The Transmission of Chinese Medicine, and: Science and Civilisation in China. Vol. 6, Biology and Biological Technology; part VI, Medicine (review)

Elisabeth Hsu. The Transmission of Chinese Medicine. Cambridge Studies in Medical Anthropology, no. 7. Cambridge: Cambridge University Press, 1999. ix + 296 pp. Ill. $64.95 (cloth, 0-521-64236-1), $24.95 (paperbound, 0-521-64542-5).

Joseph Needham. Science and Civilisation in China. Vol. 6, Biology and Biological Technology; part VI, Medicine. Edited and introduced by Nathan Sivin. Cambridge: Cambridge University Press, 2000. xviii + 261 pp. Ill. $75.00 (0-521-63262-5).

In The Transmission of Chinese Medicine Elisabeth Hsu, a medical anthropologist, provides an analysis of her notes taken as a participant observer in three Chinese health-care settings. During an extended stay in Kunming in 1988-89, she affiliated herself with a practitioner of Qigong "who taught her his esoteric arts by imitation and repetition only," with a so-called senior physician "who plunged his followers into studying arcane medical classics", and with the Yunnan College of Traditional Chinese Medicine (TCM) "where the standardised knowledge of official Chinese medicine is inculcated" (all three quotations from the unpaginated frontispiece). Among the recently published depictions of the current heterogeneity in the Chinese health-care system, Hsu's is certainly the most ambitious and comprehensive.

The book is strongest where Hsu relates her insights into the social dynamics among healers and their clients, their colleagues, and their students, and where she records her view of realities that are not documented by any other source. In due time, historians will cherish such accounts as invaluable entries into the context of healing and teaching in the closing decade of the twentieth century. The third part of the book adds much valuable information to our understanding of the transformation of a vast and conceptually heterogeneous array of health-care traditions in pre-1950 China into a well-defined "traditional Chinese medicine" in more recent decades.

Hsu's book raises questions when it attempts to connect the present to the past. In the very first sentence the author states: "Chinese medicine is grounded in medical practice and in texts--in experience and in its transmission from one generation to another" (p. 1). This statement neglects a fact that plays a significant role in her own discussions of the redefinition of TCM in the People's Republic of China in the final section of her book--namely, that the theoretical basis of Chinese medicine and many of the practices resulting from it are, and have been throughout history, primarily grounded in projections of social realities and ideologies. For example, neither "medical practice" nor "experience" could have stimulated the transition from Chinese traditional medicine to so-called TCM beginning in the 1950s; it was grounded solely in the social, economic, and ideological context. Hsu admits that "[Chinese medicine] changes over time as its social and historical contexts change" (p. 1), but it is not the anthropologist's task to provide a meticulous analysis of past or present interactions between context and medicine, and thereby to explain why traditions of thought emerge and appear plausible.

Hsu presents her material from a perspective where the past is seen as a huge box filled over time with an increasing number of building blocks, while the present is their accidental accumulation. This accumulation, she writes (following Ian Hacking), manifests itself in different "styles," and "every style comes into being by little microsocial interactions and negotiations" (p. 4). Different interactions and negotiations have justified the styles of the Qigong healer, of the senior physician, and of the TCM College. In explaining the mosaic of the present, Hsu picks bits and pieces from the most diverging periods and traditions to demonstrate that "historical processes are often best understood as historical accident, and the contemporary conceptions . . . are thus best viewed as a result of such historical accident" (p. 79).

A serious challenge confronted by Hsu was to bridge...