Toward an Understanding of TCM, Part II
One thing I was surprised to learn in my amateur exploration of TCM is that it is not, in fact, traditional Chinese medicine. Perhaps we’re already a bit jaded when it comes to such nomenclature: the World Series in baseball is not truly global, and most of us have heard of the Peacekeeper Missile (now retired), collateral damage and pacification programs (these being instances of euphemisms as doublespeak).
In many not insignificant respects, TCM is decidedly modern, a selective appropriation of specific medical modalities mined from what is better termed Classical Chinese medicine (CCM). What was christened in the second half of the twentieth century as “TCM” involves the ideological legitimation (see below for the motley motivating interests) and selective use of classical Chinese diagnostic techniques and therapeutic regimens by the People’s Republic of China (PRC) under Mao Zedong (or Mao Tse-Tung for the older among us) in the late 1950s and early 1960s.
At first the Communists followed in the footsteps of their Nationalist government opponents in characterizing traditional Chinese medicine as exemplifying superstition and magical thinking, in other words, a theory and practice inimical to modernity and Western biomedicine (xiyi) in particular. Interestingly, from the early nineteenth to early twentieth centuries in China there was an effort toward a via media or rapprochement between the old and the new from within the medical profession by those committed to the hallowed “ideal of the broadly educated master physician” (the movement now referred to as the Chinese-Western Integration School) as they attempted to incorporate some features of modern biomedicine “into the traditional mother body of Chinese medicine” (Fruehauf, 1999). The terms of this incorporation, however, were set by the parameters of CCM.
This endeavor was historically superseded by the naked politicization of Chinese medicine in the first half of the twentieth when adjectives denoting and connoting the hoary properties of CCM became “despicable symbol[s] of everything old and backward” (Fruehauf), the Nationalists and Communists alike adopting attitudes similar to the Jacobin revolutionaries toward the ancien régime.
Mao’s later public embrace of CCM (as TCM) garnered widespread support among the masses, a noticeable portion of which had earlier taken to the streets when Kuomintang public health officials initiated legislative proposals with the goal of abolishing the “Old Medicine.” Baptised “Traditional Chinese Medicine,” colleges became its first institutional vehicle, with hospitals and clinics as well soon vigorously propagating putatively traditional Chinese medicine.
While nominally hearkening back to an earlier era, Mao clarified the nature of State-directed TCM, speaking of “Chinese-Western medicine integration” in a manner that assured everyone that classical Chinese medicine would no longer be transmitted through the venerable hands of its lineage holders, that is, from master to disciple, with its modes of transmission primarily “secret” and “personal” (See Hsu for detailed descriptions of this). To be sure, Mao’s programmtic efforts to modernize Chinese medicine, in effect to standardize its knowledge and practice, has long and well-established precedent in Chinese history. But standardization in this case is accomplished in reliance on philosophical, political, bureaucratic, scientific, technological, and pedagogical ideas, methods and institutions ineluctably associated with modernity. Of course it is naïve, even fantastical, to think CCM could carry over into our time and place unscathed or unaffected by a confrontation (at the levels of both doctrine and practice) with this or that facet of modernity (if you prefer, post-modernity). But we might consider—as a thought-experiment, an act of imagination, or counterfactual reasoning—how the nature and pace of such a confrontation (and negotiation) might vary, depending on several sorts of variables, for example, its leading agents: the State? physicians? regional public health officials? politicians? physicians and their patients? several sectors of civil society free from State manipulation (including some or all of the aforementioned)? electoral outcomes? and so on.
Elisabeth Hsu found the following motivating interests in support of the official and informal ideological sanctioning of TCM in the People’s Republic of China: “nationalism, Confucian values, humanitarian ideals, reformist and Enlightenment movements, the pragmatic politics of a party in pursuit of power, and economic considerations fo how to allocate manpower and scarce resources” (Hsu, 1999).
CCM is clearly in a subordinate and severely circumscribed role vis-à-vis Western medicine as a result of Mao’s vision of “Chinese-Western medicine integration,” as Hsu makes clear: “TCM…is generally referred to as the ‘modernised’ (xiandaihuade), ‘scientific’ (kexuehuade), ‘systematic’ (xitonghuade), and ‘standardised’ (guifanhuade) Chinese medicine.” Insofar as traditional or classical Chinese medicine is indissolubly bound up with ancient religio-philosophical ideas (e.g., dao [or tao], qi [or ch’i], yin/yang, wuxing [Five Phases], and shen [spirit]) essential to its doctrine, as well as shamanic, temple-based, divinatory, qigong (breath control or meditation), and home-based herbal drug and other pre-modern practices that conspicuously clash with Mao’s variation on the Marxis-Leninist ideological theme, we can readily make sense of this.
Indeed, “Chinese-Western medicine integration” as TCM calls to mind Eric Hobsbawm’s oft-cited because important observation that “‘Traditions’ which appear or claim to be old are often quite recent in origin and sometimes invented” (Hobsbawm and Ranger, eds., 1983). And those attracted to TCM because they are generally enamored of all things exotic and Orientalist might consider the fact that acupuncture and moxibustion had been used in Europe for roughly 300 years and were popular among physicians in early nineteenth century America before their recent ascendancy as one form of alternative or complementary medicine (Sivin, 1990).
Finally, we should note the Chinese have understood the benefits and burdens that come with traditional physicians having been confined to a “largely hereditary office holding elite before the present millenium, but one based increasingly on wealth and achievement from the eleventh century on” (Sivin, 1999). They all-too-keenly appreciate the historical distinction “between the relatively few literate, well-born physicians who left the enormous written record, and the plebian practitioners of every stripe, generally illiterate for most of Chinese history, who cared for the overwhelming majority of the population” (Sivin, 1999). And the “enormous written record” referred to here, as Sivin reminds us, “were not abstact bodies of theories, but keys to diagnosis, prognosis, and therapy. Mastering them was a necessary step on the way to becoming a good doctor.”
To repeat: such mastery was achieved in the intimate interpersonal context of the master/student relationship defined by its personal and secret modes of transmission of medical knowledge and practice. The distinction between elite and plebian doctors was (and is) transcended in part by the nature of the transformation of CCM into TCM under the aegis of the PRC, effectively serving to democratize aspects of CCM that were once the prerogative of well-born physicians and their equally if not better-placed patients. I would argue that one salutary aspect of this democratization was well expressed in China’s “barefoot doctor” program, an ambitious, imaginative, and long-overdue attempt to extend the concrete achievements and virtues of urban public health into the countryside (on the eve of the 1949 revolution, about 80 percent of the population were rural peasants) (For a brief introduction, see Vikki Valentine’s piece for NPR, 2005. I hope to examine the “barefoot doctor” program in more detail in a future post).
We’ll close with the following from Heiner Fruehauf’s article that first appeared in The Journal of Chinese Medicine (6/16, October 1999): Recent institutional developments, most of them tied to market imperatives and priorities established in the wake of “cowboy capitalism” (William Hsiao) in China, and which give pride of place to Western medical concepts and practices, are “finaliz[ing] the process of ‘evolution by integration’ that Mao had prescribed for Chinese medicine 40 years ago—a process that involves gutting the indigenous art of its spirit and essence and subsequently appropriating its material hull (i.e., herbs and techniques) into the realm of a medicine that declares itself scientifically superior.”
Our next and final installment on this topic will discuss the religio-philosopical foundations—spirit and essence—of CCM and the issue of incommensurability between CCM and Western biomedicine, with an admittedly narrow focus on acupuncture.
Fruehauf, Heiner. “Chinese Medicine in Crisis: Science, Politics, and the Making of 'TCM,'" The Journal of Chinese Medicine, 61/6, October 1999. Online version (slightly longer): http://www.classicalchinesemedicine.org/ccm/index.htm
Hobsbawm, Eric and Terence Ranger, eds. The Invention of Tradition. Cambdige, UK: Cambridge University Press, 1983.
Hsu, Elisabeth. The Transmission of Chinese Medicine. Cambridge, UK: Cambridge University Press, 1999.
Sivin, Nathan. “Science and Medicine in Chinese History,” (1990) Available at http://ccat.sas.upenn.edu/~nsivin/writ.html
Sivin, Nathan. “Text and Experience in Early Chinese Medicine,” (1999) See above for URL.
Valentine, Vikki. “Health for the Masses: China’s ‘Barefoot Doctors,’” NPR.org, available at http://www.npr.or/templates/story/story.php?storyId=4990242