Neither Donkey nor Horse: Medicine in the Struggle over China's Modernity (Studies of the Weatherhead East Asian Institute) Reprint Edition
by Sean Hsiang-lin Lei (Author)
4.8 out of 5 stars 7 ratings
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.
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비려비마
중국의 근대성과 의학 소득공제
레이샹린 (지은이), 박승만, 김찬현, 오윤근 (옮긴이) 읻다 2021-02-05
정가 20,000원
원제 Neither Donkey nor Horse - Medicine in the Struggle over China's Modernity (2014년)
364쪽152*225mm529g
책소개
읻다의 '척도와 구성' 시리즈 첫 번째 책. 중국의학사를 연구한 레이샹린의 저작인 이 책은 20세기 초반 중국의학의 역사를 살핌으로써 중국의학 고유의 근대성, 더 나아가 중국 고유의 근대성이 형성되는 과정을 탐구한다.
근대화의 흐름 속에서 세계의 전통 의료 대부분이 소멸되거나 주변으로 밀려난 것과 달리, 중국의학은 독특하게도 과학과 근대성의 공격을 견뎌내고 국가의 공인을 받은 지식이 되었다. 중국의 모든 과학 분야를 통틀어 "1850년에서 1920년까지 가해진 근대 과학의 충격에서 살아남은"(벤저민 엘먼) 전통 학문은 중국의학이 유일하다.
이제 중국의학은 세계보건기구에 의해 보완대체의학의 중요한 흐름으로 인정받고 있을 뿐 아니라, 각국의 의료 서비스에도 편입되고 있다. 저자인 레이샹린은 중국의학의 근대사가 중국이 근대성을 탐색해나가는 과정의 핵심에 있다고 주장한다. 그러나 지금까지의 의학사 서술은 전통적인 것과 근대적인 것을 대립시킴으로써 중국의학을 중국의 의학적 근대성으로부터 배제해왔다.
여러 역사학자는 근대적 제도와 가치, 지식이 중국의학의 궤적에 미친 영향을 다각도로 분석했지만, 중국의학이 서양의학의 도입, 공중보건과 의료 행정의 구성 과정에 미친 영향에 대해서는 별다른 연구를 진행하지 않았다. 그러나 레이샹린의 주장에 따르면 중국의학의 독특함은 바로 중국의 근대성과 얽힌 치열하고도 모호한 관계에서 비롯한다.
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목차
1장 서론
1. 1. 중국의학과 근대국가의 조우
1. 2. 전통과 근대의 이분법을 넘어
1. 3. 공진화적 역사를 향하여
1. 4. 중국의 근대성
1. 5. 근대성 담론
1. 6. 비려비마
1. 7. 용어들
2장 주권과 현미경: 1910~1911년 만주 페스트 방역
2. 1. “페스트는 전염될 수 있습니다”, “아니오, 믿지 못하겠소”
2. 2. 폐페스트 대 선페스트
2. 3. “4,000년 동안 가장 잔혹했던 경찰”
2. 4. 중국의학의 도전: 홍콩과 만주
2. 5. 추안란: 감염자 간의 연결망과 그 확장
2. 6. 유행병을 피해서
2. 7. 국제감시체계의 일원이 되다
2. 8. 결론: 만주 페스트의 사회적 특성
3장 의료와 국가 연결하기: 1860~1928년 선교의료에서 공중보건으로
3. 1. 선교의료
3. 2. 서양의학의 지위: 청말과 메이지 일본
3. 3. 1세대 서의의 등장
3. 4. 공공사업으로서의 서양의학
3. 5. “공중보건: 대규모 사업을 벌이기에 아직은 때가 이르다”, 1914~1924
3. 6. 위생부와 ‘근대 정부의 의료에 대한 의무’, 1926~1927
3. 7. 결론
4장 중국의학과 서양의학의 관계를 상상하다, 1890~1928
4. 1. 1890년대 말 중국의학과 서양의학의 회통
4. 2. 경맥과 혈관의 불통
4. 3. 위옌과 셋으로 나누어진 중국의학
4. 4. 대결 장소를 피해서
4. 5. 에페드린과 ‘국산 약물의 과학 연구’
4. 6. 중국의학에서 경험 전통을 만들어내기
4. 7. 결론
5장 중국의학 혁명과 국의운동
5. 1. 중국의학 혁명
5. 2. 중의학교의 합법화를 둘러싼 논란
5. 3. 중국의학의 폐지: 1929년의 제안
5. 4. 3월 17일의 시위
5. 5. ‘국의’의 양면적 의미
5. 6. 난징에 파견된 중의 대표단
5. 7. ‘국의’의 상을 그리다
5. 8. 결론
6장 1930년대 상하이 보건의료의 시각화
6. 1. 상하이의 의료 환경에 대한 도해를 읽다
6. 2. 서양의학: 통합과 경계 긋기
6. 3. 중국의학: 분열과 파편화
6. 4. 중국의학의 체계화
6. 5. 결론
7장 동사로서의 과학: 중국의학의 과학화와 잡종의학의 부상
7. 1. 국의관
7. 2. 중국 과학화 운동
7. 3. 중국의학의 과학화를 둘러싼 논쟁: 세 가지 입장
7. 4. 기화를 버리고 과학화를 택하다
7. 5. 과학화를 거부하다
7. 6. 중국의학의 재조립: 침구와 축유
7. 7. ‘잡종의학’의 도전
7. 8. 결론
8장 세균 이론과 ‘변증론치’의 전사
8. 1. 감염병의 존재를 알아보시겠소?
8. 2. 신고 대상 감염병
8. 3. 질병 분류의 통일과 장티푸스의 번역
8. 4. 중국의학에 세균 이론을 녹여 넣기
8. 5. 병증 대 질병
8. 6. ‘변증론치’의 전사
8. 7. 결론
9장 정치 전략으로서의 연구 설계: 항말라리아제 신약 상산의 탄생
9. 1. 상산 연구라는 이례적 사례
9. 2. 국산 약물의 과학 연구
9. 3. 1단계: 문턱을 넘기
9. 4. 추씨 부인의 치험례
9. 5. 2단계: 상산의 새로운 연결망
9. 6. 상산의 정체를 확인하다
9. 7. 두 가지 연구 절차: 1 -2 -3 -4 -5 대 5 -4 -3 -2 -1
9. 8. 역순 연구 절차: 5 -4 -3 -2 -1
9. 9. 정치 전략으로서의 연구 절차
9. 10. 결론: 지식 정치와 가치 체제
10장 국가의료와 중국 향촌, 1929~1949
10. 1. 중국 의료의 문제를 정의하다
10. 2. 중국 향촌을 발견하다
10. 3. 딩현의 공동체 의료 모형
10. 4. 국가의료와 중화의학회
10. 5. 국가의료와 지방자치정부
10. 6. 보건원 제도의 폐지 문제
10. 7. 향촌을 위한 중국의학
11장 결론: 근대 중국의학을 생각하다
11. 1. 의학과 국가
11. 2. 가치의 창조
11. 3. 의학과 중국의 근대성: 국민당과 공산당
11. 4. 중국의학과 과학기술학
감사의 글
주
찾아보기
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책속에서
첫문장
중화민국의 국부이자 '서의西醫'였던 쑨원孫文, 1866~1925은 생의 끝자락에서 중국의학에 대한 자신의 견해를 밝혀야 했다.
P.17
‘중국의학의 생존’과 ‘근대 의학의 발전’이라는 이원화된 역사관을 넘어서기 위해, 나는 중국의학과 서양의학, 그리고 국가 간의 상호작용에 주목했다. 그리고 제대로 조명받지 못했던 상호작용을 드러내기 위해 서로 무관하다고 여겨졌던 세 갈래의 역사, 즉 중국 서양의학의 역사, 중국의학의 역사, 그리고 국가의 정치사를 하나로 통합했다. 나는 새로운 접근법을 통해 세 갈래의 역사를 공정하게 다룰 수 있었을 뿐 아니라 지리적으로 분리되어 있고, 상이한 범주에 속하며, 따라서 실질적으로 동떨어졌으리라 간주되던 여러 역사적 실체 간의 놀라운 동맹 관계를 밝혀낼 수 있었다.
P.23
중국의학은 20세기 전반기를 거치며 불과 수십 년 전만 해도 중국에 존재하지 않았던 여러 가지 새로운 생각과 인공물, 사람, 제도를 마주했다. 앞으로 다룰 몇 가지를 예로 들면 현미경, 증기기관, 《그레이 해부학Gray’s Anatomy》, 세균 이론, 근대적 병원, 사회 조사, 위생부, 록펠러 재단, 전문가주의 등이다. 중의들은 이와 같은 근대 세계의 여러 측면 앞에서 충격을 받거나 위협을 느꼈고, 때로는 매혹되기도 했다. 그러나 이들 가운데 ‘근대성 담론’보다 근대 중국의학의 역사에 큰 영향을 미친 것은 없었다. 유일한 예외가 있다면 근대국가뿐이었다. 근대성 담론은 중국의학과 과학을 화해 불가능한 대립물로 만드는 데 크게 일조했고, 이로써 중국의학을 옹호하거나 개혁하려던 이들에게 힘겨운 과제를 안겨주었다.
P.25
영어에는 이런 표현이 없으므로 비려비마라는 말의 기원과 의미를 먼저 설명하는 편이 유용할 것이다. 이는 2,000년 전의 역사서인 《한서漢書》에서 처음 쓰인 문구이다. 오늘날의 신장 지역에는 구자국龜玆國이라는 나라가 있었는데 이곳의 왕은 한나라의 문화를 너무나 동경한 나머지 신하들에게 한나라풍으로 궁궐을 짓고, 한나라풍으로 옷을 지어 입으며, 한나라풍의 의례와 제도를 도입하라고 명했다. 그러자 구자국의 사람들은 “나귀처럼 보여도 나귀가 아니고, 말처럼 보여도 말이 아니니, 구자국의 왕은 그저 노새일 뿐”이라며 비웃음을 숨기지 않았다. 이처럼 여기에는 왕이 한나라와 구자국 모두의 문화적 전통을 배반했다는 뜻이 담겨 있고, 그런 의미에서 비려비마는 경계를 가로지르는 문화적 통합에 대한 강한 반감을 담아내는 표현으로 자리 잡았다.
P.33~34
거즈 마스크를 둘러싼 갈등은 외국인 의사들이 폐페스트와 선페스트가 구분된다는 생각에 얼마나 거부감을 보였는지를 드러내는 단적인 예이다. 호흡기를 통한 직접 감염으로부터 사람들을 보호하기 위해, 우롄더는 위생국 직원들과 일반 대중 모두에게 자신이 고안한 거즈 마스크를 권했다. 그러나 선페스트에 대한 최신의 지식을 굳건히 신뢰하던 일본, 러시아, 프랑스 출신의 의사들은 우롄더의 분석을 믿지 않았고, 중증의 페스트 환자를 지근거리에서 대할 때에도 마스크를 쓰지 않았다. 우롄더가 회고하길 그가 소속된 페스트 방역반의 선임이자 베이양의학당北洋醫學堂의 주임교수였던 프랑스 의사 제랄드 메니Gerald Mesny, 1869~1911 역시 우롄더의 발견에 강한 거부감을 표출했고, 우롄더는 분을 참지 못하여 청 조정에 사임 의사를 밝혔다. 그러나 며칠 후 메니가 마스크를 쓰지 않고 러시아의 피병원避病院을 방문했다가 페스트에 감염되었다는 소식이 전해졌다. 그리고 6일이 지난 후, 페스트 방역반의 상징과도 같았던 메니는 사망하고 말았다. 만주는 곧 공황 상태에 빠졌다. 사람들은 이제야 만주 페스트의 위험성을 인지했다.
P.143
중국 사람들은 보통 중국어 ‘과학화하다科學化’를 서양 단어의 번역이라고 생각하지만, 그에 대응하는 영어 ‘scientize’는 사실 제대로 된 단어가 아니다. 워드프로세서에 ‘scientize’를 입력해보라. 맞춤법 검사기는 모조리 빨간 밑줄을 그어댈 것이다. 컴퓨터가 틀린 것 같다면 옥스퍼드 영어사전을 찾아보라. ‘scientize’가 거의 쓰이지 않는 단어임을 알 수 있다. 옥스퍼드 영어사전에 나오는 몇 안 되는 인용문에서조차 따옴표에 둘러싸인 경우가 태반이다. ‘과학화하다’라는 말은 분명 과학이라는 개념에서 자연스럽게 바로 도출된 단어처럼 보이지만, 근대 과학의 개념을 함께 벼려낸 유럽의 국가들은 ‘과학’을 동사로 사용할 필요성을 느끼지 않았다. 극명히 대조적으로 현대의 중국, 일본 그리고 한국에서는 ‘과학화하다’는 말을 일상적으로 쓰는데 말이다. 따라서 중국인이나 일본인, 한국인이라면 서양인이 ‘과학화하다’라는 말을 사용하지 않고도 과학을 할 수 있다는 점이 의아할 수 있다.
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저자 소개
지은이: 레이샹린 저자파일 신간 알림 신청
최근작 : <비려비마> … 총 1종 (모두보기)
대만 중앙연구원 근대사연구소와 국립양밍대학 과학기술학연구소에서 근대 중국 의학사와 과학사를 연구하고 있다. 시카고 대학교에서 화학과 과학사를 공부했다. 전통 의학과 공중보건의 역사에 초점을 맞추어 연구했으며, 최근에는 중국의학에서 임상 연구가 등장한 역사적 궤적을 탐구하고 있다. 《비려비마: 중국의 근대성과 의학》을 비롯하여 다수의 연구를 발표하였다.
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Editorial Reviews
Review
"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 story, and one that will do much to advance the field of medical history in the non-West."― Studies in History and Philosophy of Science
"This book is equally about the surprising and dynamic history of Chinese medicine, Western medicine, and the modern Chinese state, and it deserves the careful attention of historians of China and state-building as much as historians of medicine and science. . . . Lei's intervention provides the most sophisticated and clear explanation yet of the issues involved."― Social History of Medicine
"Neither Donkey Nor Horse is a tremendous accomplishment that marks Lei as a leading historian of Chinese medicine and a major thinker in acience and technology studies. With this book, Lei has set a conceptual framework that will shape all future work on the subject."― East Asian Science, Technology and Society
"It is difficult to overestimate the value of this book. Empirically rich and theoretically sophisticated, it presents the most comprehensive analysis to date of medical developments in twentieth-century China. This book delights at every turn; every chapter uses exhaustive research to build a sophisticated argument. It will be duly recognized as a masterpiece."― Bulletin of the History of Medicine
"In conceptualizing how the insights of critical interdisciplines—postcolonial studies or science studies—might be incorporated into the field of Asian history, two possible scenarios come to mind: in one, critical vocabularies are selectively adopted but the overall enterprise remains unmoved; in another, the foundational issues at stake in the interdiscipline become themselves the subject of the Asia historian, thus transforming the questions that are asked and the way research is carried out. It is the latter approach that Lei brilliantly demonstrates in Neither Donkey Nor Horse."
― Chinese Literature and Culture
“If you are going to read just one book on the modern history of Chinese medicine, this is the work to read. Lei’s analysis of the entwinement of medicine, science, modernity, and the state is brilliantly original and persuasive, and argued with admirable clarity. Neither Donkey nor Horse is a major contribution to science studies and the history of global health, as well as to the study of twentieth-century China.”-- Shigehisa Kuriyama, Harvard University
“Reaching far beyond the history of modern China, Neither Donkey nor Horse challenges conventional understanding of modernity, science, and state power through an intellectual and social history of medical debate and development in East Asia from the late nineteenth century forward. This is a thoughtful and meticulously researched investigation of transnational modernizing processes in the twentieth century as they touched down and transformed worlds in China. The book demonstrates that medical knowledge and practice, whether ‘modern’ or ‘traditional,’ historicized or fixed as policy, are nowhere innocent of politics, culture, and social hierarchy. It offers surprising historical lessons for everyone interested in science and local knowledge, socialism and capitalism, institutions and ideas about nature as they weave together in modern regimes of health and population governance.”-- Judith Farquhar, University of Chicago
“Neither Donkey nor Horse is a tour de force of how both Western and Chinese medicine played central roles not only in Chinese modernity but also the formation of the state in Republican China. Lei thus adroitly relates the politics of medicine and debates over making Chinese medicine more scientific to the big themes of nationalism, the state, and modernity that dominated the political struggles of early twentieth-century China.”-- Marta Hanson, Johns Hopkins University
“Neither Donkey nor Horse is a major work by the leading scholar in the field of modern Chinese medical history. Lei argues that what we now know as traditional Chinese medicine as it emerged as a discourse in the early twentieth century was fundamentally shaped by the encounter with Western medicine and the relationship with the state that this dictated. Chinese medicine was something new that was created during this period in response to themes with Western biomedicine as traditional practitioners sought social mobility through participation in the state. Lei’s argument is backed up by research of the highest standard: his knowledge of the historical sources is outstanding, and he is impressively familiar with the secondary and theoretical literature in both English and Chinese. His book will be of interest not only to historians of Republican China but also to those interested in the history of science more widely.”-- Henrietta Harrison, University of Oxford
“In this insightful and provocative book, Lei shows us what it meant to practice ‘modern’ medicine in Mao Zedong’s semicolonial and semifeudal society. Drawing on rich historical sources, Neither Donkey nor Horse reveals that modern medicine will always be mongrel medicine. Importantly, Lei gives us the critical postcolonial genealogy for ‘Traditional Chinese Medicine,’ the epitome of Chinese modernity, now a global phenomenon.”-- Warwick Anderson, University of Sydney
About the Author
Sean Hsiang-lin Lei is associate research fellow at the Institute of Modern History, Academia Sinica, Taiwan, and associate professor at the Institute of Science, Technology, and Society at National Yang-Ming University.
Product details
Publisher : University of Chicago Press; Reprint edition (July 18, 2016)
Language : English
Paperback : 394 pages
ISBN-10 : 022637940X
ISBN-13 : 978-0226379401
Item Weight : 1.24 pounds
Dimensions : 6 x 1 x 9 inches
Best Sellers Rank: #563,247 in Books (See Top 100 in Books)
#173 in History of Medicine (Books)
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#439 in Asian History (Books)
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Ted Kaptchuk
5.0 out of 5 stars sinologists and serious practitioners will enjoy this bookReviewed in the United States on February 19, 2015
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Where does Chinese medicine fit into a modern world guided by science? Dr. Lei explains the origin of this debate in the early 20th century. His book explains that that this question was a critical component of how China during the Republican period constructed a form of "modernity" that gave ever shifting space (with restrictions) to the practice of a form of literate Chinese medicine compatible with what was considered science. Besides Chinese medical practitioners and institutions, the government, the western medical establishment (both Euro-American and Japanese trained), the Chinese pharmaceutical industry, and intellectuals on all sides engaged in shaping a Chinese medicine that was compatible with their own agendas.Dr. Lei has made a tremendous contribution to helping scholars and practitioners understand the debates and compromises (on all sides) that defined Chinese medicine as it evolved in the 20th century. This is a scholarly and critical contribution to the Chinese medicine literature. Historians, anthropologists, sinologists and serious practitioners will enjoy this book.
Ted Kaptchuk
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5.0 out of 5 stars Excellent read.Reviewed in the United States on August 14, 2015
More reasonable here: https://cdcshoppingcart.uchicago.edu/Cart/ChicagoBook.aspx?ISBN=9780226169880&PRESS=CHICAGO
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Editorial Reviews
Review
"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 story, and one that will do much to advance the field of medical history in the non-West."― Studies in History and Philosophy of Science
"This book is equally about the surprising and dynamic history of Chinese medicine, Western medicine, and the modern Chinese state, and it deserves the careful attention of historians of China and state-building as much as historians of medicine and science. . . . Lei's intervention provides the most sophisticated and clear explanation yet of the issues involved."― Social History of Medicine
"Neither Donkey Nor Horse is a tremendous accomplishment that marks Lei as a leading historian of Chinese medicine and a major thinker in acience and technology studies. With this book, Lei has set a conceptual framework that will shape all future work on the subject."― East Asian Science, Technology and Society
"It is difficult to overestimate the value of this book. Empirically rich and theoretically sophisticated, it presents the most comprehensive analysis to date of medical developments in twentieth-century China. This book delights at every turn; every chapter uses exhaustive research to build a sophisticated argument. It will be duly recognized as a masterpiece."― Bulletin of the History of Medicine
"In conceptualizing how the insights of critical interdisciplines—postcolonial studies or science studies—might be incorporated into the field of Asian history, two possible scenarios come to mind: in one, critical vocabularies are selectively adopted but the overall enterprise remains unmoved; in another, the foundational issues at stake in the interdiscipline become themselves the subject of the Asia historian, thus transforming the questions that are asked and the way research is carried out. It is the latter approach that Lei brilliantly demonstrates in Neither Donkey Nor Horse."
― Chinese Literature and Culture
“If you are going to read just one book on the modern history of Chinese medicine, this is the work to read. Lei’s analysis of the entwinement of medicine, science, modernity, and the state is brilliantly original and persuasive, and argued with admirable clarity. Neither Donkey nor Horse is a major contribution to science studies and the history of global health, as well as to the study of twentieth-century China.”-- Shigehisa Kuriyama, Harvard University
“Reaching far beyond the history of modern China, Neither Donkey nor Horse challenges conventional understanding of modernity, science, and state power through an intellectual and social history of medical debate and development in East Asia from the late nineteenth century forward. This is a thoughtful and meticulously researched investigation of transnational modernizing processes in the twentieth century as they touched down and transformed worlds in China. The book demonstrates that medical knowledge and practice, whether ‘modern’ or ‘traditional,’ historicized or fixed as policy, are nowhere innocent of politics, culture, and social hierarchy. It offers surprising historical lessons for everyone interested in science and local knowledge, socialism and capitalism, institutions and ideas about nature as they weave together in modern regimes of health and population governance.”-- Judith Farquhar, University of Chicago
“Neither Donkey nor Horse is a tour de force of how both Western and Chinese medicine played central roles not only in Chinese modernity but also the formation of the state in Republican China. Lei thus adroitly relates the politics of medicine and debates over making Chinese medicine more scientific to the big themes of nationalism, the state, and modernity that dominated the political struggles of early twentieth-century China.”-- Marta Hanson, Johns Hopkins University
“Neither Donkey nor Horse is a major work by the leading scholar in the field of modern Chinese medical history. Lei argues that what we now know as traditional Chinese medicine as it emerged as a discourse in the early twentieth century was fundamentally shaped by the encounter with Western medicine and the relationship with the state that this dictated. Chinese medicine was something new that was created during this period in response to themes with Western biomedicine as traditional practitioners sought social mobility through participation in the state. Lei’s argument is backed up by research of the highest standard: his knowledge of the historical sources is outstanding, and he is impressively familiar with the secondary and theoretical literature in both English and Chinese. His book will be of interest not only to historians of Republican China but also to those interested in the history of science more widely.”-- Henrietta Harrison, University of Oxford
“In this insightful and provocative book, Lei shows us what it meant to practice ‘modern’ medicine in Mao Zedong’s semicolonial and semifeudal society. Drawing on rich historical sources, Neither Donkey nor Horse reveals that modern medicine will always be mongrel medicine. Importantly, Lei gives us the critical postcolonial genealogy for ‘Traditional Chinese Medicine,’ the epitome of Chinese modernity, now a global phenomenon.”-- Warwick Anderson, University of Sydney
About the Author
Sean Hsiang-lin Lei is associate research fellow at the Institute of Modern History, Academia Sinica, Taiwan, and associate professor at the Institute of Science, Technology, and Society at National Yang-Ming University.
Product details
Publisher : University of Chicago Press; Reprint edition (July 18, 2016)
Language : English
Paperback : 394 pages
ISBN-10 : 022637940X
ISBN-13 : 978-0226379401
Item Weight : 1.24 pounds
Dimensions : 6 x 1 x 9 inches
Best Sellers Rank: #563,247 in Books (See Top 100 in Books)
#173 in History of Medicine (Books)
#400 in Alternative Medicine (Books)
#439 in Asian History (Books)
Customer Reviews:
4.8 out of 5 stars 7 ratings
More about the author
› Visit Amazon's Xianglin Lei Page
Customer reviews
4.8 out of 5 stars
4.8 out of 5
7 global ratings
5 star 77%
4 star 23%
3 star 0% (0%)
0%
2 star 0% (0%)
0%
1 star 0% (0%)
Top reviews from the United States
Ted Kaptchuk
5.0 out of 5 stars sinologists and serious practitioners will enjoy this bookReviewed in the United States on February 19, 2015
Verified Purchase
Where does Chinese medicine fit into a modern world guided by science? Dr. Lei explains the origin of this debate in the early 20th century. His book explains that that this question was a critical component of how China during the Republican period constructed a form of "modernity" that gave ever shifting space (with restrictions) to the practice of a form of literate Chinese medicine compatible with what was considered science. Besides Chinese medical practitioners and institutions, the government, the western medical establishment (both Euro-American and Japanese trained), the Chinese pharmaceutical industry, and intellectuals on all sides engaged in shaping a Chinese medicine that was compatible with their own agendas.Dr. Lei has made a tremendous contribution to helping scholars and practitioners understand the debates and compromises (on all sides) that defined Chinese medicine as it evolved in the 20th century. This is a scholarly and critical contribution to the Chinese medicine literature. Historians, anthropologists, sinologists and serious practitioners will enjoy this book.
Ted Kaptchuk
12 people found this helpful
HelpfulReport abuse
Joseph C. Coyle
5.0 out of 5 stars Five StarsReviewed in the United States on August 13, 2016
Verified Purchase
great
HelpfulReport abuse
:)
5.0 out of 5 stars Excellent read.Reviewed in the United States on August 14, 2015
More reasonable here: https://cdcshoppingcart.uchicago.edu/Cart/ChicagoBook.aspx?ISBN=9780226169880&PRESS=CHICAGO
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roarr.rs viii
Contents
Introduction
When Chinese Medicine Encountered the State
Beyond the Dual History of Tradition and Modernity
Toward a Coevotutionary History
Chinas Modernity
The Discourse of Modernity
Neither Donkey nor Horse
Conventions
2 Sovereignty and the Microscope:
Thc Containment of the Manchurian Plague, 5950-i!
Not Believing That This Plague Could Be Infectious" Pneumonic Plague versus Bubonic Plague
"The Most Brutal Policies Seen in Four Thousand Years" Challenges from Chinese Medicine: Hong Kong versus Manchuria
Chuonron: Extending a Network of Infected Individuals Avoiding Epidemics
Joining the Global Surveillance System
Conclusion: The Social Characteristics of the Manchurian Plague
3 Connecting Medicine with the State: From
Missionary Medicine to Public Health,
1860-19x8 45
Missionary Medicine
Western Medicine in Late Ding China versus Meiji Japan
The First Generation of Chinese Practitioners of Western
Medicine
Western Medicine as a Public Enterprise
"Public Health: Time Not Ripe for Large Work," 1914-24
The Ministry of Health and the Medical Obligations of
Modern Government, 1926-27
Conclusion
4 Imagining the Relationship between Chinese
Medicine and Western Medicine, 1890-192.8 69
Converging Chinese and Western Medicine in the Late
1890s
Non-Identity between the Meridian Channels and the
Blood Vessels
Yu Van and the Tripartition of Chinese Medicine
To Avoid the Place of Confrontation
Ephedrine and Scientific Research on Nationally Produced
Drugs
Inventing an Empirical Tradition of Chinese Medicine
Conclusion
5 The Chinese Medical Revolution and the
National Medicine Movement
The Chinese Medical Revolution
Controversy over Legalizing Schools of Chinese Medicine
Abolishing Chinese Medicine: The Proposal of 1929
The March Seventeenth Demonstration
The Ambivalent Meaning of Guoyi
The Delegation to Nanjing
Envisioning National Medicine
Conclusion
6 Visualizing Health Care in i93os Shanghai
Reading a Chart of the Medical Environment in Shanghai Western Medicine: Consolidation and Boundary-Drawing
97
Chinese Medicine: Fragmentation and Disintegration Systematizing Chinese Medicine
Conclusion
7 Science as a Verb: Scientizing Chinese Medicine
and the Rise of Mongrel Medicine 141
The Institute of National Medicine The China Scientization Movement The Polemic of Scientizing Chinese Medicine: Three Positions Embracing Scientization and Abandoning Qi-Transformation Rejecting Scientization
Reassembling Chinese Medicine: Acupuncture and Zhuyou Exorcism
The Challenge of "Mongrel Medicine" Conclusion
8 The Germ Theory and the Prehistory of "Pattern
Differentiation and Treatment Determination" 167
Do You Recognize the Existence of Infectious Diseases?
Notifiable Infectious Disease
Unifying Nosological Nomenclature and Translating
Typhoid Fever
Incorporating the Germ Theory into Chinese Medicine
Pattern versus Disease
A Prehistory of "Pattern Differentiation and Treatment
Determination"
Conclusion
9 Research Design as Political Strategy: The Birch
of the New Antinsalaria Drug Changshan 193
Changshan as a Research Anomaly
Scientific Research on Nationally Produced Drugs
Stage One: Overcoming the Barrier to Entry
Curing Mrs. Chu
Stage Two: Re-networking Changshan
Identifying Changshan
Two Research Protocols: 1-2-3-4-5 versus 5-4-3-2-1
Reverse-Order Protocol: 5-4-3-2-1
Research Protocol as Political Strategy
Conclusion: The Politics of Knowledge and the Regime of Value
10 State Medicine for Rural China ,1919-49 2.2.4
Defining China's Medical Problem
Discovering Rural China
The Ding County Model of Community Medicine State Medicine and the Chinese Medical Association State Medicine and Local Self-Government The Issue of Eliminating Village Health Workers Chinese Medicine for Rural China
11 Conclusion: Thinking with Modern
Chinese Medicine 259
Medicine and the State
Creation of Values
Medicine and China's Modernity: Nationalist versus
Communist
Chinese Medicine and Science and Technology Studies
Acknowledgments 2.83
Notes 2.89
Index 359
=====================
CHAPTER 1 Introduction
During the last months of his life, Sun Yat-sen (i8661925), 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 i 2., 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 (i SST-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 tin Chinese medicine]. How can one rake drugs without a trust-worthy diagnosis? There is no need to take them."' After hearing that Sun had consistently refused to take Chinese medicine (which turned out not to be true in the end),! 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." 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 I9o9-95), 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 toj 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,' 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." 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.' Thus it was precisely in the process of
INTRODUCTION
CHAPTER I 4
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: Flow 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 3928, amid civil war, social unrest, and foreign occupation, the Nationalist Parry (guotnindang, 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 (960-12.79),' this was the first time that China had a national administrative center to rake 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 izos, 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 )'ears 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."
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 t929. 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. 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 19205 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
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have taken a very different form, if the state had not intervened to abolish the practice of Chinese medicine in the late i 92.0$. 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 i 92.9—'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 1919 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 (1CM) that emerged in Communist China in the mid- i 9505. In this sense, the creation of modern Chinese medicine began at the moment when Chinese medicine of the 1910S encountered the state.
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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 (i9ti—) can be sharply divided into two largely independent categories:° histories of biomedicine in China and histories of traditional Chinese medicine." 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 "surriveld] the impact of modern science between iX5o and 192.o."' I 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.'
Unfortunately, many people continue to view Chinese medicine as a "survivor" or remnant of premodern China. Although scholars like El-man have been careful to emphasize that the entity that survived the at‑
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tack of science is "a modernized version of Chinese medicine,"" 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 med-icine—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 modem 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 medicinc.'"13 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.'"" 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 Prot'incializing 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 hand and the development of biomedicine on the other.
Toward a Coevolutionary History
While it is important to recognize the unique status of Chinese medicine as a survivor of science and modernity, the concept of speciation is more appropriate for writing the modern history of Chinese medicine. First
of all, what the advocates of Chinese medicine strove for during this period was neither the preservation of Chinese medicine nor even the so-called modernization of Chinese medicine.20 As many leading figures of the National Medicine Movement explicitly pointed out, they strove to create a "new Chinese medicine" (xtnzhnngyi), namely, a recognizably new species of Chinese medicine. The metaphor of biological evolution can help us to appreciate the crucial difference between the survival of Chinese medicine and the speciation of what they called National Medicine. While the modernization of Chinese medicine can be likened to the transformation of a group of organisms (i.e., Chinese medicine), the vision of a National Medicine actually involved a dual transformation of both this group of organisms and of its new niche, that is, the emerging nation-state of China. The term survivor fails to capture the speciation process of a new Chinese medicine that coevolved with its new niche in the environment of the modern Chinese state.
In order to go beyond the dual history of the "survival of traditional medicine" and the "development of modern medicine," I have fore-grounded the reciprocal interactions among Chinese medicine, Western medicine, and the state. To highlight these otherwise obscure interactions, I have synthesized into a single historical narrative what has previously been separated into three independent histories: the history of Western medicine in China, the history of Chinese medicine, and the political history of the state. This unconventional research design keeps me from doing full justice to any one of these three histories nevertheless, it does reveal the surprising alliances among historical entities that were considered to be geographically separated, categorically distinct, and therefore practically remote from each other.
For one concrete but simplified example, consider the control of the Manchurian plague in 1911, whose history I present in chapter z. It was widely considered to he a landmark event in the history of Western medicine in China, because the control of the Manchurian plague demonstrated the political and indispensable rote of Western medicine in state building. In the process of confining the plague, practitioners of Western medicine successfully defended China's territorial sovereignty against encroachment from Japan and Russia. This landmark success of Western medicine depended on the combined forces of a new geopolitical power (resulting from the sovereignty crisis) and a new knowledge (the germ theory of the plague). To understand why Chinese medicine revealed itself as irrevocably inferior to Western medicine in this event, we have to take into account the unprecedented alliance between sovereignty and the microscope (see chapter z).
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In addition to tracing the reciprocal interactions and surprising alliances among these three histories, there are practical reasons to include them all in this study. In terms of narrating the modern history of Chinese medicine, the emergence of the nation-state and of Western medicine in Republican China were simply too radical, too profound, and too directly related to our topic to be treated as mere historical background. After the suppression of the Manchurian plague, the advocates of Western medicine came to the ironic conclusion that the scientific truth of biomedicine could not diffuse in China on its own but demanded as its vehicle the modern state and its accompanying institutions. In order to implement this newly developed strategy of "popularizing Western medicine by means of the state" (see chapter 3), they endeavored to turn Western medicine into a tool for state building. In response, the struggling practitioners of Chinese medicine soon adopted a similar goal as their crucial challenge. Striving to link Chinese medicine to the modern nation-state, they started the historic process of politicizing Chinese medicine. In other words, the rise of National Medicine as a collective vision for Chinese medicine was a direct response to a recently developed local feature of Western medicine in China.
As a result of the politicization of both styles of medicine, the state became the undisputed driving force behind the history of medicine in modern China. In practice, the relationship between the state and medicine went through a profound transformation during this period. Although the late Qing state had shown little concern for medical and public health matters until the outbreak of the Manchurian plague in 1910, by 19z8 the Nationalist government had committed itself to building an independent Ministry of Health—only one decade after Britain had established the world's first Ministry of Health in 1919. In 1947, the Nationalist government included in its first constitution a national policy of State Medicine (gongyi), an unusual form of national health system staffed, sponsored, and controlled completely by the government. Within less than forty years, China thus went from being regarded as "one of the last of the world's communities to undertake the utilization of scientific medicine "21 to having a government with a firm commitment to providing modern health-care services to all of its citizens, foreshadowing the further development of the world-famous primary health-care system under the Communist government. This dramatic transformation of the state radically altered the social space for both styles of medicine; simultaneously, though, the interaction of the government with the two styles of medicine also resulted in some important features for the Chinese state. In this sense, the present book is intended both as a political history of medicine and as a medical history of the Chinese state.
To summarize, it is important to assimilate the history of Chinese medicine into the general history of modern medicine in China because the crucial features of modernity were not produced in any one of three insulated, categorically pure historical processes, but in the conjunction of three interrelated histories. By considering these three histories as moving targets, rapidly influencing and being influenced by each other, this book intends to capture the reciprocal relationships and coevolu-tionary processes among these three histories. From this viewpoint, the unique "survival" of so-called traditional Chinese medicine has been influenced greatly by the knowledge, discourses, and institutions that originated in Europe and Japan; conversely, what makes modern health care in China a unique contribution to global medicine is precisely its incorporation of these newly transformed indigenous health practices. Instead of reproducing the dichotomy between tradition and modernity, this coevolutionary history reveals the intensive interplay between them in a concrete historical process, thereby elaborating the features of manifested modernity in China.
China's Modernity
So far, my discussion has focused on the policy aspect of the struggle between these two styles of medicine. Nevertheless, as Ralph Croizier cogently pointed out in his pioneering work published almost four decades ago, the debate over Chinese medicine concerned much more than medical policy. Contextualizing this struggle within the cultural milieu of the May Fourth Movement, Croizier convincingly explained why this controversy over medical policy drew in so many passionate participants from outside the medical circle, including the most prominent intellectuals and political leaders of that time. In his view, the controversy over Chinese medicine was a manifestation of a larger conflict, and a crucial paradox, between two modernist ideological forces in China, namely, cultural nationalism and scientism. Building upon his ideological analysis of this medical struggle, I argue that there were actually two separate but related struggles--a policy struggle over the role of Chinese medicine in the national health-care system and an ideological struggle over the nature of China's modernity.
Personified as "Mr. Science" (sai xiansbeng), scientism became a dominant force in modern Chinese thinking in the context of the May Fourth Movement in r9iS. Its influence peaked in the debate between
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science and metaphysics in 1923, which addressed the question of whether one's "philosophy of life" could be determined in a scientific f2shion.23 As this controversy reveals, progressive intellectuals strove to turn science into the representative of modernity so that the directions of various rampant changes of China could all be determined with confidence by the so-called scientific method. Because of this historical Context, science was not considered merely a specialized way of knowing about and controlling the natural world; it was also used as an ideological authority to excoriate the Confucian religion and to direct social and cultural changes. Paradoxically, as intellectual historian Wang I lui has pointed out, the leaders of the May Fourth Movement did not advocate science as the antithesis of Confucian religion. Instead, they strove to promote a "belief" (xizyang) in science and advocated the "replacement of religion by science.""
They thus endeavored to introduce to China a monotheistic framework that was to be implemented in various aspects of culture and daily life, including political ideology, historical development, love affairs, and the doctor-patient relarionship.21 Instead of attacking the religious concept of belief, science was supposed to serve as the defining example of what constituted a monotheistic belief.
This ideological function of science was by no means a Chinese phenomenon. On the basis of his study of British colonialism in India, political historian David Arnold has emphasized the crucial role that science played in giving shape and authority to the understanding of modernity.1e In my opinion, his conception of "science as modernity" is more appropriate than the concept of scientism for understanding why Chinese intellectuals treated the debate over Chinese medicine as a life-or-death struggle over China's modernity. In the context of Chinese medicine, the modernist debate centered not on scientism in the sense of whether the scientific method could he applied to realms apparently outside of science, such as the "philosophy of life," but on whether modern science could claim a monopoly on cultural authority within the realms presumably belonging to the natural sciences, such as medicine. While both of these debates were concerned with the cultural authority of science, they represented two extreme poles of a spectrum. When viewed against this background—progressive intellectuals fighting aggressively to maximize the authority of science in a variety of cultural realms—it becomes understandable why they appeared so angry and anxious when they were forced to defend the authority of science in the struggle over Chinese medicine. Fu Sinian (1896-1950), one of the leaders of the May Fourth Movement, made the following strong statement in 1934: "The most shameful, the most resentful, and the most saddening aspect of contemporary China is the so-called struggle between Chinese and Western medicine."27 Fu was right to feel that way, because what was at stake was much more consequential than the scientism debate over "philosophy of life." As the struggle over Chinese medicine called into question the very foundation of science as modernity in China, it also constituted the most dangerous and unacceptable challenge to the universalist conception of modernity for the world beyond.
In the eyes of these participants, the central question of this struggle was whether there was any room at all for presumably premodern, nonscientific Chinese medicine in the project of defining China's modernity. The answer to this question would determine whether China's modernity would have to be a faithful copy of the universalist modernity. Nowadays, some scholars of modern China tend to use the term no-derniy in a rather loose fashion, identifying as modernity almost any aspect of the historical processes that took place during the nineteenth and twentieth centuries. The unfortunate result of such historiography is that we end up losing sight of both its epistemic violence and the painful confinement that historical actors faced in their efforts to cope with the universalist conception of modernity. As Arnold has summarized insightfully in the Indian context, "acceptance of modernity as parti-sanly presented by the colonial officials, missionaries, educationalists and scientists would always confine Indians to a state of tutelage and subordination, always leave them one step behind, second-best and imperfect copies of a Western ideal."21 In order to understand this difficult position, scholars need to take seriously the normative as well as confining effect of modernity when conceived in terms of science.
To begin with, science has been considered the most objective and universal knowledge that humans could ever possess. Other aspects of modernity may have been open to negotiation and local modification, but it was much more difficult to consider meddling with science, whose universality was guaranteed by "nature," which presumably stood outside history and culture. Once conflaced with nature, science thus conceived was able to serve as the most solid foundation for a culture-free, universalist conception of modernity.29 To resist this modernity, or to propose its local modification, amounted to embracing obscurantism, if not irrationality and superstition (mixin))°
The ideological struggle over Chinese medicine was deeply embedded within this framework of "science as modernity." As revealed in the comment by Lu Xun with which I opened this introduction, in the early
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twentieth century, Chinese medicine was considered one of the most salient opposites of science. It was in this ideological context that the act of summoning a traditional physician to Dr. Sun Yat-sen's deathbed became such a high-profile controversy. If Dr. Sun, the most admired persona of modernity in China, openly embraced Chinese medicine, the perceived opposite of science, it would have spelled a "split personality" for Mr. Science and thereby the bankruptcy of science as modernity.
While the struggle over Chinese medicine indeed took place within the larger context of ideological conflict, and the two struggles thus became entangled, the struggle over medical policy should not be equated with, or reduced to, the ideological struggle over the concept of modernity. I emphasize the crucial importance of differentiating these two conflicts and yet keeping track of both within one study, because the ideological struggle over China's modernity did not take place in a purified discursive or conceptual space. Equally relevant were the practical context of resolving Chinas health-care problem and the sociotechnical processes of transforming, or "scientizing," traditional Chinese medicine. If one reduces the struggle over Chinese medicine to a purely ideological struggle over China's modernity, the multilayered attempts to transform Chinese medicine—institutional, epistemological, and tech-nical—fall by the wayside. While Croizier brilliantly reconstructed the larger ideological context for the struggle over Chinese medicine, this book is devoted to contextualization in the reverse fashion—that is, to reconstructing the medical and sociotechnical contexts for the purpose of understanding the ideological struggle over China's modernity.
It is important to situate the ideological struggle over China's modernity within these medical and practical contexts. In a nutshell, modernity is not "a thing in itself," let alone a fixed entity insulated from real-life concerns and sociotechnical developments in specific local settings. In order to investigate the nature of China's modernity with regard to the issue of Chinese medicine, we must suspend the abstract concept of a universalist modernity. Instead, we need to consider the possibility that a radically transformed modern Chinese medicine might have contributed to and even given shape to the modernity that came to be historically realized in China. For the sake of exploring this possibility, I examine the specific processes through which advocates of Chinese medicine embraced and negotiated the discourses of modernity and reassembled Chinese medicine. In this sense, this book is devoted to tracing the coproduction of modern Chinese medicine and China's modernity.-"
The Discourse of Modernity
Throughout the first half of the twentieth century, Chinese medicine encountered numerous new ideas, artifacts, people, and institutions that had not existed in China just decades earlier: the microscope, the steam engine, Gray's Anatomy, the germ theories of disease, the modern hospital, social surveying, the Ministry of Health, the Rockefeller Foundation, and professionalism, to cite just a few examples that are discussed in the following chapters. Although practitioners of Chinese medicine felt shocked, threatened, and sometimes enthralled by these various aspects of the modern world, none of these innovations—with the exception of the modern state—was as crucial as what I characterize as the "discourse of modernity" in shaping the modern history of Chinese medicine. Because the discourse of modernity was instrumental in turning Chinese medicine and science into incompatible opposites, it constituted the most daunting challenge for the advocates and reformers of Chinese medicine.
Central to the discourse of modernity was what philosopher of science Ian Hacking has characterized as the representationist conception of reality." As a philosophy of science, it suggests that the objective of science is to create representations of the natural world, which is assumed to be unique, eternal, and transcultural—that is, natural and thus universal. Moreover, the act of making representations should imitate the act of unmediated seeing, as if scientists were doing nothing but holding Up a mirror in front of nature, without disturbing in any way the reality to be represented. From this point of view, the main function of theoretical concepts is to represent the material entities that already exist in the real and eternal world. Because this conception of reality makes it possible to conflate science with nature, it provides the unquestionable basis for science to serve as the guardian of modernity. Although this philosophy would now have few supporters among researchers in science and technology studies, it persists as the commonsensical view of reality for both the general public and most practicing scientists. More importantly, historians have yet to understand the historical influence of this philosophy in shaping the modern history of China, not to mention the full consequences of abandoning it.
The embrace of this representationist conception of reality fundamentally transformed the relationship between the two competing styles of medicine. First of all, although none of the historical participants in the struggle over Chinese medicine ever mentioned this commonsensical philosophy of science explicitly, their arguments put into practice this
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theory of scientific knowledge, which was rather novel to many of their contemporaries. As the following chapters show, when critics of Chinese medicine accused it of being antiscientific—its cardinal sin and the ultimate rationale for its abolition—they meant to say that its theories failed to represent the known natural world as it was infallibly represented by science and biomedicine. As the result of this accusation, ontology thereby came to be valorized as the key to deciding the fate of Chinese medicine and China's health-care policies. Moreover, by conflating science with nature and reality, this theory of science turned the competition between "scientific medicine" and Chinese medicine into a zero-sum game. From now on, Chinese medicine had formally entered the strange ontological space of modernity, a space that was deemed too crowded to allow Chinese medicine to coexist with biomedicine.
It is remarkable how little we know about the historical processes through which Chinese people came to embrace this fundamental framework about knowledge and reality. Scholars of modern history have been so focused on tracing the eye-catching changes in the intellectual landscape that it has become easy to miss the restructuring of the conditions of knowledge underlying it. Because the modern history of Chinese medicine involved an intensive public debate about the project of "scientizing Chinese medicine," a debate concerned with both the nature of science and the controversial idea of "scientizing" its salient Other, this history offers a rare perspective from which to examine how the Chinese people came to embrace and later to negotiate these new conditions of knowledge.
Neither Donkey nor Horse
The key to answering the question posed in the beginning of this introduction lies in the book's title, Neither Donkey nor Horse (feilu feinta). To summarize the answer, the key development in this historic transformation was the rise of a new "species" of Chinese medicine that was seen by its detractors as "neither donkey nor horse," a new medicine that demonstrated in concrete terms that the relationship between Chinese medicine and modernity was not to be antithetical. Although I feel slightly apprehensive about choosing a phrase that was meant to be derogatory as the title of this book on the modern history of Chinese medicine, I believe that this Chinese idiom correctly captures the historic challenge that the reformers of Chinese medicine took on—the challenge to realize a project that was assumed to be unimaginable and doomed to fail.
It may be useful to first spell out the origin and connotations of this expression, because there is no direct counterpart for this Chinese idiom in English.35 Its earliest use is found in the Book of the Han Dynasty (Hanshu) from about two thousand years ago, which concerns the King of Qiuci, a Central Asian country in contemporary Xinjiang. This king admired the Han culture so much that he ordered his court to construct a I-lan-style palace, to wear Han-style clothes, and to adopt 1-lan-style rituals and institutions. The non-Han people in his region bitterly commented: "It looks like a donkey but is not a real donkey. It looks like a horse but is not a real horse. The King of Qiuci is nothing but a mule." Criticizing the king's efforts as a double betrayal of both cultural traditions, this idiom thus became an emotionally charged expression intended to show one's strong disapproval of boundary-crossing cultural integration.
This expression is illuminating in understanding the modern history of Chinese medicine for several reasons. First of all, it registered the rise of a new kind of medical syncretism at a specific historical juncture. Instead of being a tool of analysis, like the valuable postcolonial concept of hybridity,17 the idiom "neither donkey nor horse" was used by the actors at the time (and is intended in this book) as a reference to a new medicine in formation. It was not until the late 1920$ that this idiom, which had existed in Chinese literature for roughly two thousand years, was used to criticize efforts to integrate Chinese and Western medicine. When Tang Zonghai (1851-1908), the widely acclaimed founder of the "school of converging Chinese and Western medicine" (z.bongxiyi huitong pai), launched his medical syncretism in the i 890s, almost no one attacked him with such a strongly worded expression. In fact, Tang's positive and optimistic attitude toward cultural integration was representative of the reformist group in the late Qing period. Liang Qichao (i 873-1929), a leading reformist and the most influential scholar-journalist in the late Qing, took pride in his devotion to creating "a new school of learning which would be 'neither Chinese nor Western but in fact both Chinese and Western' (buthong buxi jizbong jXI).'K There was no sign then that such an effort of integration was either ill-conceived or doomed to fail.
As I argue in detail in chapter 6, it was only after the 1929 confrontation, especially after the establishment of the Institute of National Medicine by the Nationalist government in 1931 in order to "scicn-tizc" (kexuebua) Chinese medicine, that people from both sides of this medical struggle started to recognize the rise of a "mongrel medicine"
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(zaabongyi) that was "neither donkey nor horse." In other words, both the popularity of a new kind of medical syncretism (among reformers of Chinese medicine) and its derogatory characterization as a "mongrel medicine" were closely associated with the notion of science and the related discourse of modernity. In order to transform it into a state-sanctioned modern profession and a legitimate member of world medicine, reformers of Chinese medicine accepted the project of scientizing Chinese medicine and committed themselves to a path of integrating Chinese medicine with biomedicine. Risking the accusations and derision implied by the stigmatizing expression "neither donkey nor horse," many leaders of the National Medicine Movement nevertheless devoted themselves wholeheartedly to the creation of this new Chinese medicine.
In addition, this expression highlights the fact that this medical syncretism was doomed to fail because it was an artificial creation against nature. As the story about the King of Qiuci reveals, this Chinese idiom conceptualizes a cultural phenomenon in terms of a biological metaphor, comparing cross-cultural integration to cross-species reproduction. The reference to the King of Qiuci as a mule clearly draws on the biological knowledge that cross-species breeding between a female horse and a male donkey always leads to an infertile creature. Just like mules, which are incapable of reproducing, the "neither donkey nor horse" medicine, no matter how vigorous it appeared at the present moment, was seen as nothing but a monstrous creature that was destined to have no future.
During the 1930s, even reformers of Chinese medicine found it hard to imagine a future for this new Chinese medicine that they had struggled to reassemble. Citing as an example the successful integration of Confucianism and Buddhism that had taken place during the Song dynasty (960-1278), some reformers of Chinese medicine clearly aimed at a similar kind of audacious and creative integration between Chinese and foreign cultures." Nevertheless, because the foreign culture involved in this case was "science," which supposedly held a monopoly on the truth about the natural world, it became impossible to imagine how one could integrate Chinese medicine with science without corrupting the latter's "truth contents." As these reformers were not able to articulate their vision for this hybrid medicine and to defend its values, they either silently endured the stigmatization or were forced to denounce the concept of a "mongrel mcdicinc."' And the medical reformers who aimed at the kind of cross-cultural integration comparable to the one between Confucianism and Buddhism had to live with the fact that their enterprise had been successfully defined, not by themselves but by their critics, with an explicitly derogatory term. Because the vision for this medicine appeared utterly unthinkable and unspeakable, and also because the advocates of Chinese medicine indeed often appealed to the rhetoric of cultural nationalism, it was just too easy to fail to properly appreciate this crucial development in the modern history of Chinese medicine—that is, the rise of a new Chinese medicine that was self-consciously "neither donkey nor horse."
Even though such innovative efforts have now been going on for more than eight decades, some people still find it hard to imagine a future for this kind of "neither donkey nor horse" medicine. Even within China, there have been widely supported efforts to say "farewell to Chinese medicine and Chinese herbs" as recently as 2oo6.' Unlike other histories of modern science, the modern history of Chinese medicine remains a highly contested and therefore open-ended history. Precisely because the future of this "neither donkey nor horse" medicine continues to be hotly debated today, it is helpful to understand the process by which reformers of Chinese medicine have carved out a future for it since they began to commit themselves to the project of "scientizing Chinese medicine" in the 1930s.
Finally, I want to highlight the fact that the use of this idiom was an emotional tactic. Instead of arguing against the specific content of this medical syncretism, critics often used this idiom to remind everyone that the only appropriate way of dealing with such a self-contradictory endeavor was to laugh it off as a joke. Nowadays, when I mention the idiom "neither donkey nor horse" in public lectures, the audience invariably responds with friendly laughter. This response reveals the huge emotional distance between us and the actors in the 19305. Since one of my objectives is to give the readers a sense of the emotional and epistemological violence that the reformers of Chinese medicine had to endure during that time, I have decided to follow my actors' use of this idiom and to render it as mongrel medicine in English. Only when readers have acquired a sense of this taken-for-granted disdain for mongrel medicine, a disdain perceived as so natural that there was no need to spell out its rationale, can they begin to understand the historic challenges associated with supporting such an endeavor in 1930$ China, and perhaps also in many other parts of the world. The title of my book is thus intended to highlight this enterprise as a historical challenge--a challenge to realize a project that its critics had successfully defined as impossible, pathological, and self-contradictory.
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Conventions
It is essential to clarify from the outset what I mean by "practitioner of Western medicine" (xiyi) and "practitioner of Chinese medicine" (zhongyi). For the sake of argument in this book, practitioners of Western medicine refers to Chinese nationals educated in Western-style medical schools, either in China or overseas, roughly starting from the last two decades of the nineteenth century. Those whom I call "practitioners of Western medicine" therefore do not include foreign doctors and medical missionaries. An important detail in this context is that the majority of these "practitioners of medicine," in fact, acquired their medical training either in Japan or in Japanese-influenced medical colleges in China. On the eve of the historical events of 192.9, the number of practitioners of Western medicine was about two thousand.'2
It is more difficult to define what I mean by "practitioners of Chinese medicine." By the term Chinese medicine I mean primarily the medicine of the scholarly elites during the Imperial period as well as the subsequent development of this medicine in the modern period. These scholarly elites were particularly important because they led the way in organizing the National Medicine Movement and subsequently transforming Chinese medicine into a modern profession. During the Imperial period, however, as Nathan Sivin has pointed out, the scholar-physicians "were not organized, did not think of themselves as a group, and could not set or enforce common standards of medical education, skill, or compensation. "41 As the result, before the government stepped in to regulate practitioners of indigenous medicine in the 1920s, the barrier to professional entry into the medical field amounted to nothing. Therefore, practitioners of Chinese medicine refers broadly to everyone who practiced traditional Chinese medicine and lacked formal medical training in biomedicine. Since membership identification is precisely one of the key issues at stake in this study, it would be counterproductive to provide more precise definitions of either kind of medical practitioner at this point in our investigation. With the help of a highly informative chart entitled "Medical Environment in Shanghai," drawn by a vocal critic of Chinese medicine in 1933, 1 analyze the complexity and heterogeneity of both Chinese medicine and Western medicine in 2930$ Shanghai in detail in chapter 6. Thanks to the history documented in this book, what we now called Chinese medicine and Western medicine (in China) gradually took shape as they struggled against each other in the field of the state.
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