The Neglected Role of Buddhism in the Development of Medicine in Late Imperial China Viewed through the Life and Work of Yu Chang (1585-1664).

Despite significant revisions over recent decades, the field of medicine in late imperial China continues to be defined by a number of problematic boundaries such as that between medicine and religion. In this article I challenge the validity of this boundary through a detailed examination of the life and work of the hugely influential seventeenth-century physician Yu Chang (1585-1664), whose openly Buddhist critique of literati medicine has hitherto largely escaped the attention of medical historians. I argue that Yu Chang's case, read against the more widespread revival of Buddhism at the time, the important historical role of literati-Buddhist networks, and evidence of many other late imperial physicians' interest in Buddhism, was not exceptional. A wider reevaluation of Buddhism's role in the development of medicine in late imperial China as well as its historical neglect is therefore called for.

Promoting free flow in the networks: Reimagining the body in early modern Suzhou.

The history of Chinese medicine is still widely imagined in terms dictated by the discourse of modernity, that is as 'traditional' and 'Chinese.' And yet, so as to be intelligible to us moderns, it must simultaneously be framed through categories that make it comparable somehow to the 'West' and the 'modern' from which it is said to be essentially different. This is accomplished, for instance, by viewing Chinese medicine as fundamentally shaped by cosmological thinking, as focusing on process rather than matter, and as forever hampered by attachments to the past even when it tries to innovate. At the same time, it is described as pursuing its objectives in ways that make sense in 'our' terms, too, such as the goal of creating physiological homeostasis through methods of supplementation and drainage. In this paper, I seek to move beyond this kind of analysis through a two-pronged approach. First, by focusing on the concept of tong - a character that calls forth images of free flow, connectivity, relatedness and understanding - I foreground an important aspect of Chinese medical thinking and practice that has virtually been ignored by Western historians of medicine and science. Second, by exploring how the influential physician Ye Tianshi (1664-1746) employed tong to advance medical thinking and practice at a crucial moment of change in the history of Chinese medicine, I demonstrate that physicians in early modern China moved towards new understandings of the body readily intelligible by modern biomedical anatomy. I argue that this mode of analysis allows us to transcend the limitations inherent in the current historiography of Chinese medicine: because it allows for comparison to emerge from our subject matter rather than imposing our imaginaries onto it in advance.

Chinese herbal medicine for treating menopausal symptoms in London women: developing a good practice protocol via the factor analysis of prescribing patterns in a clinical study.

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to inform the development of best practice guidelines for a future pragmatic randomised controlled trial, with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London were analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, the patterns of combined herb use were analysed by means of factor analysis, and the correlations between these patterns and the presenting symptoms were analysed using the chi square test. Treating the emergent use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks and guidelines, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice.

Chinese medicine treatment for menopausal symptoms in the UK health service: is a clinical trial warranted?

OBJECTIVES: The aims of this pilot study were to evaluate treatment effects, ascertain safety and formulate best practice Chinese medicine protocols relevant for London women suffering from menopausal symptoms. STUDY DESIGN: This clinical pilot study employed a case series design within a wider action-based research project. 117 perimenopausal women between 45 and 55 years of age recruited from the general population were treated for menopausal symptoms by six experienced practitioners of Chinese medicine at the Polyclinic of the University of Westminster. Practitioners were instructed to treat as near to their usual practice style as possible. This involved using Chinese herbal medicine and/or acupuncture along with dietary and lifestyle advice. A maximum of 12 treatments over 6 months was allowed per patient. OUTCOME MEASURES: The menopause specific quality of life questionnaire (MenQoL), the Greene climacteric scale, and flushing diaries were used to evaluate treatment outcomes. Liver and kidney function tests were carried out at intake and after 1, 6 and 12 treatments to evaluate the safety particularly in relation to the use of herbal medicines. RESULTS: Patients showed significant improvement across all domains measured by the MenQoL and Greene climacteric scales. Reduction on the MenQoL scale between first and last visit was from 4.31 to 3.27 (p<0.001) and on the Green climacteric scale from 21.01 to 13.00 (p<0.001). Study participants did not reliably complete their flushing diaries. No adverse events or abnormal liver or kidney function values were observed during the course of the study. CONCLUSIONS: Further research that seeks to investigate the effects observed in more detail and to evaluate them against other forms of treatment and/or no-treatment controls is warranted. This could be achieved by way of a pragmatic randomized controlled trial that evaluated Chinese medicine against orthodox medical care.

Convergent Lines of Descent: Symptoms, Patterns, Constellations, and the Emergent Interface of Systems Biology and Chinese Medicine.

During the first decade of the twenty-first century, a network composed of politicians, regulators, bioscientists, clinical researchers, and Chinese medicine specialists has emerged that seeks to bridge an imagined gulf between the modern West and ancient China in order to create a new type of personalized medicine. The central building block of this bridge is the Chinese medical concept of zheng /, variously translated into English as syndrome, pattern, or type. My paper places side by side two different genealogies of how zheng assumed this central role. The first genealogy examines the process by means of which zheng came to be considered as something shared by both ancient China and cutting-edge biological science and, by extension, how it manages to hold together the entire institutional, political, and economic framework into which this bridge is embedded and which it co-creates. The second genealogy shows zheng to be central to a much older series of redefinitions of Chinese medicine and Chinese medical practice that extend from the eleventh century to the present. Read together, these two genealogies-neither of which should be seen as exhaustive-raise three important issues that are further discussed in the conclusion of the paper. First, I explore how the concept of zheng has come to tie a medical tradition derided by its adversaries for being a pseudoscience to one of the most cutting-edge fields of bioscience research. I ask what is at stake in this synthesis, for whom, and why, and how it transforms Chinese medicine and/or systems biology along the way. Second, I am interested in finding out how and why the very same concept can be at the heart of two apparently agonistic visions of Chinese medicine's future as it is popularly imagined in China today. Finally, I insist that the medical humanities need to become actively involved in the construction of emergent articulations such as the ones I am exploring. Merely writing a history of the present will not be productive unless its critique can somehow be articulated into the very processes of emergence that historians or anthropologists seek to examine.

Depression, constraint, and the liver: (Dis)assembling the treatment of emotion-related disorders in Chinese medicine.

Traditional Chinese medicine (TCM) is today practiced worldwide, rivaling biomedicine in terms of its globalization. One of the most common TCM diagnoses is "Liver qi constraint," which, in turn, is commonly treated by an herbal formula dating back to the 10th century. In everyday TCM practice, biomedical disease categories such as depression or anxiety and popular disease categories such as stress are often conflated with the Chinese medical notion of constraint. Medical anthropologists, meanwhile, argue that constraint reveals to us a distinctive aesthetics of constructing body/persons in Chinese culture, while psychologists seek to define constraint as a distinctive psychiatric disorder distinctive from depression and anxiety. All of these actors agree in defining constraint as a concept dating back two thousand years to the very origins of Chinese medicine. This article disassembles the articulations by means of which these different facts about constraint are constructed. It shows how ideas about constraint as a disorder caused by the penetration of external pathogens into the body were gradually transformed from the eleventh century onward into constraint as an emotion-related disorder, while treatment strategies were adjusted to match perceptions about body/self that developed among the gentry elite of southeast China in late imperial China.

Transmitting Chinese Medicine: Changing Perceptions of Body, Pathology, and Treatment in Late Imperial China.

Historians of Chinese medicine acknowledge the plurality of Chinese medicine along both synchronic and diachronic dimensions. Yet, there remains a tendency to think of tradition as being defined by some unchanging features. The Chinese medical body is a case in point. This is assumed to have been formalised by the late Han dynasty around a system of internal organs, conduits, collaterals, and associated body structures. Although criticism was voiced from time to time, this body and the micro/macrocosmic cosmological resonances that underpin it are seen to persist until the present day. I challenge this view by attending to attempts by physicians in China and Japan in the period from the mid 16th to the late 18th century to reimagine this body. Working within the domain of cold damage therapeutics and combining philological scholarship, empirical observations, and new hermeneutic strategies these physicians worked their way towards a new territorial understanding of the body and of medicine as warfare that required an intimate familiarity with the body's topography. In late imperial China this new view of the body and medicine was gradually re-absorbed into the mainstream. In Japan, however, it led to a break with this orthodoxy that in the Republican era became influential in China once more. I argue that attending further to the innovations of this period from a transnational perspective - commonly portrayed as one of decline - may help to go beyond the modern insistence to frame East Asian medicines as traditional.

Comparing TCM textbook descriptions of menopausal syndrome with the lived experience of London women at midlife and the implications for Chinese medicine research.

Almost without exception clinical research seeking to evaluate the effectiveness of Chinese medicine relies on TCM textbook knowledge - accessed directly or via practitioners' clinical usage - in order to frame its hypotheses. Recent historical research shows that these textbooks, products of a politically directed process of modernisation, constitute complex hybrids of western and Chinese knowledge that are designed to facilitate the integration of Chinese medicine into biomedically dominated contexts of practice. As such they produce a number of unresolved and generally unacknowledged tensions, such as between the emphasis on local illness experience in the Chinese medical tradition and the universality aspired to by biomedical knowledge. To examine the effect of these tensions we have carried out a study that compares local symptom patterns experienced by post-menopausal women in London with the universal patterns described in TCM textbooks. The results of this study confirm our proposition, namely that the TCM textbook descriptions of disease are not always grounded in clinical experience even if that is what textbooks claim. This raises questions about the relation of textbooks to clinical practice, and about the validity of clinical research based on textbooks and textbook derived normative practice. We argue that only a multidisciplinary approach that includes an understanding of the historical construction of contemporary Chinese medical knowledge and its relation to clinical practice can overcome these problems and enable a meaningful evaluation and utilisation of Chinese medicine in the context of 21st century evidence-based healthcare.

The treatment of menopausal symptoms by traditional East Asian medicines: review and perspectives.

This article provides an overview and critical evaluation of the management of menopausal symptoms by traditional East Asian medicines (TEAMs). For this purpose we utilise an interdisciplinary perspective that draws on social history, medical anthropology, and clinical research. Our goal is threefold. First, we examine the research literature regarding evidence for the effectiveness of TEAMs in the management of menopausal symptoms. The failure of all studies reviewed to address the problematic articulation between tradition and modernity in the case of menopausal syndrome leads us to examine more closely how this connection has been constructed. In the second part of this review we explain how during the late 20th century various TEAMs currents such as traditional Chinese medicine (TCM), Japanese Kampo, and Korean medicine, explored different responses to a biomedically defined disorder, namely menopause, that was until then not discussed in these traditions. Third, based on the findings of the previous sections we make a number of recommendations as to how research in this field might be improved. We argue that while robust evidence for the efficacy of TEAMs in treating menopausal symptoms is currently lacking, existing studies provide sufficient evidence to warrant further research. A new interdisciplinary research framework that takes account of the actual realities of TEAMs practice will be required however for meaningful answers regarding the two most urgent problems in the field to emerge. These are, first the issue of actual treatment effects, and second the more general problem of how TEAMs might be integrated into personalised health care.

Traditional Chinese medicine--what are we investigating? The case of menopause.

CAM researchers commonly treat traditional medicines as unchanging systems. This article questions the validity of this approach by examining the treatment of menopausal syndrome by traditional Chinese medicine (TCM). Such treatment strategies were invented in 1964 and betray a strong influence of biomedical thinking. While they determine TCM treatment of menopausal syndrome in the West, physicians in China and Japan use many other treatment strategies from within the wider Chinese medical tradition in clinical practice. Cultural variability in the manifestation of menopausal syndrome furthermore questions the usefulness of simply importing treatment strategies from China to the West. This leads me to conclude that Chinese medicine as such can never be evaluated by means of clinical research. What we can do is use Chinese medicine as a resource for thinking about illness, and for formulating clinical interventions that may then be assessed using methods of evidence based research.

[A study on the Menghe medical sect].

From the late Ming to modern age, famous physicians in Menghe came forth in large numbers, contributing to the formation of the Menghe scholarly sect with the four families of the Fei, Ma, Chao, and Ding as its representatives, featuring erudite academic knowledge, rich clinical experiences with distinguished contributions to the development of TCM. The materials presented in this article include investigation from over 100 kinds of genealogies, works of the Menghe sect collected from over 100 works written by the Menghe physicians, local chronicles, family tree collected in all major libraries in China and those in Europe, the US, Hong Kong and Taiwan, as well as through interviews with over 200 persons, including descendants of the Menghe sect, physicians related to the sect. Like a shinning star, the Menghe sect illuminated the medical province during the late Qing dynasty and early republican periods and even today as well.