The period covered extends from the first contacts with Chinese ideas in the thirteenth century to the middle of the nineteenth. This is divided into five sections: from first beginnings to 1491; 1492 to 1659; 1660 to 1736; 1737 to 1804; and 1805 to 1848. As the title indicates, Barnes is concerned both with Chinese medicine (herbalism and acupuncture) and, to some extent, with Chinese ideas of 'religion', although, as she points out, the concept of religion was unfamiliar to the Chinese before the arrival of Western missionaries. But Daoism, Buddhism, and Confucianism are not discussed in any detail, and are described only in so far as their ideas influenced medical thinking.
The dominant impression one gets from the book is one of incomprehension: both Chinese and Western observers largely failed to understand what their counterparts were saying, but Barnes directs her criticism at the Westerners, whom she sees as mostly arrogant, insensitive and unimaginative. But the nature of the incomprehension differed at different times. In the earlier periods medical theories in Europe derived from the writings of Galen and were framed by the concept of the four humours, which were linked to the four elements, earth, air, fire, and water. Chinese concepts of qi and of yin and yang were seen as consonant with the humours. The 'five phases' diagram was thought to be the equivalent of the four elements, but the Chinese were reproved for having the 'wrong' elements and for believing that these could change from one to another.
Later, as medicine became more scientific and more firmly based on anatomy and pathology, disapproval of Chinese ideas began to to be based on their ignorance of anatomy. They were also found wanting in their failure to use inspection of the urine in diagnosis (thought to be important in Europe at the time), although their skill in pulse diagnosis was recognised. But in spite of such reservations, a number of Western doctors were impressed by Chinese medicine; this attitude was helped by the eighteenth-century vogue for things Chinese—Chinoiserie. Two drugs—opium and ginseng—attracted a lot of attention and were exported on a large scale.
Acupuncture had been described by a Dutch physician, Willem ten Rhijne, in 1683, but it was not used in the West until later. By the beginning of the nineteenth century it was being practised quite widely in France and Germany, and in 1821 a young surgeon, James Morss Churchill, published a monograph that prompted a wave of interest in acupuncture in Britain. But the vogue for Chinese ideas was declining now and doctors in Europe had little knowledge of, or interest in, the Chinese theory of acupuncture. In any case, there was as much interest in moxa (the burning of herbs on or near the skin) as in acupuncture; moxa appeared more similar to contemporary Western practices such as cauterisation. In fact, acupuncture was falling into disuse in China itself in the eighteenth century, as Barnes makes clear in a quotation from a Chinese physician of the time.
I gained the impression that Barnes is something of a cultural relativist who thinks that Western medicine is simply another way of doing things, not based on any more profound understanding of the body than was available to the Chinese. She uses the give-away expression 'biomedicine' to refer to modern medicine, and seems to suggest that it is in need of revision and is 'no longer equated with paradigms of progress and modernity'. And she goes on:
This concern has led some not only to revisit the heritage of Western vitalism but also to look beyond it to alternate formulations—in this case, through a language of energy to the paradigm of qi.I have to admit that my hackles rise when I encounter talk of 'paradigms' and 'energy', nor do I think that we should return to vitalistic ways of thinking. Chinese medicine, like that in mediaeval Europe, was based on reverence for tradition, whereas modern science is iconoclastic and irreverent, continually questioning received ideas. And the results have been astonishing. Molecular biology, genetics, and evolutionary medicine have changed our understanding of the body and of disease in ways that are incommensurate with what went before. Classical Chinese medicine is certainly fascinating and well worth studying as a historical phenomenon, but it is not going to help us much today in our attempt to understand how the body works.
25 August 2011