Knowing Practice: The Clinical Encounter of Chinese Medicine (review)

104 China Review International: Vol. 2, No. 1, Spring 1995 Judith Farquhar. KnowingPractice: The Clinical Encounter ofChineseMedicine. Boulder, Colorado: Westview Press, 1994. xii, 260 pp. Hardcover $49.95. Judith Farquhar has written a richly detailed ethnography of the clinical encounter between Chinese urban doctors and dieir patients in the early and mid-1980s. Her analysis of the contemporary practice ofChinese medicine is die first anthropological study ofits kind. Previous analyses ofChinese medicine published in English have concentrated largely on theoretical issues and have relied primarily on published texts. Farquhar's participant-observation approach and her careful attention to practice as well as theory allows her to transcend eidier the skeptical or idealized tone that sometimes characterizes text-based studies of Chinese medicine in contemporary China. As Farquhar began her field research, she was interested in learning how Chinese doctors reconciled certain inconsistencies in Chinese medical dieory in their clinical practice. When she questioned physicians about these dieoretical conflicts she was invariably told that "we take experience to be our guide." Farquhar's realization that practice is the key element in die epistemology of Chinese medicine provides die analytical anchor for her elegant discussion ofthe various elements of the clinical encounter in urban clinics today. Knowing Practice begins widi a briefintroduction and two preliminary orienting chapters. Chapter 1 provides a historical overview of traditional Chinese medicine since 1949 and describes the institutional features of its practice in the 1980s. Farquhar stresses the dynamic nature of such arrangements, noting that traditional medicine has become increasingly professionalized and scientized since the founding of the People's Republic. Chapter 2 introduces the basic ontological principles which undergird Chinese medical theory and compares them to those which support biomedicine. The clinical encounter is the arena within which theory and practice come together, revealing what Farquhar terms the "practical logic" of Chinese medicine . In chapters 3-7, Farquhar explores this logic in depth, analyzing each phase of the clinical encounter in turn. Beginning with a description of the first meeting between doctor and patient, Farquhar examines each aspect of diagnosis and treatment, from the four examinations ("looking, listening/smelling, asking, and palpating") dirough the five major schémas used in analysis, to the classification of symptoms into syndromes and die simultaneous determination of therapy, and© 1995 by University finally to formulary prescriptions and adjustments in dierapy. Drawing upon ofHawai'i Pressboth her own observations in outpatient clinics and a detailed discussion of tiiree published case histories, Farquhar shows how the doctor specifies and differenti- Reviews 105 ates illness and how she/he chooses appropriate therapies from the vast archive of Chinese materia medica available to her/him. Farquhar uses all three case studies to illuminate the multiple phases of the clinical encounter, but each also illustrates distinct points. The doctor treating the first patient, a case ofacute febrile disease (classified as Spring Warm), draws upon two traditions tìiat are often presented as opposed to one anotiier, the Warm Illnesses and the Cold Damage schools. Farquhar demonstrates how the clinician transcends the theoretical wrangling and disputes of diese two schools in his actual diagnosis and treatment ofthe illness, and she suggests tìiat such practical resolution of competing theories is common in the clinical realm. Another case, involving a patient with a stomach ache, previously diagnosed in a biomedical clinic as an ulcer, is used to illustrate the ways in which Chinese medicine and biomedicine differ in conceptualizations ofthe body. The doctor does not focus on treating an anatomical structure—the stomach—but rather seeks to identify a physiological process—a visceral system—which is producing die illness. In diis particular case, the doctor considered die Liver system to be more central and powerful than the Spleen-Stomach system, and thus treatment consisted of drugs to improve the Liver's function of dispersing the body's qi. (Farquhar elects not to translate qi, arguing that all English renditions of die concept vastly oversimplify its complex meaning.) Through Farquhar's skillful handling of a third case history, traditional Chinese medicine is revealed not as a fixed body ofknowledge diat doctors must rigidly adhere to, but rather as an ever-changing generative process. A physician tries to induce...