History of Medicine in China — Conference Course
Spring 2000

TJ Hinrichs <hinrichs@post.harvard.edu>

An exploration of processes of change in medicine in China. Focuses on key transitions, such as the emergence of canonical medicine, of Daoist approaches to healing and longevity, of "Scholar Physicians," and the making of Traditional Chinese Medicine in modern China. Inquires into the emergence of new healing practices in relation to both popular and specialist views of the body and disease, "cultivating vitality" practices, modes of transmission of medical knowledge, and healer-patient relations. Course readings include primary texts in translation as well as secondary materials.

Requirements:

Texts for purchase (also on reserve):

The Yellow Emperor’s Classic of Internal Medicine, trans. Ilza Veith, New Edition, (Berkeley: University of California Press, 1949, 1966, 1972).

Ted J. Kaptchuk, The Web That has no Weaver: Understanding Chinese Medicine, (NY: Congdon & Weed, 1983).

Shigehisa Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine, (New York: Zone Books, 1999).

Hsu, Elisabeth, The Transmission of Chinese Medicine, (Cambridge: Cambridge University Press, 1999).

All other assigned texts are available on reserve.

Chinese Medicine Web Page


1. Introduction

Unit I: Canonical Medicine

In the next four weeks, we will be comparing various scholars’ explanations of canonical Chinese medicine, and examining canonical texts and their commentaries in translation. Although the "Classics" of Chinese medicine were compiled between the Han and Tang periods, centuries during which medicine continued to change in China, it has been difficult for scholars to unravel many of the conceptual and practical changes that occurred across these centuries. Modern scholars and translators often attempt to present a coherent description of Chinese medicine, and rely on the interpretations of contemporary practitioners, leading to anachronistic translations and interpretations.
 
 

2. Basic Concepts of Canonical Medicine: Body and Cosmology

What is the "body" of canonical medicine? How does this body relate to Han cosmology? What does it mean to say that the body is a microcosm? How does the language of politics appear in these descriptions of the body? How do physicians in the Greek and Chinese traditions "see" the body differently? What is the role of the Nanjing (Nan-ching) in the formation of canonical medicine? What sorts of issues were problematic for the authors of the Nanjing and its commentators?
 
Primary The Yellow Emperor’s Classic of Internal Medicine, Books 1-3, pp. 97-146.

Paul Unschuld, trans, ann., Medicine in China: Nan-Ching: The Classic of Difficult Issues, pp. 11-28, 63, Difficult Issues #12, 16, 18, 25, 31, 36-39, 42.

Secondary Ted J. Kaptchuk, The Web That has no Weaver, pp. xix-xxi; 1-76, 343-357. [Skim repetitive technical sections.]

Shigehisa Kuriyama, The Expressiveness of the Body, Preface, Chapters 3-4.

Suggested Nathan Sivin, "State, Cosmos, and Body in the Last Three Centuries b.c.," Harvard Journal of Asiatic Studies (June 1995) 55.1:5-37.

Ishida Hidemi, "Body and Mind: The Chinese Perspective," in Taoist Meditation and Longevity Techniques, ed. Livia Kohn, et. al. (Ann Arbor: Center for Chinese Studies, The University of Michigan, 1989), pp. 41-72.

John Hay, "The Body Invisible in Chinese Art?" in Body, Subject & Power in China, eds Angela Zito and Tani Barlow, (Chicago: University of Chicago Press, 1994), pp. 42-77. 

John Hay, "The Human Body as a Microcosmic Source of Macrocosmic Values in Calligraphy," in Self as Body in Asian Theory and Practice, ed. Kasulis, Ames, and Dissanayake, (New York: SUNY Press, 1993), pp. 179-211.

Roger T. Ames, "The Meaning of Body in Classical Chinese Philosophy," in Self as Body in Asian Theory and Practice, pp. 157-177.

Presentations Compare the descriptions and translations of key concepts (correlative cosmology (systems of correspondence), yin and yang, body, qi (ch’i), blood, jing (ching, essence), shen (spirit), organs (viscera), five phases) by Kaptchuk with those by Ilza Veith, Paul Unschuld, Nathan Sivin, Judith Farquhar, and Manfred Porkert, and Joseph Needham and Lu Gwei-Djen.

 

3. Basic Concepts of Canonical Medicine: Approaching Illness

What is health? What is disease? What is the difference between a patient’s experience of illness and a physician’s diagnosis of disease? How have physicians in the Greek and Chinese traditions understood the sources of illness? How do their approaches relate to their views of the body?
 
Primary The Yellow Emperor’s Classic of Internal Medicine, Books 4-7, pp. 147-211.

Nan-ching, Difficult Issue #51.

Secondary Kaptchuk, The Web That has no Weaver,pp. 77-137. 

Kuriyama, The Expressiveness of the Body, Chapters 5-6.

Presentations Compare the descriptions and translations of key concepts (pulse/meridians/channels/vessels, acupuncture points, causes of illness/disharmony) by Kaptchuk with those of Sivin, Farquhar, Porkert, Needham and Lu, Harper, Kuriyama, and Unschuld, as above.

 

4. Diagnosis and Treatment

How do physicians diagnose and treat patients? What is the importance of the patient’s family? In what ways do the Greek and Chinese traditions of pulse diagnosis differ? What is the difference between treating a disease and treating a "pattern"? Xu Dachun (Hsü Ta-ch’un (1693-1771)) was one of the first medical thinkers to explicitly differentiate disease (translated by Unschuld as "illness") from pattern (translated by Unschuld as "pathocondition"). How does he define these terms, and does his understanding differ from Kaptchuk’s?
 
Primary The Yellow Emperor’s Classic of Internal Medicine, Books 8-9, pp. 213-253.

Tamba Yasuyori, The Essentials of Medicine in Ancient China and Japan: Yasuyori Tamba’s Ishimpô, trans., Emil C. H. Hsia, Ilza Veith, Robert H. Geertsma, (Leiden: E. J. Brill, 1986), Vol. 1, pp. viii-ix, 43-60.

Nan-Ching, Difficult Issue #61.

The Divine Farmer’s Materia Medica, pp. i-xvi, selections.

Xu Dachun (Hsü Ta-ch’un) (1693-1771), Forgotten Traditions of Ancient Chinese Medicine: The I-hsüeh Yüan Liu Lun of 1757 by Hsü Ta-Ch-un, trans. and ann. By Paul U. Unschuld, (Brookline, Mass.: Paradigm Publ., 1990), pp. 114-116, 90-94.

Secondary Kaptchuk, The Web That has no Weaver, pp. 138-266

Kuriyama, The Expressiveness of the Body, Preface, Chapters 1-2.

Presentations Compare the descriptions and translations of key concepts (signs and symptoms, patterns/syndromes/manifestation types) by Kaptchuk with those of other scholars, as above. Which of these concepts are explicated in the The Yellow Emperor’s Classic of Internal Medicine?

 

5. Historical and Social Context of the Emergence of Canonical Medicine

How did early physicians distinguish themselves from other types of healers? How do scholars distinguish medicine from other types of healing? What are fangshi? In what respects do the ideals for physicians, such as Hua T’o, differ from those of other types of healers, such as Fei Ch’ang-fang?
 
Secondary
Suggested Nathan Sivin, "Text and Experience in Classical Chinese Medicine," in Knowledge and the Scholarly Medical Traditions, ed Don Bates, (Cambridge: Cambridge University Press, 1995), pp. 177-204.

 


Unit II. Diverse Perspectives

Although the literate traditions of Chinese medicine are dominated by the Inner Canon, this is not the total of Chinese healing practices. In the coming weeks, we examine traditions of healing or cultivating health whose streams of transmission did not always flow with the currents of canonical medicine. We will also examine the relationships of these practices and practitioners with those of canonical medicine.
 
 

6. "Nurturing Life"

Touched upon last week in regard to the emergence of canonical medicine, "nurturing life," "cultivating vitality," or "macrobiotic hygiene" practices have a long history in China. This history, however, is not a linear one. What are some of the major historical developments in the history of "nurturing life" practices? What do these practices include? What is the difference between "External Alchemy" and "Internal Alchemy." Is this division apparent in Ge Hong’s (Ko Hung) work (see Ware trans., below)? How do immortality cults relate to health? What do the manufacture and ingestion of gold and cinnabar elixirs have to do with to spiritual salvation? What is the role of "transformation" or "metamorphosis" in these texts?
 
Primary Harold D. Roth, "The Inner Cultivation Tradition of Early Taoism," in Donald S. Lopez, Jr., ed., Religions of China in Practice, pp. 129-148.

Donald Harper, trans. and study, Early Chinese Medical Literature: The Mawangdui Medical Manuscripts, (London and New York: Kegan Paul International, 1998), pp. 385-411, 305-371, 412-422, 425-428 (MSIIA-MSIV, MSVI.A-B, MSVII.B).

James R. Ware, trans. and ed., Alchemy, Medicine and Religion in the China of A.D. 320: The Nei P’ien of Ko Hung, (New York: Dover Publications, 1966), ch. 2, 4. [Note: Ware translates Dao "The Way" as "God," and xian "immortal" as "genie."]

Secondary Roth, "The Inner Cultivation Tradition of Early Taoism," pp. 123-128.

Donald Harper, Early Chinese Medical Literature, pp. 110-147.

Livia Kohn, "Medicine and Immortality in T’ang China," Journal of the American Oriental Society 108.3 (1988):465-469.

Charlotte Furth, "Rethinking Van Gulik: Sexuality and Reproduction in Traditional Chinese Medicine," in Christina Gilmartin, et. al., Engendering China: Women, Culture, and the State, (Cambridge: Harvard University Press, 1994), pp. 125-146, 408-412 (fn).

Suggested Tamba Yasuyori, Ishimpô, Vol. 2.

Taoist Meditation and Longevity Techniques, ed. Livia Kohn, et. al. (Ann Arbor: Center for Chinese Studies, The University of Michigan, 1989).

Suggested, cont. Douglas Wile, Art of the Bedchamber: The Chinese Sexual Yoga Classics Including Women’s Solo Meditation Texts, (Albany: State University of New York Press, 1992).

 

7. Demons, Epidemics, and Exorcism

What were demonic views of disease in early China? How did people go about preventing and healing demonic afflictions? What is gu (ku)? How do these practices and views of health and disease compare and contrast with those of canonical medicine and macrobiotic hygiene? With the populated bodies of last week? Why might epidemics lend themselves to demonic interpretations? How did plague-exorcising festivals differ from other forms of exorcism, and how did they change over time?
 
Primary Donald Harper, Early Chinese Medical Literature, pp. 301-302, 423-424 (MSI.E.271-277, MSVII.B).

Tamba Yasuyori, Ishimpô, Vol. 2, pp. 67-70.

Secondary Donald Harper, Early Chinese Medical Literature, pp. 148-183.

Bodde, Derk. Festivals in Classical China: New Year and Other Annual Observances During the Han Dynasty 206 b.c. - a.d. 220, (Princeton: Princeton University Press, 1975), pp. 387-395, 75-138. [ 

Paul Katz, Demon Hordes and Burning Boats: The Cult of Marshal Wen in Late Imperial Chekiang, (Albany: State University of New York Press), pp. 39-76.

Suggested Bodde, Derk. Festivals in Classical China, pp. 302-316.

Feng, H. Y. and John K. Shryock, "The Black Magic in China Known as Ku, Journal of the American Oriental Society, 55 (1935):1-30.


 
 
 

8. Populated Bodies, Daoism, and Medicine in Medieval China

Medieval Daoist (Taoist) texts present yet another view of the self, the body, and of disease. Do these landscapes resemble those discussed by Vivienne Lo? How do these Daoist views of the body and health compare to those of classical medicine? Of macrobiotic hygiene? Of "shamanic" or "fangshi" practices?
 
Primary "Body Gods and Inner Vision: The Scripture of the Yellow Court," trans. Paul W. Kroll, in Religions of China in Practice, pp. 149-155. 

Tamba Yasuyori, Ishimpô, Vol. 2, pp. 55-59.

Hong Mai (1123-1202), Records of the Listener (Yijianzhi) (1161-1198), selections.

Secondary Kristofer Schipper,The Taoist Body, pp. 100-112.

Michel Strickmann, "Magical Medicine: Therapeutic Rituals in East Asian Tradition," unpublished ms., selection.

Li Jianmin, "Contagion and its Consequence: The Problem of Death Pollution in Ancient China," presented at the 21st International Symposium on the Comparative History of Medicine — East and West, Taniguchi Foundation, Mishima, Japan, Sept. 1-7, 1996.

Livia Kohn, "Kôshin: A Taoist Cult in Japan; Part II: Historical Development," Japanese Religions 20.1 (January 1995): 34-55.


 

9. Gender and Healing in Late Imperial China

For the Song (960-1279), Ming (1368-1644), and Qing (1644-1911) periods, commercialization, the spread of printing, and literacy created wider markets for medical texts and other varieties of literature. The textual resources of this period give us rich materials for studying the lives of women and non-élite groups. In this section we look at scholarship on gendered bodies, and women as healers and patients. What were women’s roles as patients, decision-makers, and healers? What were women healers’ statuses, and when were they called in preference to other types of healers? How did canonical medicine theorize gender difference? How did Ming healers distinguish women’s diseases from men’s diseases? What diseases were specific to women? How were women able to assert control over their bodies?
 
Primary Donald Harper, Early Chinese Medical Literature, pp. 372-384 (MSV).

The Yellow Emperor’s Classic of Internal Medicine: Review passages on the differences between the genders.

Xu Dachun (Hsü Ta-ch’un), Forgotten Traditions of Ancient Chinese Medicine, pp. 333-334.

Secondary Charlotte Furth, A Flourishing Yin: Gender in China's Medical History: 960-1665; (Berkeley: University of California Press, 1999), pp. 19-93, 266-312.

Francesca Bray, "A Deathly Disorder: Understanding Women's Health in Late Imperial China;" in Knowledge and the Scholarly Medical Traditions, pp. 235-251.

Suggested Furth, A Flourishing Yin, pp. 94-265.

Christopher Cullen, "Patients and Healers in Late Imperial China: Evidence from the Jinpingmei." History of Science 31 (1993): 99-150.

Francesca Bray, Technology and Gender: Fabrics of Power in Late Imperial China, (Berkeley: University of California Press, 1997), Part III.


 


Unit III. Developing and Contesting Medical Orthopraxies

From the Song period (960-1278 c.e.) on, China’s ruling élites became increasingly involved in the production and distribution of medical knowledge, and eventually in the practice of medicine. This introduced new types of political, economic, social, and cultural dynamics to medical knowledge and practice. In some periods, Chinese governments became involved in medical education and the compilation and distribution of medical texts, and in providing what we today would think of as public health. In this unit, we will concentrate in particular on the development and promotion of certain styles of medicine as right and proper, and the denigration and active suppression of other styles of healing.
 
 

10. Scholar Physicians

From the tenth century, with the spread of printing, medical texts became available to a wider audience. This included élites, who took an interest in medical texts as scholars, as officials involved in epidemic relief, and as leaders morally concerned with the spread of medical knowledge. In the twelfth to fourteenth centuries, with access to bureaucratic careers increasingly restricted, élites trained in "Confucian" scholarship turned increasingly to medical careers. What made careers in medicine an attractive alternative to office-holding, scholarship, and teaching? What role did the wider availability of printed texts play? Why might medical cases histories have been especially useful both for the new styles of medical practice developed by scholar physicians, and for the new ways in which many people were now learning medicine? What were the key points of Xu Dachun’s (Hsü Ta-ch’un) moral agenda? How did textual study and historical analysis relate to this agenda?
 
Primary Zhu Danxi, Extra Treatises Based on Investigation and Inquiry: A Translation of Zhu Dan-xi’s Ge Zhi Yu Lun, Yang Shou-zhong and Duan Wu-jin, trans., (Boulder: Blue Poppy Press, 1997), pp. ix-xiii, 1-12, 29-35, 124-133. 

Xu Dachun (Hsü Ta-ch’un), Forgotten Traditions of Ancient Chinese Medicine, pp. 1-5, 51-52, 130-131, 154-155, 160-164, 169-170, 179-184, 213-214, 222-223, 228-230, 233-249, 276-277, 311- 337, 356-392.

Secondary Angela Leung, "Transmission of Medical Knowledge from the Sung to the Ming."
Suggested Robert Hymes, "Not Quite Gentlemen? Doctors in Sung and Yuan;" Chinese Science , no. 8 (January 1987): 9-76. 

Chao Yuan-ling, "Medicine and Society in Late Imperial China: A Study of Physicians in Suzhou," Ph.D. diss., UCLA, 1995.


 

11. Medical Governance in Imperial China

Here, we examine the roles of medical bureaus (from the sixth century), imperially-commissioned medical texts (from the tenth century), government responses to epidemics, and general medical relief such as the distribution of drugs to the poor (especially in the eleventh to fourteenth centuries). Did government medical activities establish medical orthodoxy? Produce and spread medical knowledge? What were some theories of epidemics? How was contagion conceived? Why were quarantines uncommon in Chinese history?
 
Primary Translations of passages concerning "Sagely Powder," from the writings of Su Shi (popular official, celebrated writer and cultural theorist, 1036-1101), Ye Mengde (official, 1077-1148), and Chen Yan (medical theorist, fl. 1174).
Secondary Hugh Scogin, "Poor Relief in Northern Sung China." Oriens Extremus , no. 25 (1978): 30-46.

TJ Hinrichs, "The Medical Transforming of Southern Customs in Song China (960-1279 c.e.)"

Angela Leung, "Organized Medicine in Ming-Qing China: State and Private Medical Institutions in the Lower Yangzi Region;" Late Imperial China (June 1987) 8.1:134-166.

Carol Benedict, Bubonic Plague in Nineteenth-Century China, pp. 100-130.

Suggested The Washing Away of Wrongs: Forensic Medicine in Thirteenth Century China, trans. Brian E. McKnight, (Ann Arbor: Center for Chinese Studies, The University of Michigan, 1981).

Marta Hanson, "Robust Northerners and Delicate Southerners: The Nineteenth-Century Invention of a Southern Medical Tradition," positions (winter 1998) 6.3:515-550.


 

12. Medical Governance in Modern China

Some Western models of public health and sanitary policing were adapted in China in the twentieth century. Which groups advocated these innovations, and why? What factors slowed, sped, or shaped the process of adaptation? What have been some common themes in the history of public health in the twentieth century?
 
Primary J. S. Horn, Away with all Pests, pp. 10, 70-80, 94-106.

A Barefoot Doctor’s Manual, (Bethesda: U.S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, 1974; repr. New York: Gramercy Publ., 1985), pp. ix-i, 35-50.

Secondary Carol Benedict, Bubonic Plague in Nineteenth-Century China, pp. 131-164.

Ruth Rogaski, "From Protecting Life to Defending the Nation: The Emergence of Public Health in Tianjin, 1859-1953," Abstract, pp. 262-312.

Suggested Ralph Croizier, Traditional Medicine in Modern China. (Cambridge: Harvard University Press, 1964).

Ka-che Yip, "Science, Medicine, and Public Health in 20th-Cent. China: Health and Society in China: Public Health Education for the Community, 1912-1937," Social Science of Medicine 16 (1982): 1197-1205.

Ka-che Yip, Health and National Reconstruction in Nationalist China: The Development of Modern Health Services, 1928-1937, Association for Asian Studies Monograph and Occasional Papers Series, 50, (Ann Arbor: Association for Asian Studies, 1995).


 

13. Discourses of Modernity and the Creation of Traditional Chinese Medicine

As western models of medical knowledge and professional practice became increasingly influential among China’s urban élites early in this century, different groups lobbied variously for the abolition, preservation, and modernization of Chinese medicine. What were the stakes for these groups? In what ways has Chinese medicine been transformed in relation to biomedical models? How has "syndrome differentiation" shifted in practice and prestige over the course of the twentieth century? What have been some common themes in the relations between Traditional Chinese Medicine and Western Biomedicine?
 
Secondary Bridie Andrews, "Tailoring Tradition: The Impact of Modern Medicine on Traditional Chinese Medicine, 1887-1937," in Notions et perceptions du changement en Chine, Viviane Alleton and Alexei Volkov, eds., (Paris: College de France, 1994) pp. 149-166.

Volker Scheid, "Subjectivity, Agency, Synthesis: The Plurality of Chinese Medicine in Contemporary China." Ph.D. diss., University of Cambridge, 1998, ch. 3.

Judith Farquhar, "Re-writing Traditional Medicine in Post-Maoist China," Knowledge and the Scholarly Medical Traditions, ed Don Bates, (Cambridge: Cambridge University Press, 1995), pp. 251-276.

Jian Xu, "Body, Discourse, and the Cultural Politics of Contemporary Chinese Qigong," Journal of Asian Studies 58.4 (Nov. 1999):961-991.

Suggested Frank Dikötter, Imperfect Conceptions: Medical Knowledge, Birth Defects, and Eugenics in China, (New York: Columbia University Press, 1998).

A Barefoot Doctor’s Manual.

Nancy N. Chen, "Urban Spaces and Experiences of Qigong," in Urban Spaces in Contemporary China: The Potential for Autonomy and Community in Post-Mao China, ed., Deborah S. Davis, et. al., (Cambridge: Cambridge University Press, 1995), pp. 347-361.

Presentations Bridie J. Andrews, "The Making of Modern Chinese Medicine, 1895-1937," Ph.D. diss., University of Cambridge, 1996, ch. 7.

Volker Scheid, "Subjectivity, Agency, Synthesis: The Plurality of Chinese Medicine in Contemporary China." Ph.D. diss., University of Cambridge, 1998, ch. 7.

Bridie J. Andrews, "Tuberculosis and the Assimilation of Germ Theory in China, 1895-1937," Journal for the History of Medicine and Allied Sciences 52, no. 1 (January 1997): 114-157.

Hugh Shapiro, "The Puzzle of Spermatorrhea in Republican China," positions (winter 1998) 6.3:551-596.

Hsu, Elisabeth, The Transmission of Chinese Medicine, (Cambridge: Cambridge University Press, 1999), Ch. 5, Ch. 6.


 

14. Accounting for Plural Healing Practices in Contemporary China

Until recently, there were predictions that Chinese medicine would be displaced or subsumed by biomedicine or would become standardized, and that "superstitious" forms of healing would disappear. Nevertheless, Chinese medical epistemologies and views of the body have retained their vitality and are increasingly influential around the world, Chinese medical practices are in some respects proliferating rather than converging, and "superstitious" healing is having a revival in mainland China. What are the sources of plurality in Chinese healing practices?
 
SecondarySuggested Arthur Kleinman, Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry, (Berkeley: University of California Press, 1980), 1-17, [60-90], 203-310.
Presentations Hsu, Elisabeth, The Transmission of Chinese Medicine, Ch. 1-4.

 

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