berkeley: University of California Press. Unschuld, P. U. (1986). Medicine in China: A history of pharmaceutics. Berkeley: University of California Press. Yao, J. (2011). Dongyi baojian yinzheng Jinkui yaolüe neirong kao. Shanghai zhongyiyao daxue xuebao, 2011(2), 23–24.  gakkai, Yoshida, K. (2010). Kyo Shun to To¯i ho¯gan ni tsuite. Nihon dento¯ shinkyu 37(1), 1–11. Zürcher, E. (2007). The Buddhist conquest of China: The spread and adaptation of Buddhism in early medieval China. Leiden: Brill (3rd/with a foreword by Stephen F. Teiser).

Please cite this article in press as: Sloane, J. D. The state, the nation, and their limits: Recent publications on the history of Chinese medicine. Studies in History and Philosophy of Biological and Biomedical Sciences (2014), http://dx.doi.org/10.1016/j.shpsc.2014.01.001