Neither Donkey nor Horse: Medicine in the Struggle over China's Modernity

Sean Hsiang-lin Lei is associate research fellow at the Institute of Modern History, Academia Sinica, Taiwan, and associate professor at the Institute of Science, Technology and Society at National Yang-Ming University.

The University of Chicago Press, Chicago 60637

The University of Chicago Press, Ltd., London

© 2014 by The University of Chicago

All rights reserved. Published 2014.

Printed in the United States of America

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ISBN-13: 978-0-226-16988-0 (cloth)

ISBN-13: 978-0-226-16991-0 (e-book)

DOI: 10.7208/chicago/9780226169910.001.0001

Published with the support of the Chiang Ching-kuo Foundation for International Scholarly Exchange.

Library of Congress Cataloging-in-Publication Data

Lei, Xianglin, author.

Neither donkey nor horse : medicine in the struggle over China’s modernity / Sean Hsiang-lin Lei.

pages cm.—(Studies of the Weatherhead East Asian Institute, Columbia University)

Includes bibliographical references and index.

ISBN 978-0-226-16988-0 (cloth : alk. paper)—ISBN 978-0-226-16991-0 (e-book)

1. Medicine—China—History—20th century.   I. Title.   II. Series: Studies of the Weatherhead East Asian Institute, Columbia University.

R601.L45 2014

610.951—dc23

2014001559

This paper meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper).

Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity

Sean Hsiang-lin Lei

The University of Chicago Press

Chicago and London

Studies of the Weatherhead East Asian Institute, Columbia University

The Studies of the Weatherhead East Asian Institute of Columbia University were inaugurated in 1962 to bring to a wider public the results of significant new research on modern and contemporary East Asia.

To my mother, Ni Mei-an, and in memory of my father, Lei Bin-sheng

Contents

1. Introduction

When Chinese Medicine Encountered the State

Beyond the Dual History of Tradition and Modernity

Toward a Coevolutionary History

China’s Modernity

The Discourse of Modernity

Neither Donkey nor Horse

Conventions

2. Sovereignty and the Microscope: The Containment of the Manchurian Plague, 1910–11

Not Believing That This Plague Could Be Infectious

Pneumonic Plague versus Bubonic Plague

The Most Brutal Policies Seen in Four Thousand Years

Challenges from Chinese Medicine: Hong Kong versus Manchuria

Chuanran: Extending a Network of Infected Individuals

Avoiding Epidemics

Joining the Global Surveillance System

Conclusion: The Social Characteristics of the Manchurian Plague

3. Connecting Medicine with the State: From Missionary Medicine to Public Health, 1860–1928

Missionary Medicine

Western Medicine in Late Qing China versus Meiji Japan

The First Generation of Chinese Practitioners of Western Medicine

Western Medicine as a Public Enterprise

Public Health: Time Not Ripe for Large Work, 1914–24

The Ministry of Health and the Medical Obligations of Modern Government, 1926–27

Conclusion

4. Imagining the Relationship between Chinese Medicine and Western Medicine, 1890–1928

Converging Chinese and Western Medicine in the Late 1890s

Non-Identity between the Meridian Channels and the Blood Vessels

Yu Yan and the Tripartition of Chinese Medicine

To Avoid the Place of Confrontation

Ephedrine and Scientific Research on Nationally Produced Drugs

Inventing an Empirical Tradition of Chinese Medicine

Conclusion

5. The Chinese Medical Revolution and the National Medicine Movement

The Chinese Medical Revolution

Controversy over Legalizing Schools of Chinese Medicine

Abolishing Chinese Medicine: The Proposal of 1929

The March Seventeenth Demonstration

The Ambivalent Meaning of Guoyi

The Delegation to Nanjing

Envisioning National Medicine

Conclusion

6. Visualizing Health Care in 1930s Shanghai

Reading a Chart of the Medical Environment in Shanghai

Western Medicine: Consolidation and Boundary-Drawing

Chinese Medicine: Fragmentation and Disintegration

Systematizing Chinese Medicine

Conclusion

7. Science as a Verb: Scientizing Chinese Medicine and the Rise of Mongrel Medicine

The Institute of National Medicine

The China Scientization Movement

The Polemic of Scientizing Chinese Medicine: Three Positions

Embracing Scientization and Abandoning Qi-Transformation

Rejecting Scientization

Reassembling Chinese Medicine: Acupuncture and Zhuyou Exorcism

The Challenge of Mongrel Medicine

Conclusion

8. The Germ Theory and the Prehistory of Pattern Differentiation and Treatment Determination

Do You Recognize the Existence of Infectious Diseases?

Notifiable Infectious Disease

Unifying Nosological Nomenclature and Translating Typhoid Fever

Incorporating the Germ Theory into Chinese Medicine

Pattern versus Disease

A Prehistory of Pattern Differentiation and Treatment Determination

Conclusion

9. Research Design as Political Strategy: The Birth of the New Antimalaria Drug Changshan

Changshan as a Research Anomaly

Scientific Research on Nationally Produced Drugs

Stage One: Overcoming the Barrier to Entry

Curing Mrs. Chu

Stage Two: Re-networking Changshan

Identifying Changshan

Two Research Protocols: 1–2–3–4–5 versus 5–4–3–2–1

Reverse-Order Protocol: 5–4–3–2–1

Research Protocol as Political Strategy

Conclusion: The Politics of Knowledge and the Regime of Value

10. State Medicine for Rural China, 1929–49

Defining China’s Medical Problem

Discovering Rural China

The Ding County Model of Community Medicine

State Medicine and the Chinese Medical Association

State Medicine and Local Self-Government

The Issue of Eliminating Village Health Workers

Chinese Medicine for Rural China

11. Conclusion: Thinking with Modern Chinese Medicine

Medicine and the State

Creation of Values

Medicine and China’s Modernity: Nationalist versus Communist

Chinese Medicine and Science and Technology Studies

Acknowledgments

Notes

Index

1

Introduction

During the last months of his life, Sun Yat-sen (1866–1925), the founding father of the Republic of China and a practitioner of Western medicine, was forced to take a personal stand on the issue of traditional Chinese medicine. Faced with the possibility of losing his life to liver cancer, his deliberation on and ultimate acceptance of treatment with Chinese medicine became a highly symbolic event, followed with great interest by countless observers from early January to his death on March 12, 1925. If Sun had refused to accept Chinese medicine even in this most vulnerable and hopeless situation, his decision would have been interpreted as a testimony to his steadfast belief in modernity, which he personified. According to the account provided by Lu Xun (1881–1936), one of the fathers of modern Chinese literature and once a student of biomedicine himself, the dying Sun in the end reasoned this way: While some Chinese drugs might be effective, knowledge of a [biomedical] diagnosis is lacking [in Chinese medicine]. How can one take drugs without a trust-worthy diagnosis? There is no need to take them.¹ After hearing that Sun had consistently refused to take Chinese medicine (which turned out not to be true in the end),² Lu could not contain his feelings and stated that Sun’s decision moved me so much that it is no less [important] than his life-long commitment to revolution.³ As revealed by Lu’s comment, to many of Sun’s comrades and progressive intellectuals of the times, the very act of taking Chinese drugs amounted to a public betrayal of the notion of modernity.

An equally symbolic event, albeit with totally different meanings, took place at the same Hospital of Peking Union Medical College nearly half a century later. In 1971, the New York Times journalist James Reston (1909–95), who had traveled to China as part of an advance team before President Nixon’s historic visit, underwent an emergency appendectomy there. As ordered by Premier Zhou Enlai (1898–1976), a team of leading medical specialists cooperated in the management of his case. The surgery went well, but Reston suffered serious postsurgical pain. After that pain was alleviated with acupuncture, he published a report in the Times on both his personal experience and his observations of the effectiveness of acupuncture on other patients. For many Westerners, this was the first time they had heard about acupuncture. Reston’s groundbreaking report was later credited for help[ing to] open the doors in this country [United States] to an exploration of alternative medicine.⁴ Reston was keenly aware of the historical irony of the event he had helped to create. The hospital where he had received surgery had been established by the Rockefeller Foundation in 1916 to serve as an elite model to instill the scientific spirit in Chinese minds,⁵ but Reston’s report noted that like everything else in China these days, it is on its way toward some different combination of the very old and very new.⁶ While Chinese medicine had been seen as the antithesis of modernity at Sun’s deathbed, fifty years later, in the same hospital, it had become a message to the world that China had developed a very different kind of medicine and, by implication, a very different kind of modernity.

Progressive intellectuals in the early twentieth century would undoubtedly have found it appalling that the view of Chinese medicine had been transformed in these fifty years from a burdensome tradition into an inspiration for the acceptance of alternative medicine around the world. They would have been even more puzzled had they known that during the same period China had dramatically increased access to modern health-care services for its citizens. By the time that Reston published his report, China had developed a primary health-care system that, in achieving 90% coverage of a vast population, was the envy of the world, according to Dr. Margaret Chan, director-general of the World Health Organization.⁷ Thus it was precisely in the process of the global expansion of modern (i.e., Western) medicine into China that traditional Chinese medicine went through its historic transformation. Against the background of this surprising and puzzling history, I attempt in this book to answer an apparently simple question: How was Chinese medicine transformed from the antithesis of modernity to one of the most potent symbols for China’s exploration of its own modernity?

When Chinese Medicine Encountered the State

It is a great irony that the turning point in the modern history of Chinese medicine was an event that was meant to put an end to it. In 1928, amid civil war, social unrest, and foreign occupation, the Nationalist Party (guomindang, also known as KMT) finally ended the political chaos of the Warlord period (1916–28) and formed a new government for China. Even though the Nationalist Party controlled only certain regions of the country, the regime nevertheless dedicated itself to the project of state building, establishing the Ministry of Health in the new capital of Nanjing. With the exception of the Song dynasty (960–1279),⁸ this was the first time that China had a national administrative center to take charge of all issues related to health care. In the next year, the first National Conference on Public Health, which was dominated by practitioners of Western medicine, unanimously passed a proposal to abolish the practice of Chinese medicine. To the great surprise of almost everyone concerned, this resolution mobilized the previously unorganized practitioners of Chinese medicine into a massive National Medicine Movement (guoyi yundong), formally instigating a decade-long collective struggle between the two factions of medical practitioners.

Half a century later, the widely respected pioneer of public health in China, Chen Zhiqian (also known as C. C. Chen, 1903–2000), reflected on this historical confrontation as follows:

In the 1920s, modern physicians, including Chinese nationals, inadvertently delayed the diffusion of scientific medicine, probably by many decades, through their demands for the abolition of traditional medicine. Fear generated by their actions caused a powerful coterie of traditional scholar-physicians in the cities to organize for collective action and to seek the intervention of high officials on their behalf. Respected by officials and the public alike, the scholar-physicians were able not only to defend what they already had but even to expand their influence. More than fifty years later, the two systems of medicine stood on equal footing in China, each with its own schools, treatment facilities, and highly placed friends in the bureaucracy.⁹

In short, from the viewpoint of biomedical practitioners such as C. C. Chen, an unforgivable miscalculation was made in proposing to abolish Chinese medicine in the spring of 1929. This miscalculation not only delayed the diffusion of Western medicine by decades, but it also gave birth to what we now know as a bifurcated medical field in China.

Presupposing the global diffusion of scientific medicine, Chen assumed that what he had witnessed in the 1920s was just a delay, a local suspension of the necessary triumph of biomedicine and of the unavoidable extinction of an indigenous medical tradition. Although Chen made the comment on this event quoted above in the late 1980s, like so many others among China’s modernizers, he still regarded the ultimate replacement of local medical traditions by scientific biomedicine as merely a matter of time. Nevertheless, the practice of traditional Chinese medicine is today legalized by the governments on both sides of the Taiwan Strait and has gradually spread into virtually all other parts of the world.¹⁰ The World Health Organization considers Chinese medicine a seminal field in the area of alternative and complementary medicine, and it is increasingly accepted into mainstream health-care services in nations around the world.¹¹ Instead of treating this history as simply an unfortunate delay or transition stage in the inevitable progression toward scientific medicine, I intend to examine the modern history of Chinese medicine as an essential part of the Chinese exploration of modernity. For this purpose, the following pages explore the events through which traditional Chinese medicine crossed the threshold to modernity—politically, institutionally, and epistemologically. As I explain below, this was also the point in time (as noted in the heading for this section) when Chinese medicine encountered the state.

First of all, my subject matter is traditionally considered to have been shaped by a cultural confrontation between two knowledge systems: scientific Western medicine and premodern Chinese medicine. This confrontation is generally taken as an unavoidable local event in the global spread of modern science and technology around the world. Nevertheless, by the 1920s practitioners of the two styles of medicine had already coexisted for decades in China without directly competing against each other. I argue, therefore, that the struggle between these two medical factions would never have taken place, or at least would have taken a very different form, if the state had not intervened to abolish the practice of Chinese medicine in the late 1920s. In this sense, the historic confrontation did not take place directly between the two styles of medicine but between Chinese medicine and the modernizing Chinese state.

Second, the two historic events that took place in 1929—the declaration of the government’s intention to abolish Chinese medicine and the rise of the National Medicine Movement—fundamentally transformed the logic of competition between Chinese and Western medicine in China. Instead of competing for individual patients, as they might have done before these events, practitioners of the two styles of medicine now occupied themselves with competing for alliance with the state. More importantly, these historic events provoked traditional practitioners to pursue actively and collectively the series of professional interests, institutional infrastructure, and governmental recognition that the state had just started to grant to Western medicine. In order to pursue the interests created and offered by the state, practitioners and advocates of Chinese medicine dedicated themselves to reforming Chinese medicine, thereby adapting it to the modernizing agenda of the state. To highlight their new vision, practitioners of Chinese medicine decided to call their style of medicine national medicine (guoyi). This name illustrates how the proponents of Chinese medicine, when forced to cope with the threat from the state, responded by striving to link the future of their profession closely to that of the state.

Third, I demonstrate that the 1929 confrontation also constituted an epistemological event for the remaking of traditional Chinese medicine. In addition to coping with the political challenges posed by the arrival of biomedical knowledge, Chinese medicine was confronted with epistemic violence when its leaders started to embrace what I characterize as discourses of modernity and committed themselves to reforming Chinese medicine on the basis of these discourses. Because these globally circulated discourses were designed to demarcate a divide between the modern and the premodern, reform-minded traditional practitioners encountered critical challenges in their efforts to reform Chinese medicine on the basis of these new conditions of knowledge. As their endeavors radically transformed the theories, practices, pedagogy, and social network of Chinese medicine, they paved the way for the full-scale creation of the standardized, textbook-based system of Traditional Chinese Medicine (TCM) that emerged in Communist China in the mid-1950s.¹² In this sense, the creation of modern Chinese medicine began at the moment when Chinese medicine of the 1920s encountered the state.

Beyond the Dual History of Tradition and Modernity

With a few notable exceptions, the majority of scholarly works on the history of medicine during the Republican period (1911–49) can be sharply divided into two largely independent categories:¹³ histories of biomedicine in China and histories of traditional Chinese medicine.¹⁴ Although no scholar has ever stated this explicitly, and most scholars might not be fully conscious of this fact, the rigorous divide between these two types of histories implies that Chinese medicine was of little relevance to the development of modern health care in China. It is certainly true that historians have been keen to document how modern institutions, values, and knowledge influenced the trajectory of Chinese medicine on many fronts. Much less, however, is known about how the advocates and practitioners of traditional medicine influenced either the introduction of Western medicine into China or the construction of public health and medical administration. Clearly, the historiography of medicine has reproduced a binary opposition between tradition and modernity, thereby preventing us from viewing Chinese medicine as a constitutive part of China’s medical modernity.

This division of intellectual labor is a great pity, because what has made Chinese medicine unique is precisely its contested and ambiguous relationship with China’s modernity. As Benjamin Elman concludes in his monumental study on science in China, among all the scientific fields of study in Imperial China, Chinese medicine was the only traditional discipline that survive[d] the impact of modern science between 1850 and 1920.¹⁵ The word survive serves as a reminder that the arrival of modern science and biomedicine in China, as in almost every other part of the non-Western world, often meant the mass marginalization—if not extinction—of traditional knowledge. No matter how hard historians of modern science have striven to go beyond the linear, teleological framework of the Enlightenment, they almost inevitably end up with the familiar story that traditional practices were pushed to the periphery, if not replaced completely by modern science. Against the unfortunate fate of either extinction or marginalization that has been common to almost all traditional practices around the globe, Chinese medicine stands out as a unique case that not only survived the attack of science and modernity but also flourished and became accepted into state-sanctioned public knowledge.¹⁶

Unfortunately, many people continue to view Chinese medicine as a survivor or remnant of premodern China. Although scholars like Elman have been careful to emphasize that the entity that survived the attack of science is a modernized version of Chinese medicine,¹⁷ people often assume without much reflection that Chinese medicine has survived as an anachronism in the fragmentary enclaves of a modernized China. If we view the modern history of Chinese medicine merely as a history of the endeavor to preserve and even modernize Chinese medicine—done only for the sake of Chinese medicine itself and relevant only in such enclaves—this history would not have much to do with the development of modern mainstream health care in China. Conversely, if the contested history of Chinese medicine is purged from the history of medicine proper, the resultant history of modern medicine in China looks conveniently close to what medical historian Warwick Anderson has criticized as local variations of a master narrative called ‘the development of modern medicine.’¹⁸ As Anderson points out, such a historiography of medicine merely reflects and reinscribes the general idea that the modern history of China, just like that of many other non-Western nations, tends to become variations on a master narrative that could be called ‘the history of Europe.’¹⁹ That is, it suggests that every major aspect of modernity developed first in Europe and then everywhere else.

If we recognize that the modern history of Chinese medicine is an integral part of China’s history of modern health care, this history will have the potential to challenge the above-mentioned Eurocentrism and historicism that Dipesh Chakrabarty criticizes in his influential book Provincializing Europe: Postcolonial Thought and Historical Difference. Although I emphasize this critical potential of the history of Chinese medicine, I certainly do not mean to romanticize the surviving tradition of Chinese medicine as a radical alternative to biomedicine. The romanticization of Chinese medicine presupposes, and thereby reinforces, a clear-cut separation between the modern history of traditional Chinese medicine and that of biomedicine in China—the former being what survives of a traditional discipline and the latter being an importation to China from modern Europe. I argue that neither of these two characterizations is historically true. As scholars, we must therefore go beyond the conventional framework that treats this complex and interwoven history as two separate historical processes: the survival of traditional medicine on the one hand and the development of biomedicine on the other.

Toward a Coevolutionary History

While it is important to recognize the unique status of Chinese medicine as a survivor of science and modernity, the concept of speciation is more appropriate for writing the modern history of Chinese medicine. First of all, what the advocates of Chinese medicine strove for during this period was neither the preservation of Chinese medicine nor even the so-called modernization of Chinese medicine.²⁰ As many leading figures of the National Medicine Movement explicitly pointed out, they strove to create a new Chinese medicine (xinzhongyi), namely, a recognizably new species of Chinese medicine. The metaphor of biological evolution can help us to appreciate the crucial difference between the survival of Chinese medicine and the speciation of what they called National Medicine. While the modernization of Chinese medicine can be likened to the transformation of a group of organisms (i.e., Chinese medicine), the vision of a National Medicine actually involved a dual transformation of both this group of organisms and of its new niche, that is, the emerging nation-state of China. The term survivor fails to capture the speciation process of a new Chinese medicine that coevolved with its new niche in the environment of the modern Chinese state.

In order to go beyond the dual history of the survival of traditional medicine and the development of modern medicine, I have foregrounded the reciprocal interactions among Chinese medicine, Western medicine, and the state. To highlight these otherwise obscure interactions, I have synthesized into a single historical narrative what has previously been separated into three independent histories: the history of Western medicine in China, the history of Chinese medicine, and the political history of the state. This unconventional research design keeps me from doing full justice to any one of these three histories; nevertheless, it does reveal the surprising alliances among historical entities that were considered to be geographically separated, categorically distinct, and therefore practically remote from each other.

For one concrete but simplified example, consider the control of the Manchurian plague in 1911, whose history I present in chapter 2. It was widely considered to be a landmark event in the history of Western medicine in China, because the control of the Manchurian plague demonstrated the political and indispensable role of Western medicine in state building. In the process of confining the plague, practitioners of Western medicine successfully defended China’s territorial sovereignty against encroachment from Japan and Russia. This landmark success of Western medicine depended on the combined forces of a new geopolitical power (resulting from the sovereignty crisis) and a new knowledge (the germ theory of the plague). To understand why Chinese medicine revealed itself as irrevocably inferior to Western medicine in this event, we have to take into account the unprecedented alliance between sovereignty and the microscope (see chapter 2).

In addition to tracing the reciprocal interactions and surprising alliances among these three histories, there are practical reasons to include them all in this study. In terms of narrating the modern history of Chinese medicine, the emergence of the nation-state and of Western medicine in Republican China were simply too radical, too profound, and too directly related to our topic to be treated as mere historical background. After the suppression of the Manchurian plague, the advocates of Western medicine came to the ironic conclusion that the scientific truth of biomedicine could not diffuse in China on its own but demanded as its vehicle the modern state and its accompanying institutions. In order to implement this newly developed strategy of popularizing Western medicine by means of the state (see chapter 3), they endeavored to turn Western medicine into a tool for state building. In response, the struggling practitioners of Chinese medicine soon adopted a similar goal as their crucial challenge. Striving to link Chinese medicine to the modern nation-state, they started the historic process of politicizing Chinese medicine. In other words, the rise of National Medicine as a collective vision for Chinese medicine was a direct response to a recently developed local feature of Western medicine in China.

As a result of the politicization of both styles of medicine, the state became the undisputed driving force behind the history of medicine in modern China. In practice, the relationship between the state and medicine went through a profound transformation during this period. Although the late Qing state had shown little concern for medical and public health matters until the outbreak of the Manchurian plague in 1910, by 1928 the Nationalist government had committed itself to building an independent Ministry of Health—only one decade after Britain had established the world’s first Ministry of Health in 1919. In 1947, the Nationalist government included in its first constitution a national policy of State Medicine (gongyi), an unusual form of national health system staffed, sponsored, and controlled completely by the government. Within less than forty years, China thus went from being regarded as one of the last of the world’s communities to undertake the utilization of scientific medicine²¹ to having a government with a firm commitment to providing modern health-care services to all of its citizens, foreshadowing the further development of the world-famous primary health-care system under the Communist government. This dramatic transformation of the state radically altered the social space for both styles of medicine; simultaneously, though, the interaction of the government with the two styles of medicine also resulted in some important features for the Chinese state. In this sense, the present book is intended both as a political history of medicine and as a medical history of the Chinese state.

To summarize, it is important to assimilate the history of Chinese medicine into the general history of modern medicine in China because the crucial features of modernity were not produced in any one of three insulated, categorically pure historical processes, but in the conjunction of three interrelated histories. By considering these three histories as moving targets, rapidly influencing and being influenced by each other, this book intends to capture the reciprocal relationships and coevolutionary processes among these three histories. From this viewpoint, the unique survival of so-called traditional Chinese medicine has been influenced greatly by the knowledge, discourses, and institutions that originated in Europe and Japan; conversely, what makes modern health care in China a unique contribution to global medicine is precisely its incorporation of these newly transformed indigenous health practices. Instead of reproducing the dichotomy between tradition and modernity, this coevolutionary history reveals the intensive interplay between them in a concrete historical process, thereby elaborating the features of manifested modernity in China.

China’s Modernity

So far, my discussion has focused on the policy aspect of the struggle between these two styles of medicine. Nevertheless, as Ralph Croizier cogently pointed out in his pioneering work published almost four decades ago, the debate over Chinese medicine concerned much more than medical policy.²² Contextualizing this struggle within the cultural milieu of the May Fourth Movement, Croizier convincingly explained why this controversy over medical policy drew in so many passionate participants from outside the medical circle, including the most prominent intellectuals and political leaders of that time. In his view, the controversy over Chinese medicine was a manifestation of a larger conflict, and a crucial paradox, between two modernist ideological forces in China, namely, cultural nationalism and scientism. Building upon his ideological analysis of this medical struggle, I argue that there were actually two separate but related struggles—a policy struggle over the role of Chinese medicine in the national health-care system and an ideological struggle over the nature of China’s modernity.

Personified as Mr. Science (sai xiansheng), scientism became a dominant force in modern Chinese thinking in the context of the May Fourth Movement in 1918. Its influence peaked in the debate between science and metaphysics in 1923, which addressed the question of whether one’s philosophy of life could be determined in a scientific fashion.²³ As this controversy reveals, progressive intellectuals strove to turn science into the representative of modernity so that the directions of various rampant changes of China could all be determined with confidence by the so-called scientific method. Because of this historical context, science was not considered merely a specialized way of knowing about and controlling the natural world; it was also used as an ideological authority to excoriate the Confucian religion and to direct social and cultural changes. Paradoxically, as intellectual historian Wang Hui has pointed out, the leaders of the May Fourth Movement did not advocate science as the antithesis of Confucian religion. Instead, they strove to promote a belief (xinyang) in science and advocated the replacement of religion by science.²⁴

They thus endeavored to introduce to China a monotheistic framework that was to be implemented in various aspects of culture and daily life, including political ideology, historical development, love affairs, and the doctor-patient relationship.²⁵ Instead of attacking the religious concept of belief, science was supposed to serve as the defining example of what constituted a monotheistic belief.

This ideological function of science was by no means a Chinese phenomenon. On the basis of his study of British colonialism in India, political historian David Arnold has emphasized the crucial role that science played in giving shape and authority to the understanding of modernity.²⁶ In my opinion, his conception of science as modernity is more appropriate than the concept of scientism for understanding why Chinese intellectuals treated the debate over Chinese medicine as a life-or-death struggle over China’s modernity. In the context of Chinese medicine, the modernist debate centered not on scientism in the sense of whether the scientific method could be applied to realms apparently outside of science, such as the philosophy of life, but on whether modern science could claim a monopoly on cultural authority within the realms presumably belonging to the natural sciences, such as medicine. While both of these debates were concerned with the cultural authority of science, they represented two extreme poles of a spectrum. When viewed against this background—progressive intellectuals fighting aggressively to maximize the authority of science in a variety of cultural realms—it becomes understandable why they appeared so angry and anxious when they were forced to defend the authority of science in the struggle over Chinese medicine. Fu Sinian (1896–1950), one of the leaders of the May Fourth Movement, made the following strong statement in 1934: The most shameful, the most resentful, and the most saddening aspect of contemporary China is the so-called struggle between Chinese and Western medicine.²⁷ Fu was right to feel that way, because what was at stake was much more consequential than the scientism debate over philosophy of life. As the struggle over Chinese medicine called into question the very foundation of science as modernity in China, it also constituted the most dangerous and unacceptable challenge to the universalist conception of modernity for the world beyond.

In the eyes of these participants, the central question of this struggle was whether there was any room at all for presumably premodern, non-scientific Chinese medicine in the project of defining China’s modernity. The answer to this question would determine whether China’s modernity would have to be a faithful copy of the universalist modernity. Nowadays, some scholars of modern China tend to use the term modernity in a rather loose fashion, identifying as modernity almost any aspect of the historical processes that took place during the nineteenth and twentieth centuries. The unfortunate result of such historiography is that we end up losing sight of both its epistemic violence and the painful confinement that historical actors faced in their efforts to cope with the universalist conception of modernity. As Arnold has summarized insightfully in the Indian context, acceptance of modernity as partisanly presented by the colonial officials, missionaries, educationalists and scientists would always confine Indians to a state of tutelage and subordination, always leave them one step behind, second-best and imperfect copies of a Western ideal.²⁸ In order to understand this difficult position, scholars need to take seriously the normative as well as confining effect of modernity when conceived in terms of science.

To begin with, science has been considered the most objective and universal knowledge that humans could ever possess. Other aspects of modernity may have been open to negotiation and local modification, but it was much more difficult to consider meddling with science, whose universality was guaranteed by nature, which presumably stood outside history and culture. Once conflated with nature, science thus conceived was able to serve as the most solid foundation for a culture-free, universalist conception of modernity.²⁹ To resist this modernity, or to propose its local modification, amounted to embracing obscurantism, if not irrationality and superstition (mixin).³⁰

The ideological struggle over Chinese medicine was deeply embedded within this framework of science as modernity. As revealed in the comment by Lu Xun with which I opened this introduction, in the early twentieth century, Chinese medicine was considered one of the most salient opposites of science. It was in this ideological context that the act of summoning a traditional physician to Dr. Sun Yat-sen’s deathbed became such a high-profile controversy.³¹ If Dr. Sun, the most admired persona of modernity in China, openly embraced Chinese medicine, the perceived opposite of science, it would have spelled a split personality for Mr. Science and thereby the bankruptcy of science as modernity.

While the struggle over Chinese medicine indeed took place within the larger context of ideological conflict, and the two struggles thus became entangled, the struggle over medical policy should not be equated with, or reduced to, the ideological struggle over the concept of modernity. I emphasize the crucial importance of differentiating these two conflicts and yet keeping track of both within one study, because the ideological struggle over China’s modernity did not take place in a purified discursive or conceptual space. Equally relevant were the practical context of resolving China’s health-care problem and the sociotechnical processes of transforming, or scientizing, traditional Chinese medicine. If one reduces the struggle over Chinese medicine to a purely ideological struggle over China’s modernity, the multilayered attempts to transform Chinese medicine—institutional, epistemological, and technical—fall by the wayside. While Croizier brilliantly reconstructed the larger ideological context for the struggle over Chinese medicine, this book is devoted to contextualization in the reverse fashion—that is, to reconstructing the medical and sociotechnical contexts for the purpose of understanding the ideological struggle over China’s modernity.

It is important to situate the ideological struggle over China’s modernity within these medical and practical contexts. In a nutshell, modernity is not a thing in itself,³² let alone a fixed entity insulated from real-life concerns and sociotechnical developments in specific local settings. In order to investigate the nature of China’s modernity with regard to the issue of Chinese medicine, we must suspend the abstract concept of a universalist modernity. Instead, we need to consider the possibility that a radically transformed modern Chinese medicine might have contributed to and even given shape to the modernity that came to be historically realized in China. For the sake of exploring this possibility, I examine the specific processes through which advocates of Chinese medicine embraced and negotiated the discourses of modernity and reassembled Chinese medicine. In this sense, this book is devoted to tracing the coproduction of modern Chinese medicine and China’s modernity.³³

The Discourse of Modernity

Throughout the first half of the twentieth century, Chinese medicine encountered numerous new ideas, artifacts, people, and institutions that had not existed in China just decades earlier: the microscope, the steam engine, Gray’s Anatomy, the germ theories of disease, the modern hospital, social surveying, the Ministry of Health, the Rockefeller Foundation, and professionalism, to cite just a few examples that are discussed in the following chapters. Although practitioners of Chinese medicine felt shocked, threatened, and sometimes enthralled by these various aspects of the modern world, none of these innovations—with the exception of the modern state—was as crucial as what I characterize as the discourse of modernity in shaping the modern history of Chinese medicine. Because the discourse of modernity was instrumental in turning Chinese medicine and science into incompatible opposites, it constituted the most daunting challenge for the advocates and reformers of Chinese medicine.

Central to the discourse of modernity was what philosopher of science Ian Hacking has characterized as the representationist conception of reality.³⁴ As a philosophy of science, it suggests that the objective of science is to create representations of the natural world, which is assumed to be unique, eternal, and transcultural—that is, natural and thus universal. Moreover, the act of making representations should imitate the act of unmediated seeing, as if scientists were doing nothing but holding up a mirror in front of nature, without disturbing in any way the reality to be represented. From this point of view, the main function of theoretical concepts is to represent the material entities that already exist in the real and eternal world. Because this conception of reality makes it possible to conflate science with nature, it provides the unquestionable basis for science to serve as the guardian of modernity. Although this philosophy would now have few supporters among researchers in science and technology studies, it persists as the commonsensical view of reality for both the general public and most practicing scientists. More importantly, historians have yet to understand the historical influence of this philosophy in shaping the modern history of China, not to mention the full consequences of abandoning it.

The embrace of this representationist conception of reality fundamentally transformed the relationship between the two competing styles of medicine. First of all, although none of the historical participants in the struggle over Chinese medicine ever mentioned this commonsensical philosophy of science explicitly, their arguments put into practice this theory of scientific knowledge, which was rather novel to many of their contemporaries. As the following chapters show, when critics of Chinese medicine accused it of being antiscientific—its cardinal sin and the ultimate rationale for its abolition—they meant to say that its theories failed to represent the known natural world as it was infallibly represented by science and biomedicine. As the result of this accusation, ontology thereby came to be valorized as the key to deciding the fate of Chinese medicine and China’s health-care policies. Moreover, by conflating science with nature and reality, this theory of science turned the competition between scientific medicine and Chinese medicine into a zero-sum game. From now on, Chinese medicine had formally entered the strange ontological space of modernity, a space that was deemed too crowded to allow Chinese medicine to coexist with biomedicine.

It is remarkable how little we know about the historical processes through which Chinese people came to embrace this fundamental framework about knowledge and reality. Scholars of modern history have been so focused on tracing the eye-catching changes in the intellectual landscape that it has become easy to miss the restructuring of the conditions of knowledge underlying it. Because the modern history of Chinese medicine involved an intensive public debate about the project of scientizing Chinese medicine, a debate concerned with both the nature of science and the controversial idea of scientizing its salient Other, this history offers a rare perspective from which to examine how the Chinese people came to embrace and later to negotiate these new conditions of knowledge.

Neither Donkey nor Horse

The key to answering the question posed in the beginning of this introduction lies in the book’s title, Neither Donkey nor Horse (feilü feima). To summarize the answer, the key development in this historic transformation was the rise of a new species of Chinese medicine that was seen by its detractors as neither donkey nor horse, a new medicine that demonstrated in concrete terms that the relationship between Chinese medicine and modernity was not to be antithetical. Although I feel slightly apprehensive about choosing a phrase that was meant to be derogatory as the title of this book on the modern history of Chinese medicine, I believe that this Chinese idiom correctly captures the historic challenge that the reformers of Chinese medicine took on—the challenge to realize a project that was assumed to be unimaginable and doomed to fail.

It may be useful to first spell out the origin and connotations of this expression, because there is no direct counterpart for this Chinese idiom in English.³⁵ Its earliest use is found in the Book of the Han Dynasty (Hanshu) from about two thousand years ago, which concerns the King of Qiuci, a Central Asian country in contemporary Xinjiang. This king admired the Han culture so much that he ordered his court to construct a Han-style palace, to wear Han-style clothes, and to adopt Han-style rituals and institutions. The non-Han people in his region bitterly commented: It looks like a donkey but is not a real donkey. It looks like a horse but is not a real horse. The King of Qiuci is nothing but a mule.³⁶ Criticizing the king’s efforts as a double betrayal of both cultural traditions, this idiom thus became an emotionally charged expression intended to show one’s strong disapproval of boundary-crossing cultural integration.

This expression is illuminating in understanding the modern history of Chinese medicine for several reasons. First of all, it registered the rise of a new kind of medical syncretism at a specific historical juncture. Instead of being a tool of analysis, like the valuable postcolonial concept of hybridity,³⁷ the idiom neither donkey nor horse was used by the actors at the time (and is intended in this book) as a reference to a new medicine in formation. It was not until the late 1920s that this idiom, which had existed in Chinese literature for roughly two thousand years, was used to criticize efforts to integrate Chinese and Western medicine. When Tang Zonghai (1851–1908), the widely acclaimed founder of the school of converging Chinese and Western medicine (zhongxiyi huitong pai), launched his medical syncretism in the 1890s, almost no one attacked him with such a strongly worded expression. In fact, Tang’s positive and optimistic attitude toward cultural integration was representative of the reformist group in the late Qing period. Liang Qichao (1873–1929), a leading reformist and the most influential scholar-journalist in the late Qing, took pride in his devotion to creating "a new school of learning which would be ‘neither Chinese nor Western but in fact both Chinese and Western’ (buzhong buxi jizhong jixi)."³⁸ There was no sign then that such an effort of integration was either ill-conceived or doomed to fail.

As I argue in detail in chapter 6, it was only after the 1929 confrontation, especially after the establishment of the Institute of National Medicine by the Nationalist government in 1931 in order to scientize (kexuehua) Chinese medicine, that people from both sides of this medical struggle started to recognize the rise of a mongrel medicine (zazhongyi) that was neither donkey nor horse. In other words, both the popularity of a new kind of medical syncretism (among reformers of Chinese medicine) and its derogatory characterization as a mongrel medicine were closely associated with the notion of science and the related discourse of modernity. In order to transform it into a state-sanctioned modern profession and a legitimate member of world medicine, reformers of Chinese medicine accepted the project of scientizing Chinese medicine and committed themselves to a path of integrating Chinese medicine with biomedicine. Risking the accusations and derision implied by the stigmatizing expression neither donkey nor horse, many leaders of the National Medicine Movement nevertheless devoted themselves wholeheartedly to the creation of this new Chinese medicine.

In addition, this expression highlights the fact that this medical syncretism was doomed to fail because it was an artificial creation against nature. As the story about the King of Qiuci reveals, this Chinese idiom conceptualizes a cultural phenomenon in terms of a biological metaphor, comparing cross-cultural integration to cross-species reproduction. The reference to the King of Qiuci as a mule clearly draws on the biological knowledge that cross-species breeding between a female horse and a male donkey always leads to an infertile creature. Just like mules, which are incapable of reproducing, the neither donkey nor horse medicine, no matter how vigorous it appeared at the present moment, was seen as nothing but a monstrous creature that was destined to have no future.

During the 1930s, even reformers of Chinese medicine found it hard to imagine a future for this new Chinese medicine that they had struggled to reassemble. Citing as an example the successful integration of Confucianism and Buddhism that had taken place during the Song dynasty (960–1278), some reformers of Chinese medicine clearly aimed at a similar