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History 5: Internationalization
历史沿革5：国际化 〔歷史沿革5：中國際化〕 lì shǐ yán gé 5: guó jì huà
China’s healing arts have spread far beyond its own frontiers, first taking deep roots in its immediate satellites and spreading to its overseas settlements. It has attracted Western interest for centuries and in the latter half of the 20th century has come to be widely practiced in affluent Western countries and, as a result, has gained adherents in other not-so-affluent countries worldwide.
Contents
- The Spread of Chinese Medicine Before the Modern Era
- The Reception of Chinese Medicine in the Modern West
The Spread of Chinese Medicine Before the Modern Era
Long ago Chinese medicine began to spread beyond the borders of China itself. In the medieval period, it spread to China’s cultural satellites, eastward to the Korean Peninsula and from there to Japan, as well as southward to Vietnam and Indonesia.
Europeans first heard reports of Chinese medicine from travelers like Marco Polo in the 13th century when China was part of a large and unified Mongol empire that extended all the way to Central Europe. In the 16th century, Jesuit missionaries stationed in Japan and China studied the language and culture of the country and drew Western attention in particular to the practice of acupuncture. However, these reports failed to trigger any sustained European interest in the medical traditions of East Asia. In the ensuing period of colonial expansion, more detailed reports of Chinese medicine, some of them by Western physicians, reached the European homeland. The Danish physician Jakob de Bondt (1581–1631), the Dutchman Willem ten Rhijne (1647–1700), the German physician Andreas Cleyer (1615–1690), the Polish Jesuit Michael Boym (1612–1659), and the German Engelbert Kaempfer (1651–1716) offered detailed descriptions of various aspects of the Chinese medical tradition.
By the 19th century, the West was importing ginseng from China, and American ginseng was finding its way to China. Nevertheless, Westerners knew little of the theoretical basis of Chinese medicine nor the culture in which it was rooted. Western attitudes to the Chinese people and it culture were highly ambivalent. Alongside a vogue of chinoiserie in the decorative arts and a superficial admiration for Chinese social organization, an underlying scorn for Chinese civilization centering around aversion to Chinese physiognomy (Linnaeus classified Chinese flatheads
as Homo monstrosus) prevailed and Chinese religions (Buddhism and Daoism) were conceived as idolatrous and hence antithetical to Christianity. This poorly conceived contempt hindered any popular interest in acquiring the language of the Chinese or any desire to penetrate their culture and fathom the mysteries of their medicine.[28]
During the 19th century, Western interest turned largely to acupuncture, when it attracted attention as an analog to Western medical ideas about the role of electricity in the body. The discovery of animal electricity sparked the notion that the effect of acupuncture might be explicable in terms of electrical activity in the human body. The French physician Jean-Baptiste Sarlandière (1787–1838) was the first to conduct experiments in strengthening needle stimulation by the application of electrical currents. Despite these developments, acupuncture did not gain acceptance by the Western medical establishment and was generally regarded as quackery.
Acupuncture was to be the focus of Western medical interest until the end of the 20th century, while in China by the 18th century it had fallen to the status of a folk healing art, and in 1822 was banned from the imperial court, even though this was not the case in other regions of Chinese influence.
The Reception of Chinese Medicine in the Modern West
The development of Chinese medicine in the modern West deserves special attention, since it helps readers to orient themselves in the Western world of ideas about Chinese medicine.
Early Writers
It was not until the twentieth century that the West received by far the most complete account of acupuncture in a European language: In 1939 French diplomat George Soulie de Morant, already fluent in Chinese, began a 20-year stay in China, during which he studied with the most eminent physicians. In 1955 he published L’Acuponcture chinoise, a multivolume work in French. Soulie de Morant incorporated Western anatomy, physiology, and pathology into his description of acupuncture therapy and its theoretical bases. Although in some circles his work was initially received with skepticism or scorn, it nevertheless broke ground for the modern acceptance of acupuncture and Chinese medicine that came decades after his death. Soulie de Morant explained the concept of qì in terms of energy, which helped to make it plausible to modern Westerners. He also coined the word meridian,
which is still commonly used to this day.
Two other French writers subsequently exerted considerable influence in Europe and the United States. Albert Chamfrault, a student of Soulie de Morant, had already studied acupuncture before he was enlisted as a naval officer in Vietnam, where he met Nguyen Van Nghi (1909–1999), a Vietnamese practitioner of Chinese origin, who deepened Chamfrault’s knowledge of the subject. Between 1954 and 1969, Chamfrault published Les livres sacrés de medecine chinoise (Sacred Books of Chinese Medicine
) a six-volume work devoted in particular to the implications of the qì circulation system. His teacher, Nguyen Van Nghi, further boosted the interest in and practice of acupuncture in the West, writing and translating, and lecturing in France after immigrating from Vietnam.
The English-speaking world, which had scant access to the major works in French, was sorely lacking in published sources of Chinese medical knowledge. In the United States, many people eager to learn about acupuncture were turning to East Asian immigrants knowledgeable in the art, whose often scant mastery of spoken English was the only basis for communication with their students. They had been brought up in the master-apprenticeship tradition, and they taught their art to Westerners within the same framework.
One of the more widely influential of the old-style teachers was James Tin-Yau So (苏天佑 Mandarin Sū Tiān-Yòu), who founded the New England School of Acupuncture in Massachusetts. He was an apprentice-trained acupuncturist from the same lineage as Chéng Dàn-Ān (Black Book,
a collection of empirically grounded point locations and treatments that had been transmitted from teacher to student over generations.[29]
These contacts between East and West spawned broad interest. And a natural reaction was for people of different backgrounds to explain in their own terms. This was especially so for people of a medical background.
One of those who took a scientific approach was a British MD of German extraction, Felix Mann. In his first work, Acupuncture: The Ancient Chinese Art of Healing,[30] he presented a conceptually simplified form of Chinese acupuncture. With a minimal knowledge of Chinese, he was more interested in the effects of acupuncture and their basis in biomedical theory. In time, he distanced himself from traditional beliefs in the existence of acupuncture points and channels and spoke quite derogatorily of them. In his Reinventing Acupuncture: A New Concept of Ancient Medicine,[31] he presented cartoon pictures of Chinese physicians, mocking them as complicating something that by modern medical standards appeared quite simple. Nevertheless, Mann was highly influential in his time, and his works have been translated into Dutch, Finnish, German, Italian, Spanish, and Swedish.
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| Felix Mann’ s cartoon |
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The confrontation of traditional Chinese medicine with modern Western thought also gave rise to another, completely different interpretation. Sinologist Manfred Porkert, in his book, Theoretical Foundations of Chinese Medicine,[32] propounded the view that Chinese medical theory was entirely based on systems of correspondence and contained no significant materially based understanding of the human body. This created a vision of Chinese medicine that, having nothing whatsoever in common with modern biomedicine, that was totally exotic. For some, the exotic mystique was further enhanced by the intellectual complication of Porkert’s Latin terminology for the key terms of the subject. Consequently, for a time, Theoretical Foundations was a challenge that any self-respecting acupuncture adept had to face. However, in the long run, Porkert’s approach failed to find many followers, at least outside the German-speaking world. His claim that Chinese medicine was a pure science of systematic correspondence was countered by a historically oriented presentation of the development of Chinese medicine by Paul U. Unschuld in Medicine in China: A History of Ideas.[33] Chinese medical theory adopted materially oriented approaches as well as cognitive methods based on analogy and systems of correspondence. The latter always required materially oriented approaches to make any sense.
Acupuncture and Chinese medicine spoke not only to people in the medical and sinological worlds. It captured the attention of a broad segment of the educated population. The reasons for this lie in changing attitudes to modern biomedicine and broader concerns about the unbridled use of technology.
Despite centuries of exposure in the Western world, it was only after the West’s own medicine attained global dominance that healing arts with roots in Chinese antiquity finally gained broad acceptance in the West. Over the last hundred years, Western medicine has spread to all parts of the globe and has become the authoritative, if not the most commonly used, medicine in the world. This includes China and its former cultural satellites. This adoption has been attributed to its notable achievements, which include the eradication of diseases such as smallpox, the successful control of the plague and malaria, and painless surgery for a variety of diseases. In fact, Western medicine has advanced in tandem with the modern sciences on which it is based, as well as with the political, economic, and cultural dominance of Western nations in the modern world as a whole.
More recently, increasing specialization and the depersonalization of therapeutic intervention, the rise in chronic illness, as well as the harsh side effects of certain treatments, have led many Westerners to seek alternatives. Over the last four decades or more, complementary medicines have greatly gained in popularity. Some are traditional medicines with long histories, such as Western herbology and Chinese medicine. Others, such as homeopathy and aromatherapy, are relatively new to the medical field. All complementary medicines claim the qualities of naturalness and holism, perceived by many to be lacking in modern biomedicine. These alternative medicines are rejected by most MD physicians as being unscientific and ineffective, although their empirical merits are recognized by some.
The disaffection with biomedicine has coincided historically with a growing concern about the destructive applications of modern science. Pollution of the biosphere from the use of fossil fuels and other contaminating substances, among numerous other things, has cultivated a general fear that the unbridled use of scientific knowledge for economic benefit will undermine the ecological balance of the Earth’s biosphere, on which all life depends. The alternative health care ideals of naturalness and holism undoubtedly reflect not only purely medical concerns but also concerns about preserving life in a planetary context.
The reasons for the popularity of Chinese medicine are obvious. The two chief therapeutic modalities of Chinese medicine are medicinal therapy, which prescribes the ingestion of naturally occurring products, and acupuncture therapy, which uses ultra-fine needles inserted at specific points on the surface of the skin to adjust physiological functions by acting on qì. Medicinal therapy is viewed as natural because it uses simply prepared vegetable, animal, and mineral products. Acupuncture is considered natural because it does not introduce any foreign matter into the body that is not removed before the end of the treatment.
Chinese medicine holds an additional appeal because its theoretical basis is provided by systems of universal correspondence (yīn-yáng and the five phases), which assume a resonance between the human body and psyche on the one hand and nature as a whole on the other. This makes it a highly holistic medicine. It also includes techniques for self-cultivation through holistic exercises (qì-gōng, tài-jí-quán), a dietary therapy, and a highly developed system of medical massage (tuī-ná). It offers a broad platform of preventive therapies that are aimed at maximizing health as opposed to simply treating disease.
In the US, the 1970s boom in acupuncture coincided with what became known as the New Age
movement in Western culture. A time of rapid economic growth and democratization in the Western world after World War II gave birth to an unprecedented development in world history, namely a youth subculture that questioned the values of the establishment status quo. This youth culture was fed by opposition to American imperialist involvement in Vietnam, by a desire for a return to nature, by a fascination with the spiritual traditions of India and the Far East, and by notions of spirituality that dispensed with the trappings of Western establishment religions. Among the Eastern religions and philosophies that sparked interest, Buddhism, Hinduism, and Daoism figured prominently. Somewhat simplistically, Daoism was identified as the representation of values such as personal and social freedom, naturalism, and oneness with the universe.
This cultural environment exerted a strong influence over the development of Chinese medicine in the West. It gave rise to one of the major Western schools of thought about acupuncture, namely the Five Elements School of acupuncture started by British osteopath Jack R. Worsley (1923–2003). This school deviates from traditional interpretations and practices in China by redefining the Chinese concept of spirit, shén
By mid-century, acupuncture was developing among peripheral groups and becoming active in health care politics. In the 1980s interest in the study and practice of acupuncture had begun to flourish. Various forms of acupuncture therapy—Chinese, Japanese, Vietnamese, Korean, and several modern variants—became readily available in every large city and even many small towns in the Western world. East Asian (chiefly Chinese) medicinal therapy also became prominent.
Influence of the PRC
The influence of the old-style teachers was short-lived. Soulie de Morant, Chamfrault, Van Nghi, and Tin-Yau So had studied Chinese medicine long before the Communist Party of China came to power and started to influence the course of the development of Chinese medicine.
The opening of China to the West that followed US President Richard Nixon’s historic visit to the country in 1972 led to the promotion of Chinese medicine in the West. Reports of barefoot doctors’ contribution to the health of the Chinese people and Chinese efforts to develop analgesia by electro-acupuncture stimulated popular Western knowledge of China’s healing arts. It helped to promote acceptability for acupuncture research in the Western scientific community. At the same time, it made the Chinese aware that they had a cultural product attractive to Westerners. As a result, major colleges of traditional Chinese Medicine in China established training programs specially designed for foreigners. The basic textbooks of Chinese acupuncture written in English and other Western languages used in these training programs found their way to acupuncture and Chinese medicine schools abroad. These new Chinese texts provided a preliminary basis for the teaching of acupuncture in several colleges founded in the 1980s.
Nevertheless, these newer texts presented a simplified form of acupuncture theory and practice, which reflected little of the complexity of the traditional body of Chinese medical knowledge. A reduced information load can be helpful in the initial stages of transmission. However, in textbooks such as Essentials of Chinese Acupuncture[34] and Chinese Acupuncture and Moxibustion,[35] the reduction of information was significant: the first of these texts accorded less than 70 pages for basic theory (yīn-yáng, five phases, organs, qì, blood and fluids, causes of disease) and for diagnosis (four examinations, pattern identification). By contrast, Chinese education puts basic theory and diagnosis into two whole volumes. However, the texts were welcomed because they filled a gap in the US market in the 1980s and 1990s. They established Chinese acupuncture
as the acknowledged standard form of the art, eclipsing Japanese, Korean, and Vietnamese traditions. Despite their lack of detail, these texts were comprehensive in scope.
With the development of national examinations in the US, these texts were taken as the basis for the knowledge necessary to practice TCM. Although professionalization was a win for the practicing community, the new profession’s depth of knowledge was not questioned. Little has changed since then in this regard. Because Chinese medicine is mostly taught in schools not incorporated into university education, the stimulus for increased knowledge is lacking. Since the Chinese medical community sees itself restricted by the dominance of biomedicine, any moves toward more stringent educational requirements are strongly resisted.
At the same time, Western translators and writers started to produce translations and compilations of modernized Chinese medicine (TCM
). A major best-selling and highly influential introduction to Chinese medicine was The Web That Has No Weaver by Ted J. Kapchuk.[36] The first major text translation was John O’Connor and Dan Bensky’s Acupuncture: A Comprehensive Text,[37] which for the first time gave English speakers, as the title suggests, a comprehensive description of acupuncture as taught and practiced in the PRC. Giovanni Maciocia’s Foundations of Chinese Medicine[38] and Practice of Chinese Medicine[39] are two other notable Western contributions of the period. These works provided considerably more detail that the PRC texts mentioned above. Nevertheless, in the US, the PRC texts supplemented by these newer-English language publications essentially set the scope for national examinations.
Until the 1980s, acupuncture was the center of Western attention. This was partly because of the fascination with needles almost painlessly inserted into the body to work their magic on the mysterious substance or energy called qì.
It was also partly attributable to the practicality of a therapy requiring minimal equipment. However, with greater mobility and contact with the Chinese world, where medicinal therapy is by far the more widely practiced tradition, Western interest in medicinal therapy was growing.
From the 1980s onward, numerous books on acupuncture and Chinese medicine have been produced in the West. Some of them are translated or compiled from Chinese sources; others represent the experience and expertise of their authors. Some of them accurately reflect the Chinese tradition, while others are heavily colored by Western interpretation and lack translation fidelity.
PRC publications gradually lost their initial major presence on the Western market. In the late 2000s, the People’s Medical Publishing House (PMPH,
Nevertheless, the PRC has not faded from the scenes. Major Chinese medical colleges in China offer Chinese medicine programs taught in English or other languages, as well as programs involving a year or so of language study followed by study of Chinese medicine in Chinese. The latter courses are the PRC’s best contribution to the transmission of Chinese medicine.
Translation of the Classics
Much of the English-language literature has offered rehashes of basic theories, new interpretations, and personal experience. Classical literature, being the product of a culture removed not only in space but also in time from our own, present a greater challenge to modern Western readers than modern Chinese presentations of Chinese medical theory. It is useful, therefore, to note a few of the highlights in the field of classical translation.
The Huáng Dì Nèi Jīng, Nàn Jīng, Shāng Hán Lùn, and Jīn Guì Yào Lüè have all been translated several times. However, the impact of the translation effort on the Western practitioner community has been slow, owing to the arcane nature of these texts and styles in which they have been presented in English.
The first published English translation of the Huáng Dì Nèi Jīng was medical historian Ilza Veith’s, which appeared in 1949 with the English title of The Yellow Emperor’s Classic of Internal Medicine. Its impact on the burgeoning Chinese medical profession was limited, probably because, having apparently gone out of print, copies of it were scarce. However, this work has recently been reintroduced in a new publication with a forward by Linda Barnes.[40]
Numerous translations have been done by Chinese translators, but these, in general, have also had little impact. Most are translations of the text with scant commentary. Where any explanation of the text is provided, it supports only one among the many interpretations that have been offered over the centuries. Examples of this are seen in the translations of the Shāng Hán Lùn[41] and Jīn Guì Yào Lüè[42] by Luó Xī-Wén (
The most influential translations of classics are those of Paul Unschuld, who published a translation of the Nàn Jīng in 1986,[43] Sù Wèn in 2011,[44] and Líng Shū in 2016.[45] Unschuld’s meticulous and ground-breaking scholarship is geared towards philologically accurate translations intended to elucidate the origins of the ideas.
1999 saw the publication in the USA of Shāng Hán Lùn: Cold Damage,[46] followed in 2013 by that of its sister volume Jīn Guì Yào Lüè: Essential Prescriptions of the Golden Cabinet.[47] These translations provide annotations and commentaries that reflect the main clinical thoughts of commentators over the centuries. Because of this, they have reached a wider audience than other Shāng Hán Lùn and Jīn Guì Yào Lüè translations.
Lastly, the large amount of historical research by scholars such as Donald Harper, Vivienne Lo, Livia Kohn, Sabine Wilms, Linda L. Barnes, Elisabeth Rochat de la Vallee, Volker Scheid, Marta Hanson, Judith Farquhar, and Elisabeth Hsu has attracted attention in the Western Chinese medical community. This has done much to enhance the historical perspecti ve of students and practitioners. For example, many books published by Monkey Press and works like Humming with Elephants[48] have provided a bridge between the classics and the modern Western student seeking clinical understanding rather than academic information.
Terms and Translation
Chinese medicine presents numerous challenges for Western translators, which arise from the nature of both the subject matter and the Chinese language. These problems are discussed in terms and translation.
Links to Other Periods
- History 1: The Formative Period
- History 2: The Early Medical Classics
- History 3: Post-Classical Evolution
- History 4: The Modern Era (1911–present)