1922 was a most important year in the history of Chinese medicine even if the importance of that historical moment has largely been erased from our collective memory. Forgetting, of course, has its benefits. It allows us to do what we do without continuously feeling compelled to reflect upon it. But it also has its dangers. For it prevents us from understanding how we came to be who we are and thereby occludes certain futures.
The first decades of the twentieth century witnessed momentous transformations in Chinese society and culture. Following China’s defeat in the first Sino-Japanese war in 1895, progressive intellectuals began arguing for a process of social and cultural transformation that eventually led to the overthrow of the Qing dynasty and the founding of the Chinese Republic in 1911. After the humiliation of the 1919 Versailles treaty, where foreign powers made decisions about China’s territorial integrity without allowing it a seat at the negotiating table, influential sections of the country’s elite and especially its youth became ever more radicalised. They called for full-scale Westernisation and a complete break with the past. The stage was thereby set for several decades of culture wars between radical modernisers and reformers who had supported or even participated in the 1911 revolution but clung to the idea of preserving the country’s national essence (guocui 國粹). In the domain of medicine these culture wars played themselves out in a struggle for the abolition or reform of traditional medicine. In the early 1920s, Yun Tieqiao 惲鉄樵 (1878-1935), a gifted scholar physician with a background as publisher and translator of English language novels, emerged as the most influential spokesman for the cause of Chinese medicine.
In his writings, Yun Tieqiao took a pragmatic position that admitted to deficiencies in Chinese medicine, which, like Chinese society at large, he considered to be in need of reform. Such deficiencies included aspects of Chinese anatomy, which were clearly objectively wrong, but also an imbedded acceptance of fuzzy (mohu 模糊) thinking that in Yun Tieqiao’s eyes stood in the way of progress. At the same time, Yun Tieqiao claimed for Chinese medicine a perspective worth preserving. This position is neatly summed up in his contribution to a special issue of the journal Annals of Medicine (Yijie chunjiu 醫界春秋) devoted to a proposed reform of disease names in Chinese medicine
My humble opinion is that science is progressive. What was right yesterday is wrong today. So we cannot say that the today’s science is the truth. This is clearly demonstrated by the fact that Western medicine has numerous discourses that do not correspond to reality. This is my first point. Ultimately, there is only one truth in the world. But with regards to the methods of studying this truth, there are many paths that lead to the same end. There is not just one method…. Western science is not the only path of scholarship. Eastern medicine has its perspective. This is my second point.(1)
Classically educated but well-read in Western science and philosophy Yun Tieqiao was able to present sophisticated arguments to underpin his pragmatic view of reform. For instance, to support his argument that Chinese medicine was scientific in nature he drew parallels between its understanding of disease and phenomenological perspectives utilised in Western psychological research at the time. And to show that utilising foreign knowledge was not intrinsically inimical to productively developing indigenous Chinese traditions he pointed to the influence of Indian Buddhism on the development of Neoconfucianism during the Song dynasty.
Culture wars, like all wars, require short-term tactical decisions as well as long-term strategical goals and Yun Tieqiao excelled at both. He quickly realised that the biggest weakness of Chinese medicine was an often mistaken description of the physical body that was difficult to defend against the clearly much more accurate knowledge of Western anatomy. Rather than risk losing the war by continuing to defend the indefensible Yun therefore decided to withdraw the “body of flesh and blood” from the field of debate altogether. In a famous passage from his Record of Wisdom Observed in the Canons (Qunjing jianzhi lu 群經見智錄) published in 1922 he stated:
Therefore, the five organs of the Inner Canon are not the five organs of flesh and blood but the five organs of the four seasonal (transformations). (2)
Yun Tieqiao claimed that although Chinese medicine talked about the body it was not actually all that interested in the material body. Rather, it focused on the body as process and on how that process was integrated into other processes outside the body proper. It followed that criticising Chinese medicine for its inaccurate physical anatomy was not merely futile but evidence of an inability or unwillingness to grasp its essential nature.
Heart disease in the Inner Canon is not the heart disease of Western medicine. Skilled Western medicine doctors can cure serious diseases; Chinese medicine practitioners who have grasped the essence of the Inner Canon can also cure serious diseases. The same goal is reached by different routes.(3)
Factually, Yun Tieqiao’s argument was, of course, wrong because Chinese doctors had always been keenly interested in the body of flesh and blood. Ming dynasty debates on the nature of the gate of vitality (mingmen 命門), for instance, turned not merely on points of philosophy but on disagreements about the actual physical location of that mysterious organ.(4) Differences between 12th and 17th century understandings of the six warps (liu jing 六經) in Zhang Zhongjing’s Treatise on Cold Damage (Shanghan lun 傷寒論) were likewise not just disagreements about how to interpret the original text but about the physical nature of the jing themselves.(5) And ideas about what the organs of Chinese medicine do were based from the very beginning on often dodgy anatomical knowledge as much as on five phases theory and macro/microcosm cosmologies.(6) However, by disallowing the importance of these aspects of Chinese medical history, Yun Tieqiao succeeded in shifting public debate entirely onto the field of clinical effectiveness where, at the time, Western medicine did not enjoy any obvious advantage.
Abandoning the body of flesh and blood also allowed Yun Tieqiao to advance his second agenda, that of reforming Chinese medicine itself. A key aspect of this reform was the transformation of Chinese medicine’s conceptual fuzziness into a more rational and internally consistent system of thought and practice analogous to how Western medicine and science were perceived at the time. Research into the Treatise on Cold Damage (Shanghan lun yanjiu 傷寒論研究), published in 1923, exemplifies how he proposed to realise this agenda.
In the very first chapter of the text Yun Tieqiao blamed the fuzziness at the heart of Chinese medicine for failing to grasp on of the most fundamental concepts of the tradition.
The six warps (liu jing 六經) are the most important locations in the Treatise on Cold Damage. However, the six warps are also the locations most difficult to understand. Everyone who reads the Treatise on Cold Damage cannot but devote oneself to this and neither can all those who have annotated it.(7)
Over several pages Yun Tieqiao then went on to outline the many inconsistencies in the medical literature. The yang brightness warp, for instance, could according to some authors be located in between the greater and lesser yang warps, but also be interior to both. Sometimes the warps were equated to the acupuncture channels, sometimes to distinct bodily spaces, sometimes to disease processes or the progression of an illness in time. Then there were the many different theories that tied themselves in knots to square these many inconsistencies. Yun Tieqiao proposed a simple but very ingenious solution in order to cut through this confusion. He denied the six warps any kind of physical existence within the body and defined them instead as momentarily emergent manifestations of patho-physiological processes:
The six warps are recordings of symptoms in the human body ordered through bounded definitions. Hence, one can say that after one gets ill the six warps come into being, but when one is not ill these entities do not exist.(8)
The dematerialisation of the Chinese medical body begun in Record of Wisdom Observed in the Canons is thereby extended to medical practice itself. According to Yun Tieqiao Chinese medicine can function exceedingly well by focusing entirely on the external manifestations of internal processes without needing to engage with the material substrate that produces these manifestations. I showed above that Western phenomenology provided some of the inspiration behind this argument. Equally important was the influence of Japanese Kampo on the thinking of Yun Tieqiao and many of his contemporaries.
In the early years of the twentieth century, Japan and not the West was the most important model for intellectuals and politicians committed to the modernisation of Chinese society and culture. This was because even though Japan had succeeded in becoming a modern nation it also had been able to preserve its cultural integrity as a distinctly Asian country. This appealed to Chinese physicians like Yun Tieqiao who wanted to reform Chinese medicine with the help of science without thereby assimilating it to Western science. These physicians were particularly drawn to the ancient formula current (kohoha 古方派) of Japanese Kampo whose empiricist orientation and rejection of speculative metaphysics chimed well with their own vision of a new more rational Chinese medicine. Japanese Kampo texts thus started to circulate widely among Chinese physicians, Japanese doctors began to publish in Chinese medical journals, and some Chinese medicine colleges even taught Japanese as part of their curriculum.
Yun Tieqiao thus cites the Japanese scholar physician Kitamurana Ohira 喜多村直寬 (1804－1876) as a major influence on his own revision of the concept of the six warps. In his Point by Point Explanations of the Treatise on Cold Damage) published in 1852 Kitamurana had proposed to think of the six warps not as physical entities but solely as conceptual categories
The original text [of the Treatise] does not take the six warps literally [as channels or bodily spaces]. What is referred to as the three yin and three yang are but placeholders for the concepts of exterior and interior, heat and cold, excess and deficiency and one should not therefore talk of them as corresponding to the organs or conduits.[9]
Yun Tieqiao’s status as the leading intellectual on the Chinese side of the medical culture wars of the early 1920 ensured the wide dissemination of his ideas both directly and indirectly. In a previous blog, I showed how Chen Xunzhai 陳遜齋 (1888-1948) reproduced Yun’s conception of the six warps as cognitive concepts rather than material entities and that the same ideas can also be traced in the work of of his contemporary Hu Xishu 胡希恕 (1898—1984). However, I believe that the influence of Yun Tieqiao’s turning away from the body of flesh and blood towards a definition of Chinese medicine as grounded in immaterial process was far more influential. It is reflected, for instance, in the writings of Peng Ziyi 棚子益 (1871-1949) who blames the deterioration of Chinese medicine of the course of its history on a concern for material embodiment rather than cosmological process:
The study of Chinese medicine is the study of the microcosm of the human body.… The original study of the human body as a microcosmic reflection was abandoned because the way of understanding the universe was lost, and with it, the way of understanding Chinese medicine. … The only remedy for this deviation is to rediscover the true method of researching Chinese medicine. The result of such a method is to immediately grasp the macrocosm. If one grasps the macrocosm, naturally they will also grasp Chinese medicine.[10]
Peng Ziyi is acknowledged by the famous contemporary physician Li Ke 李可 as a major influence on his own work and, by implication, on the current jingfang renaissance. The same turning away from the material body is equally visible in textbook TCM against which the proponents of jingfang so forcefully define themselves. There are many diagrams in TCM textbooks but few images of the body of flesh and blood (acupuncture channels excepted), and wherever the material body does make a reappearance it is clearly constituted in the light of biomedical anatomy. Analogies between Chinese medicine and systems theory likewise emphasise diagrammatic representations of process and physiology over anatomy. Five element acupuncturists focus their energies on the immaterial spirit but know little about material qi transformation. Contemporary definitions of Chinese medicine as grounded in philosophy vis-à-vis biomedicine’s rooting in the physical sciences are produced by the same discursive opposition. And when medical historians teach us that Chinese medicine is intrinsically focused on process as opposed to Western medicine’s concern for the material body they are teaching us more about medical history as a formation of modernity than about Chinese medicine itself.
To make sure, I am not seeking to blame Yun Tieqiao for any of this. On the contrary. There is no way of knowing where Chinese medicine would be today without his tactical abandonment of the body of flesh and blood. Furthermore, the opposition between East and West as one between process (focused on qi transformation) and structure (focused on anatomy) was not Yun Tieqiao’s own invention but something he inherited from an earlier generation of thinkers who felt compelled to work out the distinguishing features of a newly defined “Chinese” medicine. However, physicians like Zhou Xuehai 周學還 (1856-1906) and Tang Zonghai 唐宗海 (1846-1897) laboured hard to anchor the processes of qi transformation in the material bodily spaces Chinese medicine mapped with the help of the six warps and the Triple Burner. Yun Tieqiao merely went one step further by divesting Chinese medicine as a medicine of process of any residual materialism.
In the sense that Chinese medicine has always progressed through novel constellations of heterogenous ideas and practices, Yun Tieqiao’s synthesis of ancient texts and later commentaries, of Japanese Kampo and German phenomenology was actually very traditional. In the sense that modernity can be defined as a discursive formation that elaborates categorical oppositions between the modern/West and the traditional/rest the dematerialisation of Chinese medicine that enabled him to oppose structure/the West with process/China was, however, distinctly modern.
What, then, can we take away from this for our own engagement with Chinese medicine in the present?
First, we might want to accept that all forms of Chinese medicine that define themselves as grounded in tradition/process/philosophy or whatever else against a modern/Western medicine grounded in anatomy/science/structure and so on are themselves fundamentally modern. Such self-awareness could do away with a lot of unnecessary infighting within our tradition.
Second, in as much as modernity as a dominant historical formation is visibly crumbling all around us, a space is currently opening up for other possibilities of thinking about and developing Chinese medicine. It is up to us to seize that moment. What will emerge from this is as yet unclear. But I predict with some certainty that the Chinese medicine of the future will have to leave behind both the “traditional” and the “modern” if it wants to be part of a broader search for newly productive ways to engage with difference.
Re-emphasising that Chinese medicine has access to the body of flesh and blood without needing to take a detour through biomedicine is an important first step in this process. Outward facing, in as much as all medical practices are ultimately focused on embodiment, this will enable a conversation on more equal terms not only with biomedicine in all its various forms but also with other medical traditions East and West, North and South. Inward facing, it may help rebalance the often unproductive priority given to the interpretation of texts rather than living bodies that Chinese physicians have consistently lamented for over two thousand years.
Endnotes
1. Zhao Hongjun 趙洪鈞. History of the Polemics Between Chinese and Western Medicine in Modern Times 近代中西醫論爭史. Hefei: Anhui kexue jishu chubanshe, 1989, p. 237.
2. Yun Tieqiao 惲鐵樵. “Qunjing jianzhi lu 群經見智錄 (Record of Wisdom Observed in the Medical Classics),” In Yun Tieqiao yishu heji 惲鐵鍬醫書合集 (A Collection of Yun Tieqiao’s Medical Works), 121–98. Tianjin: Tianjin kexue jishu chubanshe, 2010 (1922), p. 35
3. Cited in Deng Tietao 鄧鐵濤 and Cheng Zhifan 程之范 (eds). 2000. Zhongguo yixue tongshi 中國醫學通史：近代卷 (A General History of Chinese Medicine: The Modern Period). Beijing: Renmin weisheng chubanshe, p. 133.
4. See for instance Wu, Yi-Li. Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China. Berkeley: University of California Press, 2010, pp. 97-105.
5. Scheid, Volker. “Transmitting Chinese Medicine: Changing Perceptions of Body, Pathology, and Treatment in Late Imperial China.” Asian Medicine 8, no. 2 (2013): 299–360.
6. The idea that the lesser yang needs to be treated by way of harmonisation because the Gallbladder is the clean bowel that has not entry or exit pathways 少陽膽為清淨之府，無出入之路，只有和解一法 is a typical example of what I am referring to.
7. Yun Tieqiao 惲鐵樵. “Shanghan lun yanjiu 傷寒論研究 (Research on the Treatise of Cold Damage),” In Yun Tieqiao yishu heji 惲鐵鍬醫書合集 (A Collection of Yun Tieqiao’s Medical Works), 199–284. Tianjin: Tianjin kexue jishu chubanshe, 2010 [1923], p. 210.
8. ibid., p. 214
9. Kitamurana Ohira 喜多村直寬. Shōkanron sogi 傷寒論疏義. (Point by Point Explanations of the Treatise on Cold Damage). Gakkundō 学訓堂, 1852.Cited in Yun Tieqiao 惲鐵樵. “Shanghan lun yanjiu 傷寒論研究, p. 212.
10. Peng Ziyi 彭子益. 2007. Yuandong de gu zhongyi xue 圓動的古中醫學, p.1. Translated by Bryan McMahon, 2019, as “Circular dynamics of ancient Chinese Medicine I” and available at https://www.thewanderingcloud.com/the-archives/circulardyn...3wvhJ-b8GO49NNl-bDqCW3t5UOy5swMQJM6kMYg32ZaVbwaZ0kHbh7U2s.