What Is Medicine? Western and Eastern Approaches to Healing (review)

Paul Unschuld is well known as a specialist in Chinese medicine, on which he has written a series of important studies. Three of the most remarkable (all from the University of California Press) are Medicine in China: A History of Ideas (1985), Medicine in China: A History of Pharmaceutics (1986)—both containing useful collections of source materials—and his monograph on one of the two chief recensions of the Chinese medical classic, Huang Di Nei Jing Su Wen (2003). His latest book, What Is Medicine?, is claimed by the publisher to be the first comparative history of two millennia of Western and Chinese medicine from their beginnings to "present advances in sciences like molecular biology and in Western adaptations of traditional Chinese medicine." Clearly the task set is formidable. How well is it executed?

The principal thesis advanced relates to Unschuld's contrast between healing and medicine. The latter is here defined as depending on the recognition of the laws of nature. The further claim is that both in Greece and in China the breakthrough to medicine from (mere) healing was accomplished largely under the stimulus of new sociopolitical conditions, the need to find order in the chaos of political circumstances. Unschuld is confident enough in his reconstruction of the political events (such as the unification of China under Qin Shi Huang Di) that led up to what he considers the breakthrough from healing to medicine in China. But in general he is less sure of himself when dealing with Greek materials, where he claims (surprisingly, to my mind) that the background to the development of science and medicine in Greece is less well documented than for China and where he is sometimes misled by some of his (mostly German) sources into errors, repeating, for example, the view that Galen was the first to distinguish the nerves, when that had been achieved centuries before by Herophilus. But in both cases he sees the notions of law and order, developed in the sociopolitical domain, as a key stimulus to the emergence of the idea of laws of nature in medicine.

Even this brief sketch reveals the highly positivist character of. Unschuld's discussion. While there are several strong features of the study, notably the range of materials brought into consideration and the recognition of the heterogeneity of traditions of healing in both civilizations, and not just in ancient times, the study suffers from severe shortcomings, the most fundamental of which is easily stated. The very idea that the notion of laws of nature can be found in antiquity is highly controversial (to say the least), and I side with those who protest that to attribute such a notion to ancient Greeks or to ancient Chinese is anachronistic and seriously misleading. Both ancient Greek and ancient Chinese writers acknowledge—as do writers in other ancient societies, especially Mesopotamia—regularities in certain phenomena, especially but not exclusively in the heavens, but that does not justify ascribing any notion of laws of nature to either. So far as the Greeks are concerned, Aristotle has nature cover events that happen "always or for the most part," an idea that is incompatible with that of an exceptionless, universal law, unless one is prepared to commit the further anachronism of attributing a concept of statistical probability to him. So far as the Chinese are concerned, they do not even have a single term that covers precisely what "nature" does in English, or phusis in ancient Greek, as indeed Unschuld recognizes in the case of the concept of tian, whose primary connotation is "heaven," though that does not persuade him to modify his overall thesis.

The answer this book offers to the question posed by the title is, then, unduly narrow. Unschuld discounts more or less everything we have learned from medical anthropology on the grounds that that deals with no more than...