Studies of the Weatherhead East Asian Institute

Medicine in the Struggle over China's Modernity

Sean Hsiang-lin Lei

• Publisher: University of Chicago Press
• Year: 2014
• ISBN:
  9780226169910
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Neither Donkey nor Horse tells the story of how Chinese medicine was transformed from the antithesis of modernity in the early twentieth century into a potent symbol of and vehicle for China's exploration of its own modernity half a century later. Instead of viewing this transition as derivative of the political history of modern China, Sean Hsiang-lin Lei argues that China's medical history had a life of its own, one that at times directly influenced the ideological struggle over the meaning of China's modernity and the Chinese state.
           
Far from being a remnant of China's premodern past, Chinese medicine in the twentieth century coevolved with Western medicine and the Nationalist state, undergoing a profound transformation—institutionally, epistemologically, and materially—that resulted in the creation of a modern Chinese medicine. This new medicine was derided as "neither donkey nor horse" because it necessarily betrayed both of the parental traditions and therefore was doomed to fail. Yet this hybrid medicine survived, through self-innovation and negotiation, thus challenging the conception of modernity that rejected the possibility of productive crossbreeding between the modern and the traditional.
           
By exploring the production of modern Chinese medicine and China's modernity in tandem, Lei offers both a political history of medicine and a medical history of the Chinese state.

1

Introduction

During the last months of his life, Sun Yat-sen (1866–1925), the founding father of the Republic of China and a practitioner of Western medicine, was forced to take a personal stand on the issue of traditional Chinese medicine. Faced with the possibility of losing his life to liver cancer, his deliberation on and ultimate acceptance of treatment with Chinese medicine became a highly symbolic event, followed with great interest by countless observers from early January to his death on March 12, 1925. If Sun had refused to accept Chinese medicine even in this most vulnerable and hopeless situation, his decision would have been interpreted as a testimony to his steadfast belief in modernity, which he personified. According to the account provided by Lu Xun (1881–1936), one of the fathers of modern Chinese literature and once a student of biomedicine himself, the dying Sun in the end reasoned this way: “While some Chinese drugs might be effective, knowledge of a [biomedical] diagnosis is lacking [in Chinese medicine]. How can one take drugs without a trust-worthy diagnosis? There is no need to take them.”¹ After hearing that Sun had consistently refused to take Chinese medicine (which turned out not to be true in the end),² Lu could not contain his feelings and stated that Sun’s decision “moved me so much that it is no less [important] than his life-long commitment to revolution.”³ As revealed by Lu’s comment, to many of Sun’s comrades and progressive intellectuals of the times, the very act of taking Chinese drugs amounted to a public betrayal of the notion of modernity.

An equally symbolic event, albeit with totally different meanings, took place at the same Hospital of Peking Union Medical College nearly half a century later. In 1971, the New York Times journalist James Reston (1909–95), who had traveled to China as part of an advance team before President Nixon’s historic visit, underwent an emergency appendectomy there. As ordered by Premier Zhou Enlai (1898–1976), a team of leading medical specialists cooperated in the management of his case. The surgery went well, but Reston suffered serious postsurgical pain. After that pain was alleviated with acupuncture, he published a report in the Times on both his personal experience and his observations of the effectiveness of acupuncture on other patients. For many Westerners, this was the first time they had heard about acupuncture. Reston’s groundbreaking report was later credited for “help[ing to] open the doors in this country [United States] to an exploration of alternative medicine.”⁴ Reston was keenly aware of the historical irony of the event he had helped to create. The hospital where he had received surgery had been established by the Rockefeller Foundation in 1916 to serve as an elite model to instill “the scientific spirit” in Chinese minds,⁵ but Reston’s report noted that “like everything else in China these days, it is on its way toward some different combination of the very old and very new.”⁶ While Chinese medicine had been seen as the antithesis of modernity at Sun’s deathbed, fifty years later, in the same hospital, it had become a message to the world that China had developed a very different kind of medicine and, by implication, a very different kind of modernity.

Progressive intellectuals in the early twentieth century would undoubtedly have found it appalling that the view of Chinese medicine had been transformed in these fifty years from a burdensome tradition into an inspiration for the acceptance of alternative medicine around the world. They would have been even more puzzled had they known that during the same period China had dramatically increased access to modern health-care services for its citizens. By the time that Reston published his report, China had developed a primary health-care system that, in “achieving 90% coverage of a vast population, was the envy of the world,” according to Dr. Margaret Chan, director-general of the World Health Organization.⁷ Thus it was precisely in the process of the global expansion of modern (i.e., “Western”) medicine into China that traditional Chinese medicine went through its historic transformation. Against the background of this surprising and puzzling history, I attempt in this book to answer an apparently simple question: 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?

When Chinese Medicine Encountered the State

It is a great irony that the turning point in the modern history of Chinese medicine was an event that was meant to put an end to it. In 1928, amid civil war, social unrest, and foreign occupation, the Nationalist Party (guomindang, also known as KMT) finally ended the political chaos of the Warlord period (1916–28) and formed a new government for China. Even though the Nationalist Party controlled only certain regions of the country, the regime nevertheless dedicated itself to the project of state building, establishing the Ministry of Health in the new capital of Nanjing. With the exception of the Song dynasty (960–1279),⁸ this was the first time that China had a national administrative center to take charge of all issues related to health care. In the next year, the first National Conference on Public Health, which was dominated by practitioners of Western medicine, unanimously passed a proposal to abolish the practice of Chinese medicine. To the great surprise of almost everyone concerned, this resolution mobilized the previously unorganized practitioners of Chinese medicine into a massive National Medicine Movement (guoyi yundong), formally instigating a decade-long collective struggle between the two factions of medical practitioners.

Half a century later, the widely respected pioneer of public health in China, Chen Zhiqian (also known as C. C. Chen, 1903–2000), reflected on this historical confrontation as follows:

In the 1920s, modern physicians, including Chinese nationals, inadvertently delayed the diffusion of scientific medicine, probably by many decades, through their demands for the abolition of traditional medicine. Fear generated by their actions caused a powerful coterie of traditional scholar-physicians in the cities to organize for collective action and to seek the intervention of high officials on their behalf. Respected by officials and the public alike, the scholar-physicians were able not only to defend what they already had but even to expand their influence. More than fifty years later, the two systems of medicine stood on equal footing in China, each with its own schools, treatment facilities, and highly placed friends in the bureaucracy.⁹

In short, from the viewpoint of biomedical practitioners such as C. C. Chen, an unforgivable miscalculation was made in proposing to abolish Chinese medicine in the spring of 1929. This miscalculation not only delayed the “diffusion” of Western medicine by decades, but it also gave birth to what we now know as a bifurcated medical field in China.

Presupposing the global diffusion of scientific medicine, Chen assumed that what he had witnessed in the 1920s was just a “delay,” a local suspension of the necessary triumph of biomedicine and of the unavoidable extinction of an indigenous medical tradition. Although Chen made the comment on this event quoted above in the late 1980s, like so many others among China’s modernizers, he still regarded the ultimate replacement of local medical traditions by scientific biomedicine as merely a matter of time. Nevertheless, the practice of traditional Chinese medicine is today legalized by the governments on both sides of the Taiwan Strait and has gradually spread into virtually all other parts of the world.¹⁰ The World Health Organization considers Chinese medicine a seminal field in the area of alternative and complementary medicine, and it is increasingly accepted into mainstream health-care services in nations around the world.¹¹ Instead of treating this history as simply an unfortunate delay or transition stage in the inevitable progression toward scientific medicine, I intend to examine the modern history of Chinese medicine as an essential part of the Chinese exploration of modernity. For this purpose, the following pages explore the events through which traditional Chinese medicine crossed the threshold to modernity—politically, institutionally, and epistemologically. As I explain below, this was also the point in time (as noted in the heading for this section) when Chinese medicine encountered the state.

First of all, my subject matter is traditionally considered to have been shaped by a cultural confrontation between two knowledge systems: scientific Western medicine and premodern Chinese medicine. This confrontation is generally taken as an unavoidable local event in the global spread of modern science and technology around the world. Nevertheless, by the 1920s practitioners of the two styles of medicine had already coexisted for decades in China without directly competing against each other. I argue, therefore, that the struggle between these two medical factions would never have taken place, or at least would have taken a very different form, if the state had not intervened to abolish the practice of Chinese medicine in the late 1920s. In this sense, the historic confrontation did not take place directly between the two styles of medicine but between Chinese medicine and the modernizing Chinese state.

Second, the two historic events that took place in 1929—the declaration of the government’s intention to abolish Chinese medicine and the rise of the National Medicine Movement—fundamentally transformed the logic of competition between Chinese and Western medicine in China. Instead of competing for individual patients, as they might have done before these events, practitioners of the two styles of medicine now occupied themselves with competing for alliance with the state. More importantly, these historic events provoked traditional practitioners to pursue actively and collectively the series of professional interests, institutional infrastructure, and governmental recognition that the state had just started to grant to Western medicine. In order to pursue the interests created and offered by the state, practitioners and advocates of Chinese medicine dedicated themselves to reforming Chinese medicine, thereby adapting it to the modernizing agenda of the state. To highlight their new vision, practitioners of Chinese medicine decided to call their style of medicine “national medicine” (guoyi). This name illustrates how the proponents of Chinese medicine, when forced to cope with the threat from the state, responded by striving to link the future of their profession closely to that of the state.

Third, I demonstrate that the 1929 confrontation also constituted an epistemological event for the remaking of traditional Chinese medicine. In addition to coping with the political challenges posed by the arrival of biomedical knowledge, Chinese medicine was confronted with epistemic violence when its leaders started to embrace what I characterize as discourses of modernity and committed themselves to reforming Chinese medicine on the basis of these discourses. Because these globally circulated discourses were designed to demarcate a divide between the modern and the premodern, reform-minded traditional practitioners encountered critical challenges in their efforts to reform Chinese medicine on the basis of these new conditions of knowledge. As their endeavors radically transformed the theories, practices, pedagogy, and social network of Chinese medicine, they paved the way for the full-scale creation of the standardized, textbook-based system of Traditional Chinese Medicine (TCM) that emerged in Communist China in the mid-1950s.¹² In this sense, the creation of modern Chinese medicine began at the moment when Chinese medicine of the 1920s encountered the state.

Beyond the Dual History of Tradition and Modernity

With a few notable exceptions, the majority of scholarly works on the history of medicine during the Republican period (1911–49) can be sharply divided into two largely independent categories:¹³ histories of biomedicine in China and histories of traditional Chinese medicine.¹⁴ Although no scholar has ever stated this explicitly, and most scholars might not be fully conscious of this fact, the rigorous divide between these two types of histories implies that Chinese medicine was of little relevance to the development of modern health care in China. It is certainly true that historians have been keen to document how modern institutions, values, and knowledge influenced the trajectory of Chinese medicine on many fronts. Much less, however, is known about how the advocates and practitioners of traditional medicine influenced either the introduction of Western medicine into China or the construction of public health and medical administration. Clearly, the historiography of medicine has reproduced a binary opposition between tradition and modernity, thereby preventing us from viewing Chinese medicine as a constitutive part of China’s medical modernity.

This division of intellectual labor is a great pity, because what has made Chinese medicine unique is precisely its contested and ambiguous relationship with China’s modernity. As Benjamin Elman concludes in his monumental study on science in China, among all the scientific fields of study in Imperial China, Chinese medicine was the only traditional discipline that “survive[d] the impact of modern science between 1850 and 1920.”¹⁵ The word survive serves as a reminder that the arrival of modern science and biomedicine in China, as in almost every other part of the non-Western world, often meant the mass marginalization—if not extinction—of traditional knowledge. No matter how hard historians of modern science have striven to go beyond the linear, teleological framework of the Enlightenment, they almost inevitably end up with the familiar story that traditional practices were pushed to the periphery, if not replaced completely by modern science. Against the unfortunate fate of either extinction or marginalization that has been common to almost all traditional practices around the globe, Chinese medicine stands out as a unique case that not only survived the attack of science and modernity but also flourished and became accepted into state-sanctioned public knowledge.¹⁶

Unfortunately, many people continue to view Chinese medicine as a “survivor” or remnant of premodern China. Although scholars like Elman have been careful to emphasize that the entity that survived the attack of science is “a modernized version of Chinese medicine,”¹⁷ people often assume without much reflection that Chinese medicine has survived as an anachronism in the fragmentary enclaves of a modernized China. If we view the modern history of Chinese medicine merely as a history of the endeavor to preserve and even “modernize” Chinese medicine—done only for the sake of Chinese medicine itself and relevant only in such enclaves—this history would not have much to do with the development of modern mainstream health care in China. Conversely, if the contested history of Chinese medicine is purged from the history of medicine proper, the resultant “history of modern medicine in China” looks conveniently close to what medical historian Warwick Anderson has criticized as “local variations of a master narrative called ‘the development of modern medicine.’”¹⁸ As Anderson points out, such a historiography of medicine merely reflects and reinscribes the general idea that the modern history of China, just like that of many other non-Western nations, “tends to become variations on a master narrative that could be called ‘the history of Europe.’”¹⁹ That is, it suggests that every major aspect of modernity developed first in Europe and then everywhere else.

If we recognize that the modern history of Chinese medicine is an integral part of China’s history of modern health care, this history will have the potential to challenge the above-mentioned Eurocentrism and historicism that Dipesh Chakrabarty criticizes in his influential book Provincializing Europe: Postcolonial Thought and Historical Difference. Although I emphasize this critical potential of the history of Chinese medicine, I certainly do not mean to romanticize the “surviving tradition” of Chinese medicine as a radical alternative to biomedicine. The romanticization of Chinese medicine presupposes, and thereby reinforces, a clear-cut separation between the modern history of traditional Chinese medicine and that of biomedicine in China—the former being what survives of a traditional discipline and the latter being an importation to China from modern Europe. I argue that neither of these two characterizations is historically true. As scholars, we must therefore go beyond the conventional framework that treats this complex and interwoven history as two separate historical processes: the survival of traditional medicine on the one han...

Table of contents

• Cover
• Copyright
• Title Page
• Series Page
• Dedication
• Contents
• 1. Introduction
• 2. Sovereignty and the Microscope: The Containment of the Manchurian Plague, 1910–11
• 3. Connecting Medicine with the State: From Missionary Medicine to Public Health, 1860–1928
• 4. Imagining the Relationship between Chinese Medicine and Western Medicine, 1890–1928
• 5. The Chinese Medical Revolution and the National Medicine Movement
• 6. Visualizing Health Care in 1930s Shanghai
• 7. Science as a Verb: Scientizing Chinese Medicine and the Rise of Mongrel Medicine
• 8. The Germ Theory and the Prehistory of “Pattern Differentiation and Treatment Determination”
• 9. Research Design as Political Strategy: The Birth of the New Antimalaria Drug Changshan
• 10. State Medicine for Rural China, 1929–49
• 11. Conclusion: Thinking with Modern Chinese Medicine
• Acknowledgments
• Notes
• Index
• Series List