Sivin, Nathan

East Asian Science, Technology, and Medicine (EASTM - Universität Tübingen)

108 EASTM 30 (2009) 
Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthe-
sis. Durham: Duke University Press, 2002, xvii, 407 pp.  
 
Nathan Sivin 
 
[Nathan Sivin is Professor of Chinese Culture and of the History of Science, 
Emeritus, at the University of Pennsylvania. His most recent book is Granting the 
Seasons, a study and translation of the most important Chinese treatise on math-
ematical astronomy (1280). He is now working on a survey of health care in the 
eleventh century.] 
 
 
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 of “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, attain synthesis with biomedicine (xiyi 西 医), and speed 
the flow of income from abroad. 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 yearning of the outside world for something of the old China, trans-
late Zhongyi “Traditional Chinese Medicine,” TCM for short. Just about every 
introductory book on the subject begins by emphasizing its multi-millennial an-
cestry. 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 appre-
hend Zhongyi in many dimensions. Government functionaries, 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 they practice 
it. Within the ruling strata, hostility continues quietly 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 prac-
tices.  
“Traditional” practice incorporates countless new elements. The officially 
promoted system of “pattern differentiation and treatment determination (bian-
zheng lunzhi 辩 证 论 治)” was a creation of the last half-century; ear acupunc-
ture was a French invention; 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 
109 Reviews 
authorities are lax about the Chinese medical diagnosis, a Western medical diag-
nosis 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, but 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. Conventional 
studies see that enterprise as one system, competing with biomedical, popular, 
religious, empirical, and other systems. They describe its techniques, practition-
ers, and doctrines, and explain what leads people to choose its therapy. Scheid 
argues cogently and passionately that seeking a single system or essence that 
subsumes all the variation is self-defeating. Such a unity “has long since seeped 
through the cracks between whatever fragile articulations bind „Chinese‟ to „med-
icine,‟ 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 anthro-
pologist, and an accomplished critical thinker. This book is a most unusual eth-
nology, 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 
ideological, institutional, historical, and personal struggles” in Beijing, where 
that sector is strongest (p. 2). 
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 create, support, destabilize, and tear 
apart [unstable, temporary] global coherences … emerges as the new task of any 
anthropology of medicine” (pp. 13-14, 19-20). I would prefer to say “a new 
task,” since all anthropologists are no more likely than all Sinologists to clamber 
aboard any one bandwagon. 
Scheid‟s stance is post-humanist, allied to that of Andrew Pickering, which 
denies that the determinants of technical change are exclusively human. Scheid 
argues plausibly that in medical thought qi 氣 is an agent, even though obviously 
not in the sense that a physician can be one. Whether one accepts this postmod-
ern stance or not—most of social and political life has hardly evolved past the 
Neolithic, much less past modernity—Scheid characterizes Chinese medicine out 
of his empirical material. He avoids the ambiguity, coy paradoxes, and postmod-
speak on which the fashionable rely to impress their disciples. This epistemology 
yields a rich harvest. 
Concepts and doctrines. The Chinese body has never been a fixed notion. Its 
dynamics greatly outweigh its notions of structure. Systems for identifying bodily 
dysfunctions, schemata of relationships between pulses and visceral functions, 
links between diagnosis and therapy, have mutated through the centuries. Line-
110 EASTM 30 (2009) 
ages of physicians insisted upon neither unitary doctrines nor a single mode of 
knowledge transmission, and there was no profession to enforce either.  
Despite government regulation today, that remains the situation. Because the 
menu of illnesses varies with political vicissitudes and changes in culture, there is 
no consensus on how and when Chinese medicine is to be modernized, or where 
the border lies between traditional and modern forms. Heavily subsidized official 
attempts to integrate Chinese and Western medicine have not yielded a generally 
useful model. Instead of lessening the diversity they have simply added to it.  
Patients. Patients often say that Western medicine is best for acute disorders 
and Chinese for chronic. Nevertheless, Scheid shows that they base their actual 
choices on cost, quality of care, attitudes and behavior of therapists, politics, and 
so on. In the twenty-first-century market economy, many kinds of therapy, Chi-
nese and Western style, have become too expensive for ordinary people. Patients 
who choose “traditional” therapists increasingly report their problems in terms of 
such biomedical categories as diabetes or hepatitis, or refer to laboratory results. 
Because younger patients no longer understand yin-yang and the five phases, 
Zhongyi use Western disease models in their explanations.  
Physicians. It is now routine for practitioners of Chinese medicine to name 
biomedical diseases when advertising their specialties. That is what patients ex-
pect, and doctors know better than to ignore “grassroots power” (pp. 130-131). 
Scheid‟s case study of a cardiologist trained in TCM and “integrated medicine 
(Zhongxiyi jiehe 中 西 医 结 合)”—who opposes both conventional biomedicine 
and the more conservative Zhongyi—shows that “what changes in the process of 
innovation is not Chinese medicine as a system but the practices and views of 
individual physicians” (p. 161). This is the book‟s key point. 
Here is Scheid‟s conclusion: “To argue that contemporary Chinese physicians 
are losing, or may already have lost, touch with traditional medicine misses a 
more significant point—namely, that it is possible to communicate effectively 
across apparently incommensurable paradigms, that horizons are essentially 
open, that plurality is practicable. … the integration of biomedical practices and 
concepts into the field of contemporary Chinese medicine teaches us much about 
how to engage with the other without abandoning the integrity of the self” (p. 
163, my italics). This takes us far beyond the cliché (espoused by superficial 
analysts such as myself) that tradition is bound to resist the modern, but in the 
end is bound to fail.1 
Becoming a physician. Study of a famous old Chinese physician shows how 
a multiplicity of social interactions continually remakes doctrine and practice. 
Prof. Rong has a few disciples (assigned by the government) and number of 
graduate students. The disciples accompany him in the clinic, see patients, record 
his cases for his archive, help with his writing, and do research. One, his son, 
                                                 
1 My 1987 book, Traditional Medicine in Contemporary China (Ann Arbor: Center 
for Chinese Studies, University of Michigan), was based on a study of doctrines taught in 
schools of Chinese medicine during the Cultural Revolution. 
111 Reviews 
embodies the tenth generation of his line, joining him in treating powerful pa-
tients. Another teaches, assists in his writing and, as a teacher, incorporates 
Rong‟s medical lineage into the state bureaucracy. Their relationship gives them 
access to “older forms of social organization, morality, particularism, and implic-
it (or even secret) knowledge” that conflicts with the official educational insist-
ence on the modern, universal, and scientific (p. 177). 
Rong‟s students mainly work on dissertations, which, among many other 
things, “support the marketing of his patented formulas” in China and abroad (p. 
195). The more ambitious strive to establish personal ties that make them more 
like disciples. Some, when later they work in foreign countries, draw on Rong‟s 
international reputation and in turn add to his renown. 
Just as important in forming physicians are Rong‟s activities as an author of 
textbooks and a member of national committees on curricula. He is one of those 
who define the authorized knowledge on which medical-school educations are 
based. Committee members with the greatest prestige decide which of the many 
formulas and clinical patterns (zheng 证) are included and which are ignored. 
Such patterns of personal guanxi 关 系 have, for instance, made dominant in 
official teaching Ye Gui‟s 叶 桂 (or Ye Tianshi 天 士, 1667-1746) patterns for 
diagnosing liver disorders, and banished from the educational system those that 
other well-known physicians prefer. But Rong‟s local and national ties do not 
begin to exhaust the varieties of guanxi; financial relations and contacts on the 
Internet play tangible parts in the careers of other doctors. All these offer ways 
round the Party‟s prescribed ideals of conduct. The content of networks is always 
changing as new possibilities emerge; practitioners recognize each other‟s at-
tempts to combine learning from Han dynasty medical writings with that from the 
New England Journal of Medicine. 
Bianzheng lunzhi 辩 证 论 治, “pattern differentiation and treatment deter-
mination,” often described in medical-school textbooks as the pivot of Chinese 
medicine, is not traditional but an invention of the 1950‟s. From then on, this 
characterization became the norm for contrasting Chinese and Western medicine, 
and for linking TCM to “the shifting Maoist vision regarding the function of 
medicine in society” (p. 209). Teaching it in the new medical schools as an an-
cient form of “dialectics based on naive materialism” promised that “under the 
guidance of the Party and with the help of Western science” modernization could 
succeed (p. 217). 
But there is an unending tension between older generations of doctors (lao-
zhongyi 老 中 医) who insist on the primacy of experience (jingyan 经 验), based 
in the treatment of patients and classical study, and younger ones who find statis-
tics and electron microscopes more accessible than the Yellow Emperor canon. 
Neither group supports in their practice the state‟s view of pattern differentiation 
and treatment determination as a basis for standardizing doctrine and practice. 
Thus bianzheng lunzhi, touted as the basis of TCM, “continually threatens to fall 
apart and needs to be reasserted … [it] continually emerges and disappears as an 
object, discourse, and practice” (p. 237). 
112 EASTM 30 (2009) 
Scheid‟s final example of synthesis and plurality is his case study of a new 
disease in TCM, zhongfeng bu yu 中 风 不 语. He follows the research of a doc-
toral candidate at Beijing University of Chinese Medicine who worked out a new 
nosology to replace a jumble of classical terms for the speech impediments that 
follow a cerebrovascular accident; drew on “biomedical theories regarding the 
production of speech and its pathology” (p. 241); used CAT and MRI scanners to 
study the physiology of the disease; and employed acupuncture loci that Sun 
Simiao 孙 思 邈 had needled 1400 years earlier for similar purposes, adding a 
carefully planned treatment protocol and a control group. Scheid‟s ethnology 
records not only what the experimenter thought and did, but other pertinent di-
mensions: the ancient methods he drew on, the rules he followed, the expecta-
tions of his university and of his two very differently inclined supervisors, the 
standardized tests that his project substituted for classical diagnostic skills, his 
frustration because in TCM guanxi trumped the open propagation of knowledge, 
and so on. His innovation was a hybrid of the natural, the technological, the intel-
lectual, and the sociocultural. That is the norm, but not all historians recognize it. 
The plurality that Scheid has richly documented is not a special characteristic 
of Chinese medicine. Rather, it is “the way things always are—forever changing 
and transforming origins in the whirlpool of their simultaneously present pasts 
and futures.” The dynamic processes that have guided the medical tradition for 
two thousand years are what guide all human striving. In Scheid‟s ethnography, 
“Maoist philosophies of practical dialectics were seen to be infiltrating the treas-
ure-house of Chinese medicine, biomedical concepts of physiology and cybernet-
ics met with the health care of workers and peasants, while century-old tools of 
clinical practice reshaped modern biomedical physiology” (p. 263). 
Historians of medicine do not ordinarily think through a metaphysics, but 
adopt willy-nilly whatever view of reality is conventional in their particular grove 
of academe. Unaware though we may be of our own, we have no trouble recog-
nizing the Maoism of China ca. 1970, or the reductionistic positivism that is the 
norm among scientists in China and elsewhere today. This book, by its frankness 
and its independence of philosophic fashion, will jolt some readers into examin-
ing their presuppositions. We can do with fewer pious reaffirmations of the con-
ventional wisdom. 
What, then, does this book have to say about the future of Chinese medicine? 
That art is bound to remake itself, as it has been doing through the centuries. Of 
its many possible futures, what matters most is the war between two of them. One 
is the official view that, to survive, Zhongyi must be remade in the image of 
modern biomedicine by standardizing and imposing physical reductionism. The 
other leaves the future in the hands of those who practice, forming and reforming 
personal syntheses, using their tools with more or less success, correcting failures 
as they “take small steps, favor reversibility, plan on surprises” (p. 271). 
“What, ultimately, is gained from restraining Chinese medicine by means of a 
rationality blind to its own irrational constitution, and gained for whom? … Why 
not entertain the notion that the plurality of agents that impinge on human health 
113 Reviews 
may best be engaged by means of a similar plurality in the domain of medicine?” 
(p. 273). 
Having looked to the power of the state to attain its goal a quarter century 
ago, and having seen it fail, I have to admit that leaving the future of medicine to 
its practitioners—one by one—is the only realistic option. This is, to sum up, a 
book of the utmost historiographic, ethnographic, and practical importance. 


Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis 

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