Chinese Medicine in Contemporary China: Plurality and Synthesis (review)

Chinese Medicine in Contemporary China is a brilliant reflection on the dynamic complexity of contemporary Chinese medicine. Based on sixteen months of fieldwork in Beijing between 1994 and 1998, Scheid's ethnography is one of the best of a wave of new studies on Chinese medicine that are sure to change the field.

Scheid's central thesis is that Chinese medicine "is not a totality . . . reducible to a singular cultural logic or process of production" (p.13). Instead, it is a multisited manifold of practices endlessly generated through unique local syntheses of multiple factors, or "infrastructures." These factors, including human and nonhuman agents, such as doctors, patients, the state, and disease syndromes, combine dynamically and exert changing degrees of influence in a process of "emerging and disappearing." Building on Judith Farquhar's insights, Scheid also notes how Chinese doctors continue to adapt a vast textual heritage that links them to "a past not merely of fragments, ruins, and memories but of entire libraries, living commentatorial traditions and embodied lines of descent" (p.53).

He departs from Farquhar and many others by not focusing on Chinese medicine as a philosophical system whose "practical logic" is "thoroughly inconsistent with the strictures of Western science" (Knowing Practice, p.18). Scheid systematically attacks any objectifying constructions of Chinese medicine as traditional or modern in comparison with biomedicine by meticulously tracing the mixed origins of so-called traditional practices and concepts ranging from acupuncture needling to syndrome differentiation. By emphasizing the flexible disunity of Chinese medicine, he provides a model for understanding not only how the practice of Chinese medicine continues to thrive, but also how the historical medical canon has always remained relevant despite internal inconsistencies.

Scheid's more than twenty years of experience as a practitioner of Chinese medicine and deep reading in classical texts allow him to delve into topics in an unprecedented way. For example, no one outside of China deconstructs medical prescriptions as cultural artifacts, tracing the historical origins of prescription ingredients, as skillfully as Scheid. In chapter five, he unpacks the decisions of a doctor in formulating a prescription for Meniere's disease, an inbalance in the inner ear. Scheid unveils each factor, including the doctor's training, the classical medical texts the doctor consults, patient testimony, and institutional influences. He then diagrams how these factors shape the physician's creative interpretation of "excessive phlegm" as a material symptom treatable by a combination of Chinese and Western drugs.

After presenting his theoretical position, Scheid moves on to the ethnographic core of the book in chapters three through eight. With the keen eye of a clinician, he analyzes several key infrastructures, including the role of the state in establishing new medical institutions and practices (chapter three); the tactical agency of patients in shaping medical systems and narratives of illness rather than simply choosing between distinct alternatives in health care (chapter four); the influence of social networks and medical knowledge on doctors and students (chapters five and six); and the invention of the bianzheng lunzhi tradition since the 1950s and the creation of new diagnostic tests (chapters seven and eight). Though each topic is worthy of a book-length discussion, Scheid encapsulates them into independent essays accessible by the general reader.

So rich in detail and nuanced in analysis is Scheid's work that his attempt to anchor everything to Andrew Pickering's "mangle of practice" is somewhat belabored. Pickering's approach was one among several in the social studies of science that sought to write nature and other material agencies such as technology back into historical narrative in reaction to extreme relativists who argued that all scientific fact is socially constructed. Scheid contends that "synthesis is not the achievement of meanings imposed onto the world by human subjects or...of...