Forgotten Disease: Illnesses Transformed in Chinese Medicine by Hilary A. Smith (review)

Utilizing Charles Rosenberg’s influential “framing” approach to the history of disease,¹ Hilary A. Smith examines the shifting meanings of a Chinese disorder known as “foot qi” (jiao qi) from its earliest fourth-century record to the present day. Rather than interrogate Chinese sources for what they have to say (or, usually, do not have to say) about a pervasive illness now categorized as beriberi, Smith seeks to understand how Chinese doctors and laymen made sense of foot qi in the past. The equation of foot qi with beriberi occurred only in the late nineteenth century after the global ascendance of laboratory medicine fostered the idea that diseases exist independently from those who get sick, and that their etiology can be reduced to a specific cause. Smith resists imposing these ontological categories derived from modern medicine onto premodern Chinese forms of knowledge. She argues that disease is not an unmediated biological reality but is a human experience whose meanings and parameters people continually redefine over time.

Smith’s principal aim is to recover “forgotten” East Asian perspectives on foot qi by excavating previous interpretations as articulated in a wide array of medical texts, including a little-known handbook of remedies written in the early fourth century by alchemist Ge Hong (281–341). Ge Hong understood foot qi to be a regional ailment, one that primarily plagued northerners who migrated to the Yangzi River region during the period of political disunity that occurred between the third and sixth centuries. In the seventh century, elite physicians such as Chao Yuanfang (550–630) and Sun Simiao (581–682) appropriated foot qi, transforming laypeople’s conventional wisdom about the disease in ways that shored up their own authority. From the tenth century through the twelfth, Northern Song emperors sponsored standardized drug formularies, which in turn inspired privately authored texts that reduced foot qi to several different types and provided laypeople with simplified treatment options they could access directly.

New etiological theories of foot qi emerged in the thirteenth century, as represented by Li Gao’s (1180–1251) assertion that southerners suffered from a form of foot qi caused by an invasion of deviant qi from the outside, while northerners primarily contracted the disease through the excessive consumption of food and alcohol. Li Gao’s idea that overindulgence could cause foot qi became prevalent in the fifteenth and sixteenth centuries, and its association with northerners, first articulated by Ge Hong, gradually weakened. As commercialization intensified and prosperity rose in the late Ming period, foot qi became the paradigmatic disease of excess, described in numerous sixteenth-century case records as a chronic, diet-induced disease that primarily afflicted the wealthy. Three hundred years later, political and intellectual changes in nineteenth-century Japan helped reduce the cause of what had been a complex and dynamic disorder to a straightforward deficiency of vitamin B₁.

Today, foot qi retains multiple meanings in East Asia. In Japan and South Korea it refers only to beriberi, but in Taiwan and on the Chinese mainland, jiao qi also correlates to a gout-like pain disorder and “athlete’s foot.” That the meaning of “foot qi” cannot be pinned down even now underscores the author’s main point that disease is a sociocultural artifact as well as a biological experience.

The book serves not only to uncover the “forgotten” history of a widespread and enduring disease but also as a highly accessible overview of recent scholarship on the history of Chinese medicine. Smith builds upon the most innovative historiography produced over the past decade, adding further evidence that Chinese medicine was a dynamic system not entirely antithetical to its Western counterpart. She also provides an alternative to a recent wave of global histories of disease that uncritically apply modern diagnoses to past suffering. Dispensing with the question “What was the disease, really?,” Smith reminds us not only...