unschuld's case study on the history of chinese medicine mainly argues

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Paul U. Unschuld and Bridie J. Andrews (trans), Traditional Chinese Medicine: Heritage and Adaptation

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Melissa S Dale, Paul U. Unschuld and Bridie J. Andrews (trans), Traditional Chinese Medicine: Heritage and Adaptation , Social History of Medicine , Volume 32, Issue 1, February 2019, Pages 204–205, https://doi.org/10.1093/shm/hky093

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How has a foreign system of medicine, once dismissed due to its scientifically unverifiable healing methods, gained worldwide attention and become considered by some as a component of Western health care systems? In this concise history of Traditional Chinese Medicine (TCM), one of the leading experts on the history of Chinese medicine presents his readers with 19 short chapters on its history and on the changing attitudes towards TCM since it ‘went global’ in the 1970s. Paul U. Unschuld’s book, first published in German in 2013 and now translated into English by Bridie J. Andrews, carries on the long tradition of Chinese–Western medical exchange first initiated by Westerners in the late sixteenth century, both informing and stimulating thought about TCM’s cultural background and political implications today.

Decrying the vast amount of misinformation about TCM, as evidenced by an array of examples pulled from the internet, Unschuld tasks himself with writing a book that will provide ‘solid information’ for ‘decision makers and the general public’ faced with how to deal with ‘the public health problem’ (p.x) raised by TCM’s arrival in the West. Unschuld presents this information in two parts: tracing the history of Chinese medicine from its emergence more than 2,000 years ago and then devoting the rest of the book to Chinese medicine’s development and its globalization as TCM from the beginning of the nineteenth century.

Unschuld begins his history in Chinese antiquity, where he finds that political changes from about the third century bce to the third century ce , led some Chinese to reinterpret how they viewed and understood the human body. Rejecting the belief that one’s ancestors and spirits controlled one’s health and sickness, the new medicine promoted the idea of existential autonomy and gave people the means to maintain their health. Having spent his career translating ancient Chinese texts and interpreting their meaning, Unschuld is well qualified to present his readers with the historical foundations of Chinese medicine and its changes over time. Chapters in which Unschuld provides documentary evidence of these changes are highly informative yet his wording and tone may become a bit dense and academic in places for his intended audience. The significance of these textual references becomes clear though once the reader reaches the final chapters of the book where Unschuld reveals how the wealth of misinformation currently being spread through the internet and hasty and erroneous translations have now altered Western understandings of traditional Chinese medicine.

While Unschuld focuses the majority of his attention on the earlier period, he also includes chapters on the other two ‘phases of creativity’ in the development of Chinese medicine: first, from the twelfth century bce until the fifteenth century, and secondly from the late nineteenth century through to the present. Chapter 7 on the anatomy, physiology and pathology in the new medicine is particularly interesting, shedding light on the body’s defence forces, the conduits, and qi. Readers may be surprised to learn that today’s acupuncture was originally used as a method of bloodletting. Throughout Part I, Unschuld effortlessly reveals the close connections between culture and medicine in China.

In Part II, Unschuld reveals the development of Chinese medicine and its reception in both China and in Europe and America. In the mid-nineteenth century, the reception of Chinese medicine shifted from being viewed as a cure for sickness to ‘a symptom and symbol of the sickness of China and its civilization’ (p.91). In the 1970s, TCM gained worldwide attention and came to be sought out by many as a ‘physical and spiritual’ (p.5) alternative to Western medicine. Unschuld’s contribution to the field becomes readily apparent here as he describes the misconceptions created when TCM went global and how politics have influenced its development under the PRC. Unschuld highlights the heated debates within China between those calling for the continued resistance against medical Westernisation and others favouring TCM’s demise in favour of wholesale modernisation. Unschuld’s argument comes through loud and strong here—as the Chinese government promotes TCM as a medicine grounded in modern science and linked with molecular biology, the TCM of today ‘has precious little in common with the medicine of the past’ (p.117).

In his parting chapters, Unschuld endeavours to correct some of the misconceptions that have gained currency in the TCM community in the West. Here, Unschuld’s command of the Chinese sources proves crucial in presenting historical facts, translating key concepts such as qi and arguing against the description of Chinese medicine as ‘gentle’ (p.136) and ‘natural’ or ‘holistic’ (p.138). In doing so, Unschuld stresses the importance of understanding the history of medicine in China and calls for an ‘an objective examination of the problematic and potential cultural heterogeneity of health care’ (p.140). Unschuld’s critique of Chinese medicine (past and present) provides readers with a very useful resource for understanding the development of Chinese medicine and for thinking about the future of TCM and its incorporation into Western health care systems.

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An Expert on Chinese Medicine, but No New Age Healer

By Ian Johnson

• Sept. 23, 2016

BERLIN — One day in 1971, the doorbell rang at Paul U. Unschuld’s apartment in Munich. He opened the door to find a young man, who laconically said in English: “Hi, I am James Quinn, C.I.A. Tell me about the military usage of acupuncture.”

So began the German academic’s rise from relative obscurity to his position as the West’s leading authority on ancient Chinese healing practices. One of the first Western scholars to tackle Chinese medicine in a systematic and serious way, Dr. Unschuld has seen his subject more as a way to interpret Chinese civilization than as a New Age answer to modern medicine.

Respected and sometimes resented for his scrupulousness in translating Chinese medical texts, Dr. Unschuld, a tall man of regal bearing, harks back to an era of scholarship, when people who engaged with China were called Sinologists — those who studied broad swaths of the Chinese world that reflected their wide-ranging interests.

For Dr. Unschuld, that has included amassing a collection of statues of medical deities that is planned to be a centerpiece of Berlin’s Humboldt Forum , a new museum under construction that will showcase non-European cultures.

Dr. Unschuld has also collected 1,100 antique manuscripts that could give clues to how medicine was practiced at China’s grass-roots level. The manuscripts contain more than 40,000 prescriptions that are being examined for promising ingredients, with some of the remedies for epilepsy already being studied by a Chinese-German start-up .

In his spare time, Dr. Unschuld has led German government delegations to China, and has written books on how medicine helps to explain China’s rise to global prominence.

“If there are two words I’d associate with Unschuld, it’s rigor and exactitude,” said Phil Garrison, a teacher at the Pacific College of Oriental Medicine in San Diego and at the Finger Lakes School of Acupuncture and Oriental Medicine in Seneca Falls, N.Y. “But these qualities are a double-edged sword.”

That is because Dr. Unschuld, who is as blunt as he is outspoken, stands at the center of a long and contentious debate in the West over Chinese medicine. For many, it is the ur-alternative to what they see as the industrialized and chemicalized medicine that dominates in the West. For others, it is little more than charlatanism, with its successes attributed to the placebo effect and the odd folk remedy.

Dr. Unschuld is a challenge to both ways of thinking. He has just finished a 28-year English translation of the three principal parts of the foundational work of Chinese medicine: the Huangdi Neijing, or Yellow Emperor’s Inner Classic, published by the University of California Press . But unlike many of the textbooks used in Chinese medicine schools in the West, Dr. Unschuld’s works are monuments to the art of serious translation; he avoids New Age jargon like “energy” or familiar Western medical terms like “pathogens,” seeing both as unfair to the ancient writers and their worldviews.

But this reflects a deep respect for the ancient authors the detractors of Chinese medicine sometimes lack. Dr. Unschuld hunts down obscure terms and devises consistent terminologies that are sometimes not easy to read, but are faithful to the original text. Almost universally, his translations are regarded as trailblazing — making available, for the first time in a Western language, the complete foundational works of Chinese medicine from up to 2,000 years ago.

“There exist any number of critical editions of the works of Hippocrates or Galen” from ancient Greece, said Don Harper, a professor at the University of Chicago, who studies ancient Chinese religious and medical texts. “Paul is the first to provide anything comparable to the Chinese corpus.”

But for many Western practitioners of Chinese medicine, Dr. Unschuld is an uncompromising guide to the Chinese classics. His books sell well, but many Westerners prefer more accessible translations that use more familiar terms.

“People were very threatened by what he said,” said Z’ev Rosenberg, an author, and a practitioner and teacher of Chinese medicine. “He said you need access to the sources and the terminology.”

And then there is the issue of efficacy. With his extremely dry humor, Dr. Unschuld likens Chinese medicine to the herbal formulas of the medieval Christian mystic Hildegard von Bingen . If people want to try it, they should be free to do so, he said, but not at taxpayer expense. As for himself, Dr. Unschuld says he has never tried Chinese medicine.

At his office in Berlin’s famous Charité hospital — where many pioneers of modern medicine got their start — Dr. Unschuld told a story about how, several years ago, he suffered a bilateral lung embolism. Pointing out the window to the hospital’s main tower, he said he was saved by modern medicine.

“Excuse me, but acupuncture and herbs can’t help you there,” he said, with a laugh. “But there are some health problems where these therapies may be beneficial, and, hence, I’m not against it when someone uses it.”

At times, Dr. Unschuld almost seems perplexed that his field of study actually became an alternative source of medical treatment. He said Chinese medicine’s popularity in the West can trace its roots to the Cold War, to 1971 to be exact. That is when James Reston, a columnist for The New York Times, reported about how he was treated in China for a burst appendix, in part with acupuncture and mugwort.

This was during the Kissinger-Nixon rapprochement with China, and the start of China’s decades-long reopening to the outside world. Chinese medicine became part of the country’s allure. Soon came the visit to Dr. Unschuld from Mr. Quinn, the C.I.A. agent; the opening of Chinese medical schools in the West; and a flood of books and translations about the exotic-sounding healing arts from the Orient.

Dr. Unschuld’s interest in medicine was not entirely unique in his family. His great-grandfather had treated the king of Belgium and other European nobility. Dr. Unschuld says he grew up in a household filled with vases and other chinoiserie donated by grateful patients. His father had been a pharmacist who collected pharmaceutical artifacts and pharmacopoeias of past centuries.

Initially, Dr. Unschuld earned a degree in pharmacy in Munich along with his wife, Ulrike. But he had also been fascinated with foreign languages and had completed a parallel track in Chinese studies. In 1969, before what he assumed would be a career in the pharmaceutical industry, the couple went to Taiwan for a year to improve their Chinese language skills.

Instead, Dr. Unschuld spent the year interviewing medical practitioners. The resulting Ph.D. thesis started his career as an expert on Chinese medicine, and for 20 years he headed the Institute for the History of Medicine at Munich’s Ludwig Maximilian University.

His purely academic approach, however, makes him a difficult figure for China to embrace. While widely respected for his knowledge and translations, he has done little to advance the government’s agenda of promoting Chinese medicine as soft power. Echoing other critics, he describes China’s translations of the classics as “complete swindles,” saying they are done with little care and only a political goal in mind.

For Dr. Unschuld, Chinese medicine is far more interesting as an allegory for China’s mental state. His most famous book is a history of Chinese medical ideas, in which he sees classic figures, such as the Yellow Emperor, as a reflection of the Chinese people’s deep-seated pragmatism. At a time when demons and ghosts were blamed for illness, these Chinese works from 2,000 years ago ascribed it to behavior or disease that could be corrected or cured.

“It is a metaphor for enlightenment,” he says.

Especially striking, Dr. Unschuld says, is that the Chinese approach puts responsibility on the individual, as reflected in the statement “wo ming zai wo, bu zai tian ” — “my fate lies with me, not with heaven.” This mentality was reflected on a national level in the 19th and 20th centuries, when China was being attacked by outsiders. The Chinese largely blamed themselves and sought concrete answers by studying foreign ideas, industrializing and building a modern economy.

In China, Dr. Unschuld said, “Medicine and politics are similar: You don’t blame others, you blame yourself.” He added, “You ask: ‘What did I do wrong? What made me vulnerable? What can I do against it?’ This is why China has risen.”

Follow Ian Johnson on Twitter @iandenisjohnson .

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Sinosphere | q. and a.: paul u. unschuld on reconciling chinese and western medicine, q. and a.: paul u. unschuld on reconciling chinese and western medicine.

Read in Chinese | 点击查看本文中文版

Paul U. Unschuld, 72, is a leading scholar of the history and ideas that underlie Chinese medicine. He has taught at what was then the Johns Hopkins University School of Hygiene and Public Health and since 2006 has headed an institute at the Charité hospital in Berlin that studies the theories, history and ethics of Chinese life sciences.

Dr. Unschuld is the author of several of the West’s most influential books on Chinese medicine, including “Medicine in China: A History of Ideas,” “What Is Medicine? Western and Eastern Approaches to Healing” and “The Fall and Rise of China: Healing the Trauma of History.” In an interview, he discussed Tu Youyou’s Nobel Prize and how Chinese officials view their country’s medical heritage.

In “The Fall and Rise of China” you write: “From the very start (of the reform movement in the early 20th century), Chinese medicine was at the center of criticism. That is hardly surprising. Nowhere within a culture are fears and optimism expressed as swiftly and existentially as in the attitudes toward one’s own illness.”

The Chinese Empire was subject to a series of humiliations beginning with the First Opium War, 1839-42. The sovereignty of China over its territory appeared to have reached its lowest point exactly 100 years ago, in 1915, when Japan made its 21 Demands [extending its control in China]. These exceeded anything the Western powers had ever demanded from China and marked the beginning of decades of Japanese annexation efforts, a large-scale invasion, including the most appalling war crimes against the Chinese people.

Many Chinese intellectuals saw their country as ill, and writers like Ba Jin and Lu Xun identified Chinese medicine as a symbol of China’s illness. Reformers and revolutionaries were in complete agreement that it should have no future. Naturally, conservatives raised their voice, too, warning against elimination of such a central element of Chinese culture, but, in general, ideas like yin and yang or the Five Phases [the interaction among the five elements: wood, earth, water, fire and metal] were denounced as obsolete.

And eventually the government shifted on Western medicine?

The turning point was the Manchurian plague of 1910-11 . The population burned vinegar and set off fireworks to drive out demons, but such traditional measures didn’t stop the plague. Finally, the authorities turned to an ethnic Chinese from Malaysia, Wu Lien-teh, a Western-trained microbiologist. He quickly brought the plague under control with basic public health policies unknown before in Chinese medicine. This was a big signal to the Chinese government: We have to get closer to Western medicine, or we’re finished.

And China did move quickly.

Once the superiority of such public health measures had been recognized, a very rational attitude towards Western science and medicine was adopted that may be characteristic of China. A victim needs to look at himself to realize why he was put down. If the West can do this to us, they must have something we don’t have. We’ll get it, and in the next round we shall see. There’s an old saying: “Wo ming zai wo, bu zai tian.” My fate is in my hands, not heaven’s. This principle has been applied in China both in politics and in health care for the past 2,000 years.

In terms of Chinese medicine, do you see this continuing today?

Certainly. In 2007, the government invited politicians and experts from 50 countries to draft the Beijing Declaration on Traditional Chinese Medicine and declared T.C.M. to be part of biomedicine. The future of T.C.M. was seen in molecular biological legitimation. I was the German delegate, and one high-ranking Chinese politician voiced amazement to me that some Westerners, exposed to modern science for centuries, believe in the Five Phases theory. You see, political decision makers in China can’t understand this because the Five Phases doctrine won’t make your mobile phone work. It won’t shoot a rocket to the moon. The government is not interested in promoting yin and yang and the Five Phases because it is convinced that people who believe in that are lost for the strengthening of China vis-à-vis the West. And we do see that young Chinese people are less and less open to these ideas. T.C.M. colleges in China have problems finding competent students.

What about the Nobel Prize and Chinese medicine?

I met Prof. Tu Youyou in the 1970s. She was a modern pharmacological researcher, working on harnessing certain herbs. She’s a perfect example for the successful modernization of Chinese medicine. Her successes are unrelated to yin and yang or the Five Phases. She had a great education in Western science, and she and her team searched through ancient literature for medications recommended to cure malaria. She used modern science to analyze Artemisia annua, figured out the active ingredient of the plant and modified it until it exerted an antimalaria effect never achieved in China before. That is what Mao Zedong had asked for: the unification of historical Chinese and modern Western medicine.

These views contradict how many in the West see Chinese medicine.

Professor Tu’s discovery had nothing to do with what most Westerners define as traditional Chinese medicine, except that the substance she examined is described in ancient pharmaceutical literature. The Chinese authorities are trying to strip historical Chinese medicine of superstition and nonsense. What is left can exist with molecular biology.

That disappoints those in the West who see T.C.M. as an alternative to biomedicine. These people don’t understand why the Chinese authorities act like this. The trauma of the 19th- and early-20th-century humiliation is still present. For 100 years, China has been struggling on many fronts to catch up with the West. Professor Tu’s Nobel Prize is proof of the success of this policy.

And yet many people in China opt for traditional medicine.

Western medicine can’t achieve miracles, and there are many everyday health problems it cannot solve. Many Chinese — and Westerners — know that there are recipes in Chinese medicine that work, regardless of whether there is scientific evidence. It is a characteristic common to all societies with a coexistence of modern and traditional health care options. Patients are aware of the strengths and weaknesses of the alternatives and oscillate between modernity and tradition accordingly.

Follow Ian Johnson on Twitter @iandenisjohnson .

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Traditional Chinese medicine : heritage and adaptation

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• Preface to the English Edition Introduction Part I: The Historical Foundations
• 1. Origins and Characteristics of Chinese Medicine
• 2. The Lack of Existential Autonomy
• 3. The Longing for Existential Autonomy
• 4. Quotations from the Medical Classics
• 5. The Banality of Violence
• 6. The Mawangdui Texts
• 7. Anatomy, Physiology, and Pathology in the New Medicine
• 8. Deficiencies in the Credibility of the New Medicine
• 9. The Alternative Model: The View from Illness
• 10. Radical Healing: Life as a Form of Disease
• 11. Between Antiquity and the Modern Age
• 12. Two Medical Authors of the Ming and Qing Dynasties Part II: Modern and Contemporary Times
• 13. The Confrontation with the Western Way of Life
• 14. The Persuasiveness of Western Medicine
• 15. The Opinions of Intellectuals and Politicians
• 16. The Selection
• 17. The Surprise
• 18. The Creative Reception of Chinese Medicine in the West
• 19. The Objectification of the Discussion: Opportunity and Challenge Epilogue Notes Index.
• (source: Nielsen Book Data)

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Traditional Chinese Medicine

Heritage and adaptation.

• Paul U. Unschuld
• Translated by: Bridie Andrews
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• Language: English
• Publisher: Columbia University Press
• Copyright year: 2018
• Audience: Professional and scholarly;
• Published: January 14, 2019
• ISBN: 9780231546263

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Medicine in China A History of Ideas, 25th Anniversary Edition, With a New Preface

• by Paul U. Unschuld (Author)
• First Edition
• Paperback $34.95,  £30.00

Title Details

Rights: None Pages: 464 ISBN: 9780520266131 Trim Size: 6 x 9

About the Book

In the first comprehensive and analytical study of therapeutic concepts and practices in China, Paul Unschuld traced the history of documented health care from its earliest extant records to present developments. This edition is updated with a new preface which details the immense ideological intersections between Chinese and European medicines in the past 25 years.

About the Author

Paul U. Unschuld is Professor and Director of the Horst-Goertz Endowment Institute for the Theory, History, and Ethics of Chinese Life Sciences at Charité-Medical University Berlin.

"Unschuld has accomplished monumental labours of translation and annotation. He has a fine historical sense . . . and a colourful and easy style which makes these esoteric subjects more accessible." — Nature

"Successfully weaves the evolution of medical ideas with the prevalent socio-political events of the past three and one-half millennia. . . . The reward is immense." — Medical Anthropology

"Undeniably valuable." — Times Literary Supplement

• 11th Special Book Award of China, State Administration of Press, Publication, Radio, Film and Television

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