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

Hilary A. Smith's Forgotten Disease: Illnesses Transformed in Chinese Medicine is an extraordinary book, replete with rich and imaginative storytelling and insightful analyses of materials spanning different periods and national traditions. Forgotten Disease also intervenes in a key debate among historians of Chinese medicine. Since some readers may be unfamiliar with this debate, it would be useful to situate Smith's contribution within its historiography. Exemplified by the writings of scientists, such as Joseph Needham in his Science and Civilisation project, the older approach narrates—or, better still, measures—the history of medicine from the perspective of modern Western biomedicine.¹ It privileges modern biomedical disease categories over premodern or non-Western understandings of nature and treats both premodern and non-Western understandings of the human body as incomplete or more primitive versions of science. This framework also conflates Chinese terminology for illness with modern disease categories, leading scholars to identify mafeng 麻瘋 as leprosy and nüe 瘧 as malaria. Since the 1990s, this approach has come under attack for its anachronism and its lack of sensitivity to the different ways that historical actors experienced and made sense of illness. Under the influence of postmodernism, the next generation disengages from modern biomedicine, emphasizing the incommensurability between Chinese and Western understandings of illness and the human body. Such an approach, epitomized by Shigehisa Kuriyama's The Expressiveness of the Body and Ted Kaptchuk's The Web That Has No Weaver, has prompted the next generation of historians to emphasize the alterity of classical Chinese understandings of illness.² In this framework, premodern Chinese conceptions of the body and of illness could not be reduced to more primitive understandings of (Western) disease. Yet this approach too has been criticized in recent years. A new generation of scholars, exemplified by Bridie Andrews, Sean Lei, and Volker Scheid, argue that such a contrast tends to treat Chinese medicine as an unchanging and homogeneous tradition.³

Forgotten Disease builds upon current efforts to supply a historically nuanced and culturally sensitive analysis of one elusive illness in East Asia, foot qi (Ch. jiaoqi 腳氣, J. kakke 脚気). Through this case study, Smith challenges the universality of biomedical disease categories while doing justice to the diversity of beliefs now identified with East Asian medical traditions. Previous scholars such as Hsing-Tsung Huang, a contributor to Science and Civilisation, render foot qi as the equivalent of beriberi, a condition caused by a deficiency of thiamine (vitamin B1).⁴ Biomedical researchers link beriberi with a diet high in polished rice and raw fish, both of which deplete the body of its store of vitamin B1 and cause chronic illnesses afflicting the legs. Smith argues that, while beriberi has served as the standard translation for foot qi since the late nineteenth century, the term has a broader range of meanings, which are obscured by modern renderings of the compound. Her book thus attempts to recover those meanings. Through a meticulous examination of the textual record, Smith demonstrates that foot qi only became equated with beriberi in the late nineteenth century and in Japan. Yet this period was not the first time that the meaning of foot qi was transformed. For centuries, Chinese physicians debated the meaning of foot qi, devising competing explanations of the sources of foot qi and arriving at contrasting therapies for it. To demonstrate these changing and varied understandings of foot qi, Smith reconstructs the different understandings of foot qi in seven chapters, situating each of them in their historical contexts.

Chapter 1, "Foot Qi in Early Chinese Medicine," traces the earliest extant references to foot qi in the medical writings from the fourth century by Ge Hong 葛洪 (284–364 ce). Smith places foot qi in the broader context of northern migration to the south during the period of division (221–589). As she writes, northern émigrés, such as Ge Hong, regarded the south as a...