History of tradition

I think I’ve burnt myself out on research now. There’s a lot more I could read to expand my thinking on the areas that will feature in the stories I plan to write, but I’ve been working on the background for so long, and I am so close to being able to write some actual narrative, that I don’t think I could stand to make another note. Paul U. Unschuld’s book Traditional Chinese Medicine: Heritage and Adaptation was a good one to go out on, as the most obvious adjective to describe it with might be ‘pithy’. Its chapters are short, it is short, and its arguments have obviously been refined and honed over a long period of scholarship. Unschuld is a German medical historian specialising in Chinese medical traditions, with the linguistic knowledge to research ancient Chinese primary sources directly. Which is to say he comes to write about Traditional Chinese Medicine (TCM) neither from the perspective of the Western enthusiast, nor the modern Chinese TCM practitioner, and is not beholden to the assumptions that characterise either of those positions.

The second part of his book is dedicated to comprehensively deconstructing and dismissing those sets of assumptions—inasmuch as the practices that claim the name TCM today draw on a tradition or a textual and practical history, they are almost entirely erroneous in the ways that think about it. The supposedly holistic, non-linear, spiritualistic, and systematic knowledge which Western practitioners have held up as a philosophical and pragmatic alternative to scientific medicine is shown by Unschuld to be none of those things. Instead he shows a history of medical thinking which is a piecemeal accumulation of remedies and treatments, based largely on materialist conceptions of illness (except when it is ascribed to supernatural, demonic aetiologies). The understanding of health in China can be related closely to its intellectual and cultural history, which largely does not conform to New Age ideas about society or the individual, and which has been misunderstood in the West as a consequence of some serious translation errors when it was first disseminated there. For example, the terms in which the body’s internal balance and structure are described operate in Chinese by analogy to bureaucratic and military thinking, meanings which have been completely lost in the Western appropriation of this medical tradition, with its emphasis on rather more gentle and often anti-establishment themes. The idea of qi as a form of energy is similarly ascribed to an early mistranslation: according to Unschuld there was no equivalent concept in Chinese to the Western idea of ‘energy’, which only emerged after scientific studies of electricity had begun. To the Chinese who developed the concept, qi was a bodily essence very similar to blood. The other branch of TCM, that which survived within China under government control, and which emerged into the rest of the world from the 1970s onwards, represents a very politically inflected version of traditional medical practices, whose training is founded on scientific physiology, and which bears little resemblance to either the Western touchy-feely version, or to the historical record. If claims of traditionality are to be entertained, then it is worth noting, as Unschuld points out, that until it was remade into its modern form, the flagship TCM therapy of acupuncture involved blood-letting in very much the same mould as traditional Western medicine, and was conducted with needles stored in greasy leather rolls, not cleaned between uses.

The first part of the book describes the Chinese medical tradition itself, which is to say its textual history, as doctors were low status individuals prior to the twentieth-century, and there is very little of the wealth of memoir, notebooks, practical instructions, and philosophical discussions that illustrate medicine’s history in the West. There is almost nothing to tell us what medicine looked like in practice, or what physicians thought about it. The literature consists largely of authoritative texts, handed down over very long periods, and usually ascribed at their origin to authorities that lived hundreds or thousands of years before their composition. Some discuss the things that we in the West have come to associate with TCM: qi, yin and yang, acupuncture, the Five Phases (or elements, as they are often mischaracterised), etc. Others are compendia of remedies, mostly arrived at without reference to these philosophical ideas, and frequently relying on a form of sympathetic magic, where for example something might be written on a piece of paper, which is then burnt, and the ashes incorporated into the medication. This is all very interesting to me as someone who intends to make up a pre-modern set of medical practices—perhaps less so from the point of view of the practices and philosophies themselves, than from that of their histories. The ways that ideas are transmitted, changed, and translated from one area of socio-cultural practice to another, can directly model the ways that medical knowledge will operate in my constructed fantasy world; and the second half of the book, which might at first glance have seemed less relevant to my interests, is of equal value in this effort, illustrating vividly the ways that politics may impact practice in seemingly remote areas.

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