- Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity by Sean Hsiang-Lin Lei
It is difficult to overestimate the value of this book. Empirically rich and theoretically sophisticated, it presents the most comprehensive analysis to date of medical developments in twentieth-century China. It is also an intellectual and political history of modern China, since it treats medical reform tactics as political strategies and argues that this process constitutes China’s creation of its own modernity. Lei also astutely applies Bruno Latour’s concept of the “modern Constitution” to illustrate that reformers of Chinese medicine achieved the impossible by creating a hybrid medicine that was ultimately recognized as the very expression of a distinctly Chinese scientific modernity.1 This book is valuable to scholars of the history of medicine, modern China, and science and technology studies.
Lei begins by questioning how, in the span of a few decades, Chinese medicine accomplished a remarkable transition from its lowly status as the epitome of cultural backwardness to the very expression of Chinese modernity. The book’s painstaking detail and intricate argumentation draw the reader into the suspenseful drama of astute reformers meeting the epistemic violence of Eurocentric modernity head-on and transforming Chinese medicine into a globally recognized and well-respected medical system. Although the final stages of this transformation took place in the mid-1950s, Lei convincingly asserts that the communist state would not have adopted Chinese medicine into its state system without the crucial transformations that took place under the preceding Nationalist state.
For example, one of the foundational ideas in TCM (created in 1955–56) is that Chinese medical diagnostics depend on “pattern differentiation and treatment determination” (bianzheng lunzhi) (pp. 167–92). Lei shows that Zhang Taiyan invented this tradition in 1931. This innovation allowed Chinese medical reformers to recognize the strength of biomedicine to diagnose, prevent, and control the spread of infectious diseases while also avoiding the ontological challenge that germ theory posed. Rather than despair at Chinese medicine’s failure to follow biomedical protocol and identify specific causes for each disease, Zhang asserted that Chinese medicine worked through the identification of a disease pattern and discernment of an effective treatment protocol. This strategy transformed a zero-sum game of precise diagnostics with biomedicine as the single winner into a discussion of treatment strategies that recognized the success of multiple approaches.
Another adaptive strategy was the reification of Chinese medicine physicians’ accumulated experience with their patients’ bodies (renti jingyan) as the “empirical” aspect of Chinese medicine that could be preserved even if one deemed Chinese medical theories to be erroneous and without value (as the primary challenger to Chinese medicine, Yu Yan, did in 1917 and 1920). This creation of an empirical tradition, coupled with laboratory research on Chinese materia [End Page 835] medica, allowed reformers to claim that Chinese medicine had something of value to be salvaged despite its apparent lack of “science.” Without belittling the efforts of Chinese medicine reformers, Lei traces both of these innovations to specific medical reforms in Japan.
The biggest challenge to Chinese medicine came not directly from the West, but from Chinese trained in biomedicine who used the power of the state to push their medical agenda. This began with Yu Yan’s 1929 proposal to outlaw Chinese medicine altogether. Although never enacted, partly because of the immediate and well-organized protest actions of the Chinese medical community, this proposal launched the contest between the two medicines into the arena of the state. Lei then explains why, when the state was the source of threat, Chinese medicine reformers actively recruited state involvement, founding the Institute of National Medicine (Guoyiguan) in 1930 and working to fulfill the government mandate to “scientize” (kexuehua) Chinese medicine. To state it briefly, reformers recognized that they had no choice but also cleverly recruited state power to achieve their own goals and work as agents within the “field of the state.” To develop this perspective...