Mix ’n’ match

Roy Porter

  • The Essential Book of Traditional Chinese Medicine. Vol. I: Theory by Liu Yanchi, translated by Fang Tingyu and Chen Laidi
    Columbia, 305 pp, $40.00, April 1988, ISBN 0 231 06196 X
  • The Essential Book of Traditional Chinese Medicine. Vol. II: Clinical Practice by Liu Yanchi, translated by Fang Tingyu and Chen Laidi
    Columbia, 479 pp, £80.00, April 1988, ISBN 0 231 06518 3
  • Traditional Medicine in Contemporary China by Nathan Sivin
    University of Michigan Centre for Chinese Studies, 549 pp, $22.50, September 1987, ISBN 0 89264 073 1

The more people feel that modern medicine has let them down, or at least has failed to live up to its own exalted expectations, the more alluring the prospect of looking to China as an alternative source of medical theory and practice. After all, China offers one of the very few medical traditions which continue to hold their own in the face of the hegemony of the Western medical model. Its attractions to anyone with a mind for alternative medicine are many and powerful. It is holistic through and through, and oriented upon health no less than disease. The whole body is more than the sum of its chemistry or mechanics, and so sickness is not to be understood in terms of the pathology of isolated organs considered as cogs in a machine, but rather as the disfunction of a normally harmonious, complete living entity. Hence healing requires the care of body and mind, indeed a grasp of the sway of emotion and of the dynamic interplay of the whole person with the wider sociophysical environment.

For these reasons, Chinese medicine cannot be taken – as in the West – as a technique for conquering disease, viewed as lesions caused by alien, invasive pathogens: it is, rather, an approach to healing the whole person. Each individual’s maladies are to be treated as in some degree unique, to be understood not through a battery of standardised laboratory probes, but by the astute practitioner who sensitively interprets all symptoms to form a diagnostic profile, drawing upon such craft methods as a pulse-lore which values the qualitative no less than the quantitative.

If, in the name of scientific exactitude, Western medicine tends, indeed aims, to reduce healing to standardised diagnostics, and drug therapeutics, traditional Chinese medicine, it may be argued, gives priority to the unique concatenation of circumstances producing sickness in the individual, and cultivates treatments which are less specifics against disease (the pill for the ill) than a means of fortifying the sick individual’s system. Acupuncture, above all, can be paraded as epitomising this higher wisdom of Oriental medicine: here is a therapeutic technique of proven efficacy which is quite beyond the vaunted powers of Western scientific patho-anatomy to explain.

There is much truth in claims of this sort, so often touted by Western alternative medicine fans on behalf of indigenous Chinese medicine. As is quite clearly brought out in The Essential Book of Traditional Chinese Medicine – a work specially produced for a Western readership – the thinking that underlies Chinese medicine is indeed holistic and dynamic: one is tempted to say, dialectical. Thus, yin and yang are never to be viewed as mere polar opposites, but as interpenetrating components, latent and active, of a contextual, relational system. Nothing is exclusively or permanently yin or yang: such attributes hinge upon the relationship of the object to the wider system at that particular moment.

Likewise with the so-called ‘Five Phases’ – water, fire, wood, metal and earth. It is a mistake – though a tempting one – to view these as analogous to the four elements of Greek Western humoral theory: in other words, essentially as material substrates, the building-blocks of reality. They must be seen instead as dynamic moments in continuous cycles of growth and decay, rising and falling, disintegration and re-integration, marks of the fruitful antagonisms of conflicting principles.

Above all, as Nathan Sivin emphasises in the major introduction to his translation of the Revised Outline of Chinese Medicine (1972), the entire terminology employed by traditional Chinese medicine, including such concepts as ch’i – commonly, though too loosely, translated as ‘energy’ – is one which does not label and classify physical organs, but identifies the inner processes of the organism. When Chinese medicine uses terms which, by way of convenient shorthand, tend to be translated into somatic terms such as ‘heart’, ‘kidneys’, ‘lungs’, these must not be equated with the structures so familiar from Gray’s Anatomy, but with a chain of functions, governing such bodily processes as reinforcement, purification, strengthening, digestion, purgation.

Small wonder, then, that the health-conscious Westerner finds great attraction in the Chinese conception that, for each individual, the balance between health and sickness does not primarily depend upon the invasive power of anonymous, external micro-organisms, nor even upon the arsenal of medicines available to the doctor. What counts is the vital strength of the whole person, as concentrated in the psycho-physical energetic resistances (ch’i) which the individual can fortify by leading a healthy life.

So far so good. It would, of course, be extremely easy to point to the folly and confusion brought about by indiscriminate championship and selective borrowing of Chinese healing by those intent upon making it conform to an ideal type of alternative medicine, as conceived by the radical Western imagination. It is as simple to mock all those Western health freaks who see in acupuncture a sort of fix for all their psychosomatic pains (the lure of the needle once again?) as it has been to deflate the dreams of those Sinophiles who were so confident that in the barefoot people’s doctor lay the solution to all the ills of the overbearing, over-professionalised modern Western practitioner. Using Chinese traditional medicine as a stick with which to beat modern Western scientific medicine – for being mechanistic, reductionistic, dehumanising, and all the familiar litany – obviously does not provide the ideal climate for actually understanding it.

The special strength of Sivin’s superb essay lies in his demonstration of the extreme intractability of this problem of understanding Chinese traditional medicine, both past and present: because that entity is a figment not merely of Western wishful thinking – the invention of a mythic exotic ideal – but of Chinese ideological struggles as well. When current digests of Chinese medicine recite, for instance, how the tradition has arisen out of practical experience and has been handed down in the folk memory time out of mind, such attractive visions of popular medicine, of healing from below, must not be taken at face value: they should be read as the rhetoric of the People’s Republic under the directives of the Cultural Revolution. Chinese traditional medicine – at least as transmitted in books – may be no less the work of a learned élite than is Western medicine.

Far from being a simple encodement of practical empirical wisdom, it constitutes a highly stylised and abstract literary and conceptual system. A term such as ‘hot’, used with reference to the properties of a drug, does not necessarily connote any subjective impression of warmth which a patient might directly experience; nor, of course, is it a mark of a thermometer reading. It registers a sophisticated cluster of meanings which indicate the virtues of the preparation within the internal metaphysics of the system. Automatically to construe Chinese medicine as a people’s medicine – any more than, say, Galenism was in Medieval Europe – would be to commit the romantic or the primitivist fallacy.

Above all, Sivin rightly insists, historians must not mythologise Chinese traditional medicine as a timeless folk wisdom. The guardians of the tradition have, of course, a powerful investment in commandeering immemoriality, as a way of rendering its customary authority immune to question, and denying cracks and contradictions. But this is no less a fiction than the myth of the timelessness of the British constitution or common law, once so beloved of lawyers and politicians. Indeed, historical analysis of the canonical texts of classical Chinese medicine reveals exactly the kinds of hiatuses and ambiguities to be found in the Western humoral tradition as developed from the Hippocratic writings, through Galen, to the corrupted or purified recensions produced by Arabic and Renaissance scholars. The precise meaning and status of a concept such as hsueh – very approximately translatable as ‘blood’ – has been no less a matter of evolution and protracted negotiation than the fortunes of a Western concept such as ‘black bile’.

In particular – and here lies the nub of Sivin’s argument – today’s texts of Chinese medicine – both those produced for Chinese use, such as the text of 1972 which he has translated as the Revised Outline of Chinese Medicine, and ones designed specially for Western consumption, such as the Essential Book of Traditional Chinese Medicine, the work of the Beijing College of Traditional Chinese Medicine – cannot be taken at face value as the repositories of a long tradition: they have ideological fish of their own to fry. They are, above all, the fruits of convoluted attempts to grapple with two epochal events which have shaken native Chinese medicine over the last couple of generations.

On the one hand, they have had to respond to the pressures resulting from Mao’s Cultural Revolution. The practical goals of the Revolution – above all, the anti-élitist drive to take ownership of knowledge out of the hands of cliques of experts – demanded much surreptitious simplification of the tradition. Where Chinese medicine traditionally put the greatest premium upon the subtle task of drawing a holistic illness profile unique to each sufferer, today the business of reaching clear, direct and speedy diagnoses – often as a prelude to a shot of antibiotics – has assumed greater priority.

Moreover, the revolutionary espousal of Marxism-Leninism has also had its impact. Dialectical materialism has required that certain elements of traditional medicine – the idea, for example, that some illnesses may be the result of spiritual possession – be discarded as ‘superstitious’, rather as psychiatric disorders readily became stigmatised as political deviationism. Above all, Marxist epistemology has demanded definitions of bodily functions more materially embedded than heretofore. Hence the Essential Book habitually uses organic terms such as ‘pathogen’ or ‘blood’ despite the fact that – as Manfred Porkert’s superb philological scholarship has demonstrated – such a substantialisation of concepts fundamentally betrays the ‘processual’ bent of traditional Chinese medicine, the concern not with what organs are but with what they do.

Marxism is one of two ‘alien’ materialist Western traditions which Chinese medicine has been forced for political reasons to accommodate. Another – in the long run, a far more profound challenge, or indeed threat – is Western medicine itself. In many specialities – for instance, in the treatment of acute and infectious diseases – Western scientific medicine is standardly accepted in China as superior, and Western pharmaceutics have been widely introduced. The world-wide prestige of Western scientific medicine can hardly be gainsaid.

But Western medicine brings with it investigative techniques and an ontology quite alien to the conceptual structures of Chinese medicine: above all, perhaps, an anatomical way of thought, preoccupied with the physical structure of organs, with disease localisation, and with the lesion as the site of disease. What then is to happen if the ‘channels’ of Chinese medicine are found to have no anatomical reality in the Western scientific model? How is Chinese medicine to respond to the demonstration, by Western science, that the brain and the nervous system govern consciousness – seeing that Chinese medicine attributes secondary importance to these organs, and regards the ‘heart’ as crucial to consciousness?

Precisely like a late-Medieval Scholastic summa, blithely unifying Plato and Aristotle, Greek thought and the Bible by dint of verbal gymnastics, the Essential Book does its manful best to pretend that everything in the garden is rosy, and that no fundamental incompatibilities divide the Chinese tradition and those elements of Western medicine it seeks to incorporate, or cannot avoid incorporating. But, as Sivin contends, the policy of ‘mix ’n’ match’ can at best work as a temporary expedient, a holding operation. In the long run, some less ad hoc intellectual strategy must be devised. This could be a policy of peaceful co-existence between the two medicines (adopting bipolar visions of reality, separate but equal), or an attempt to carve out a principled division of labour (say, the integration of Western scientific anatomy and pharmacology, while maintaining a traditional approach to clinical healing). Otherwise, the irony will be that the Marxist-Leninist materialism of Mao’s revolution will inevitably prove a Trojan horse, opening the gates piecemeal to the materialism of Western science. Of course, the problem in reverse form confronts Western medicine too: but the cultural pressures upon Western doctors to accommodate Chinese medicine are quite minuscule in comparison.

These works do not merely offer an accessible entrée into Chinese medicine: they also present a fascinating insight into the politics of intellectual continuity and change. Above all, they reveal the strategies typically used for reasserting tradition, stability and unity in the teeth of the disruption and disaggregation wrought by the struggle between what Thomas Kuhn called ‘incommensurable paradigms’. Watching the fate of Chinese medicine may tell us much about the processes by which, in our own Scientific Revolution, the Ptolemaic-Aristotelian tradition succumbed to Copernicus.