Chinese Medicine in Contemporary China: Plurality and Synthesis (review)

Physical science and Marxist-Leninist-Maoist doctrines have been transmuting the doctrines and practice of Zhongyi 中医 for nearly a century. Under the new gospel that believes "to get rich is glorious," the process is, if anything, accelerating. State planners expect Chinese medicine gradually to become an integral part of twenty-first-century thought and attain synthesis with biomedicine (xiyi 西医). Be that as it may, non-Chinese over much of the world make use of Zhongyi's methods and products because-in their eyes-its ancient roots make it intriguingly exotic, because its values are distinct from what they believe are the compromised ideals of modern medicine. Official spokesmen, to meet this expectation of the outside world, translate Zhongyi as "traditional Chinese medicine," TCM for short. Just about every introductory book on the subject begins by emphasizing its multimillennial ancestry. Nevertheless, its ties to early doctrine and practice become ever more tenuous.

Scheid makes it clear that to understand what is happening we have to apprehend Zhongyi in many dimensions. The government and its planners, who decide on budgets and medical school recruitment quotas, live in a different mental world from those who practice medicine-not to mention those on whom medicine is practiced. Within the ruling strata, hostility quietly continues to seethe between the champions of Zhongyi and those who consider it a useless relic of the past. And each practitioner, as well as each patient, experiences the world and acts on it differently: "No two doctors diagnose, prescribe, or treat in quite the same way" (p. 9). They define their identities not only by their place in long lineages, but by how they are using biomedical knowledge and technology to reshape their practices.

"Traditional" practice incorporates countless new elements. The officially promoted system of "pattern differentiation and treatment determination" (bianzheng lunzhi 辩证论治) was a creation of the last half century, ear acupuncture was a French invention, and the use of standard formulas processed into pills or capsules is becoming increasingly dominant. "Chinese medical case records must carry a biomedical diagnosis. Several doctors informed me that while hospital authorities are lax about the Chinese medical diagnosis, a Western medical diagnosis is obligatory for all records (that is, not only for case records but also for outpatient treatment records, laboratory examination requests, etc.)" (p. 93). In every aspect of medicine, syncretism and ambiguity are the rule. Still, this is not the standardized syncretism the state wants.

As the subtitle of this book implies, its framework has little in common with the main stream of research on the history of Chinese medicine. Most studies see that enterprise as one system, competing with biomedical, popular, religious, empirical, and other systems. They describe its techniques, practitioners, and doctrines, and explain what leads people to choose it. Scheid argues cogently and passionately that it is self-defeating to seek a single system or essence that subsumes all the variation. Such a unity "has long since seeped through the cracks between whatever fragile articulations bind 'Chinese' to 'medicine,' and further to 'contemporary' and 'China'" (p. 19).

Scheid is himself an expert Zhongyi; he has practiced his craft since 1984. He is also a deeply learned scholar of early medicine, a sophisticated social anthropologist, and an accomplished critical thinker. This book is a most unusual ethnology, based on participant observation over sixteen months between 1994 and 1999. Its object is not a single institution or group, but the whole state sector of medical practice, education, and regulation. Scheid studies the intersection of ideology with institutional, historical, and personal struggles in Beijing, where that sector is strongest.

This is a work of great ambition, far transcending medicine. It denies that Chinese or Western medicine is a system in any essential sense. Both unendingly changing, they are merely "concepts for and against which to form a position and methodology." It posits that "accounting for and describing the plural and often dispersed interactions at local levels that...