The Moral: Chinese and Western Medicines United
One thing is clear and deeply important: nobody thought that it was impossible to incorporate Western nutrition and medicine into Chinese practice. No one claimed that the traditions were different enough to be "incommensurable" (T. Kuhn 1962) or even very different. It is, however, possible that they were different enough to block widespread adoption by the Chinese of the Western techniques and medicines.
Nathan Sivin has recently edited key documents of Joseph Needhams work with Lu Gweidjen on Chinese medicine (Needham 2000; Sivin 2000). Needham died in 1991, leaving Sivin the task of completing the "Medicine" volume for the monumental project Science and Civilisation in China that had become Needhams life work. Sivin is a leading authority on Chinese medicine, and his introduction to this book provides a superb guide to the state of the art—brief yet extremely clear, informed, and authoritative. However, he and Needham differ on a key point. Needham saw Chinese medicine as part of a world medical science, although developing in some isolation from other emerging medical traditions. Sivin points out that almost all contemporary scholars of Chinese medicine see it strictly on its own terms: as a unique tradition that cannot be discussed in connection with others except to show how different it was. (Paul Unschuld 2009 takes a middle course.)
To Sivin, Chinese medicine is utterly different from biomedicine. He fixes his gaze on the underlying principles, the philosophy of the system. To Need-ham, the difference is real but can be overcome. Needham fixed his attention on practices and remedies rather than on underlying principles, so to him the difference is merely a minor roadblock rather than a total barrier. Also, Sivin cares that the Chinese did not mathematize the system; Needham cared that they could have.
Another way to look at this is to view Sivin as basically interested in cosmological principles, especially the most exotic ones, like the fivefold correspondence theory. Needham was much more interested in practical matters, which is where Chinese medicine is much closer to Western—if only because one cannot ignore the reality of sprains, broken bones, rashes, dietary regimens, and so on. Whether you believe in fivefold correspondence or biochemistry, willow-bark tea works for fevers, and oral rehydration therapy effectively treats diarrhea. Since practice is more apt than theory to be based on actual working experience, it is more apt to be commensurable across cultures.
Sivin correctly emphasizes throughout his introduction that Chinese medicine is itself incredibly diverse; by his own logic, we should not really be talking about Chinese medicine, but instead about Chinese medical traditions, some of which might be incommensurable with biomedicine. Certainly the magical material, with its dragons and demons, is not commensurable. So, I think, is the fivefold theoretic that is basic to Han medical writing. But the practical lore that actually mattered in daily medical behavior is more directly translatable. So is the yin-yang theory, which is so close to Galenic humorism in its basics.
There are two ways to salvage Needhams view. First, we can point out that the Chinese of the great dynasties were under no illusions of "incommensurability" between East and West—as the HHYF clearly shows.
Second, and this point is made by Needham, practice really has some privilege over abstract theory here. Medical science is not an example of philosophers spinning beautiful dreams in isolation. It is about maintaining health. It is tested against results. To be sure, most Chinese physicians, like Western ones, rarely question their systems when they fail in curing—they usually blame the unique situation at hand. But, in the end, the system has to deliver. All medical systems are kept on course (and occasionally even forced to change) by being tested against results. Chinese medicine has always featured "knowing practice" (Farquhar 1993) first. It is a hands-on, practice-based trade (E. Hsu 1999).
Biomedicine has found a somewhat better way to test (though be it noted that the Chinese invented case-control experimentation—for agriculture, around 150 ВСЕ; E. Anderson 1988). So much the better for biomedicine; we can now test traditional Chinese remedies and prove that many of them work. Ginseng, artemisinin, chaulmoogra oil, ephedrine, and many others have entered world medicine, proving that the systems are commensurable. Survival rates are the common measure, and a very fine measure they are, too.
Of course, the fourteenth century was a time when medicine was probably more similar between West and East than at any other time in history. The Golden Age of the Silk Road had climaxed and was soon to end with the fall of the Mongol Empire, the rise of sea trade, and the coming of the Little Ice Age, which made parts of the Silk Road almost impassable. The Chinese could reinterpret Near Eastern medicine in their terms without doing great violence to it.
At least some of the people involved in this transmission were thinking about practice, not theory. In the YSZY Hu Sihui had relatively little theory, and most of that was snippets of old stuff. The book is almost all recipes, practical tips, useful advice, and summaries of working knowledge. Obviously, a cook would not worry much about the incommensurability of Five Phases theory with Platonic or Aristotelian dogma. But Hu was clearly something of a scholar, not just a cook, so he was breaking the scholar-bureaucrat mold. In fact, his focus on real-world practice is exactly what the classic European stereotype of Chinese scholarship says the Chinese never had. Possibly Hu was enough of a semu—a Central Asian in Mongol employ—to be outside the Confucian value system, but the existence of perfectly good working recipe books by people like Ni Zan and the Ming doctor Gao Lian makes that hard to accept. The fact is that Chinese scholars sometimes interfaced with the real world and knew perfectly well how to deal with it.
The HHYF, too, is largely practical, even though the more theoretical sections can be very dense reading for anyone not highly expert in medieval Chinese medical terminology. The doctors, however, were interested in treating patients, not in philosophy. They were trying to find practices that they could actually use. The Mongol information superhighway brought them a vast bounty of good ideas.
The HHYF shows that medical systems spread rapidly, mix, merge, and go on. Nothing could be a more extreme contrast to the current reigning wisdom of medical history, which holds that every culture or region has its own medicine, completely and hermetically sealed and closed off from every other.
Sivin tells us to interpret the medicine of China only in the light of Chinese tradition, and often only in the light of literate texts from that tradition.
The reasons are clear enough: the historians fear, above all things, dismissing the past as nothing but an inferior run-up to the present—at worst steeped in error, at best merely a place to mine for innovations that later paid off and ideas that later proved correct—in either case, present knowledge is what mattered, and the past was evaluated only on presentist bases. Early histories of medicine very often did this, and histories of Chinese and Near Eastern medicine were particularly notable for it. The current fashion, however, is a sad overreaction. It mercilessly essentializes cultural traditions. It sees these traditions as wholly separate and distinct, despite overwhelming evidence of massive borrowing. It segregates them from each other behind Chinese walls.
The authors of the HHYF believed otherwise. They knew that China had been learning from the West for hundreds of years. They knew that Hippocratic-Galenic medicine and the Theophrastus-Dioscorides herbal tradition had spread over most of the known world, being readily accepted, adapted, and adjusted to local conditions wherever it went. They knew, above all, that patients were in need of all the help they could get. They knew from experience that many Near Eastern, Chinese, and Indian herbs worked, and they were not in the least interested in limiting their herbal medicine to one tradition or region.
Yet, they were not mere a theoretical pragmatists like some of Galen's rivals. The authors of the HHYF were schooled in highly sophisticated medical theories, which were fully scientific by the standards of the day. They must have had many a learned discussion of the relative merits of Galenic humoral theory and Chinese correspondence theory. They did not see these as closed, sealed jars of specimens to put on a museum shelf; they saw them as living bodies of theory to be used as tools and adapted as needed.
The historian and anthropologist need, first, to try to see what the doctors saw and try (hopelessly—but there is benefit in the attempt) to think as they thought. They were not playing word games or spinning out theory in a vacuum. They were treating patients. They tried to find what worked and to explain or understand it in light of what theories they knew. We most certainly cannot project our knowledge or views on them. We have to understand them on their terms.
We cannot view the Galenic and Dioscoridean traditions as different from or alien to China. It certainly was not alien to our own modern bioscientific world; in fact, it was ancestral to it. True, modern biomedicine is based on a classic Foucauldian "rupture" or Kuhnian "revolution": the germ theory and the consequent explanation of contagion, infection, and epidemic disease. But, on the other hand, Galenic medicine never died. Regimen—diet, rest and activity, lifestyle—was never forgotten. The Tacuinum sanitatis, a Latin version of an Arab text based on Galen, was so influential that in my youth I heard various folk versions of John Haringtons (1966) translated verse from it:
Keep three physicians: Doctor Diet, Doctor Merryman, and Doctor Quiet.
I had no idea that "Doctor Diet, Doctor Merryman, and Doctor Quiet" came from a literate scientific source going back 2,000 years.
Looking back on it all, we can see an interesting pattern, with the YSZY and HHYF squarely positioned on a key node. The ancient Babylonians and Egyptians seem to have gotten the idea of a specialized, self-conscious search for pragmatic and empirical knowledge and a further hope of systematizing it, deducing it, and possibly even explaining it. This was the dawn of self-conscious science (as we usually understand that term today). The Greeks and Chinese both developed it into an actual specialized realm of human enterprise, variously called episteme and other names by the Greeks, dao shi and other names by the Chinese; the Latin label "science" was much later. Persia and India had their own equivalents.
This activity included self-conscious medical traditions from the start. From early civilized periods, the Chinese had doctors (yi) and medicine (yao). Medical science developed to a high level with the Greeks, spread from them throughout the Mediterranean world with the Greek and later Roman empires, and thus became international. It contracted sharply in the West with the Dark Ages. Even in the East, it stagnated; there was virtually no medical progress from 400 to 800. At least the tradition survived. Finally, in the 700s, a huge boost to its international spread was provided by Islam, which adopted Greek medicine wholesale and spread it wherever the Muslims went. Thus while science almost died in the whole of Europe, it exploded in the Near East. It was then reintroduced slowly and fairly steadily to Europe until a spectacular rush in the 1200s not only brought southern Europe into parity with the Near East, but also started it on a path of growth that put it far ahead of the Near East within a couple of centuries. The geography of science had shifted rather spectacularly.
Meanwhile, Chinese medicine, which developed in the early states, spread slowly through East Asia, following the progress of civilization. A dark age (the Three Kingdoms Period), which was somewhat earlier than the Western one, set China back, but it recovered fast.
The two spheres touched by the 700s. With the continuing triumphal spread of Galenic medicine through the Western world, a climax of internationalism appeared in the 1200s and 1300s. During that period—it must have been an exciting one to be a doctor—there was a single vast medical enterprise from Spain to the Yangzi delta and from central Africa to Siberia. Serious, intensive scientific research, development, and education were found in colleges from Cordova to Beijing and from Timbuktu to Samarkand. There has never been anything quite like it before or since.
After the plague of 1346-48, science contracted again. Scientific activity, including medicine, declined in the Near East. North and central Africa went sharply downhill, especially after the slave trade began to devastate entire civilizations there. Central Asia also regressed. India and the Near East progressed slowly and haltingly, especially after 1500. China built on its traditions and developed rapidly but did not break through to biomedicine. Only Europe went from strength to strength.
Today, once again, medicine and other sciences are moving forward everywhere in the world, and a great medical tradition links humanity. The hopes embodied in the HHYF had been diminished by plague, war, climate, and human frailty but are now renewed. Yet, once again, our human enterprise is threatened by these horsemen of apocalypse. It remains to be seen whether the twenty-first century will recapitulate the fourteenth, with overpopulation, militarism, and intolerance all spiraling out of control, leading to a deadly downward cycle in Europe (Tuchman 1978) as well as in China. We have the chance and the opportunity to prevent them and to control our destiny. The wonderful dream embodied in the HHYF may provide inspiration.
Today, lifestyle-conscious doctors like Andrew Weil and Mehmet Oz teach versions of the Arabic regimen advice immortalized in the Tacuinum. (It is almost too perfect that one is Jewish and the other Turkish; verily even the nationalities have not changed.) We are all, once again, cognizant of the need for healthy eating and drinking, healthy exercise and adequate rest, healthy sex and social relations.
"The past is a different country," and historians do well to treat it as one, but we are all human, and we are all heirs of accumulated human wisdom. We are, in addition, the heirs of the medical traditions in the HHYF. Both the Western and the Chinese medical ideas in it have gone worldwide now. We cannot treat the HHYF as something alien to humanity or to our own culture. It is part of all our lives.