Chinese medicine was never homogeneous or the preserverve of an organised profession. Some physicians were highly educated in the Chinese classics, including medical texts; in these cases medicine was usually a family tradition and its secrets were closely guarded. There were also illiterate practitioners who used magic spells and incantations together with medicines, and priests in the temples had their own healing rituals with a religious element.
Before about 1850 the Chinese were not really aware of the existence of a different kind of medicine from their own. They came into contact with Western medicine initially through missionary activity. The missionaries thought that bringing Western medicine to the Chinese would be a more successful path to conversion than mere preaching. But to the extent that Western medicine became popular in this way, it was not primarily due to its success in treatment (which, after all, was modest in the nineteenth and early twentieth centuries) but to a perceived need to adopt modern ideas in general.
The medical missionaries had to adapt in various ways to Chinese practice. One reason for this was difficulty in obtaining adequate supplies of Western drugs, which required the substitution of substances that were available locally. Other accommodations were needed as well; for example, one missionary doctor reported that his patients would leave the clinic in scorn if he neglected to take their pulses in the traditional Chinese manner. The patients also objected to being given a bath when they first came into hospital (bathing was considered dangerous) and they disliked the bland over-cooked food that Western doctors thought suitable for the sick.
The early medical missionaries were not much interested in preventive medicine but later, after germ theories of disease began to be accepted in the West in the 1880s, these ideas did start to be applied to public health in China. But cultural differences sometimes obscured the message. The YMCA in China held public health festivals with music and the display of huge models of flies to convey the need for hygiene. An observer at one of these festivals commented that it was no wonder the foreigners made such a fuss about flies if those in their countries were so big. And a missionary physician relates that, after the servants at his compound were given a lecture on sanitation, one of them remarked that there were not many differences between germs and Chinese demons; both were invisible, both caused disease, and both required special rituals to exorcise them.
A second route by which knowledge of Western medicine entered China was through Japan. The role of Japan in the development of modern Chinese medicine is important but it has not received the attention it deserves, partly because many Chinese were and still are reluctant to acknowledge this influence in view of the two disastrous Sino-Japanese wars, in which China suffered severely.
Japanese medicine was informed by Chinese ideas for many centuries, but in the nineteenth and especially the twentieth centuries the roles were reversed and Japan was very influential in the modernisation of Chinese medicine. Modern scientific ideas had been increasingly adopted in Japan and this had produced a corresponding increase in the use of Western medicine. Traditional medicine did not disappear in Japan but it underwent modernisation to bring it up to date. At this time Chinese students were going to Japan to learn medicine, and the medicine they encountered there was Western or Western-influenced. They brought these ideas back to China on their return.
The Japanese influence on Chinese medicine was particularly important for acupuncture. Andrews has only one chapter on the subject (Chapter 8) but it is an important one. She shows that acupuncture, at least as practised today, is surprisingly recent—it goes back less than 100 years!
Acupuncture had long been in decline in China. In the mid-eighteenth century a physician lamented that it was a lost art, with few teachers able to instruct young physicians. By the mid-nineteenth century it was not being practised by educated physicians. In so far as it was used at all it was largely as a branch of minor surgery; the needles then in use were thicker and more varied in shape than those used today.
Its revival in China in the twentieth century was due to a physician, Cheng Dan'an, who had studied in Japan and who broke decisively with the past. He introduced the use of fine needles and based acupuncture on Western descriptions of anatomy. He rejected what he thought of as superstitious notions and taught that acupuncture worked via the nervous system. His views were widely accepted and anticipated many of the ideas that characterise Western medical acupuncture today.
This trend continues in China today. It is remarkable that most of the papers in Acupuncture in Medicine, the acupuncture research journal of the British Medical Acupuncture Society which is published by the BMJ group, now come from China. Enthusiasm for the ancient ideas is largely a Western phenomenon.
This is an important book that should be read by anyone with a serious interest in Chinese medicine and how it is perceived in the West.
See also The Art of Medicine in Early China, by Miranda Brown.