A Worlding of Chinese Medicine

Western biomedicine is the most widespread form of medicine today, serving as an international language of epistemology that connects translational institutions through its culture. From large scale projects such as the World Health Organization’s campaign to end malaria in the 1950s to modern day efforts of specific hospitals such as Johns Hopkins’ international branches, biomedicine has been endlessly exported and its influence magnified around the world. Less often, a reciprocation of traditional forms of medicine reach Western shores. The presence of medical pluralism in many first world countries is generally limited to a modest existence of alternative forms of medicine in the shadows of biomedical institutions. Other-Worldly: making Chinese medicine through transnational frames is the ethnographic culmination of Mei Zhan’s exploration of traditional Chinese medicine and its worlding through everyday culture clashes and consensuses with biomedicine. As the narrator of her encounters in various clinical and professional settings in Shanghai and California, Zhan serves as an arbiter between East and West, effectively communicating with individuals from a plethora of languages, medical cultures, professional backgrounds, ages, and perceptions. I found this ethnography to be informative and influential; it completely shattered the idea of a bilinear relationship between traditional and biomedicine that I had before and replaced it with a complex web of interconnected ties. The more I read about the interactions between Chinese medicine and the rest of the world, the more I felt its movement as an ideology. Though traditional Chinese medicine is a part of the healthcare business, it is much more than that. It is changing, animated, and driving— endlessly effecting and being affected.

Zhan packages her main points into three broad concepts: a focus on the worlding, rather than globalization, of Chinese medicine; examination of how the interactions between biomedical and Chinese medical ideologies change each other; and an analysis of the terms “local”, “global”, “traditional”, “modern”, “East”, and “West” through the context of a dynamic worlding of Chinese medicine. Each of these umbrella topics are investigated through all three of Borofsky’s anthropology’s methodological tools—“participant-observation, contextual understanding, and comparison”— (2011: 3), organized into two chapters per topic. In the first and second chapters, she determines that Chinese medicine is constantly reshaped through translocal interactions between individuals.  The third and fourth chapters highlight an interesting paradox in the relationship between biomedicine and Chinese medicine—although biomedical epistemology has alienated traditional medicine and pushed it into the realm of “otherness”, everyday interactions between those from both ideologies prove that there are many shared meanings between the two practices. In the last two chapters, Zhan concludes Other-Worldly by demonstrating that although the worlding of Chinese medicine influences both Chinese and American culture, family ties, and medical knowledge, there remains a disconnect between how traditional Chinese medicine is practiced in America as opposed to in China. The overarching theme that ties all her personal encounters, experiences, and observations is the idea that Chinese medicine is constantly and variably worlded on the individual level, with translocal occurrences producing new knowledge and leading to the evolution of the practice.  For this review, I have chosen to further discuss and explore how translocal movements between Chinese medicine and biomedicine are ironically both helpful and harmful to its progression, the paradoxes of the relationship between the two ideologies, and how the gender roles of Chinese medicine are influenced by its worlding.

Though the worlding of Chinese medicine provides many opportunities for the traditional medicine to reach a wider audience, it also unlocks a variety of cultural obstacles. Unlike its efficacy in aiding the lives of infertile individuals from Becker’s “Metaphors in Disrupted Lives”, metaphoric modes of communication between students of Chinese medicine and faculty members of universities ironically yield more confusion than understanding. Early in the book, Zhan defines the term “worlding” to mean “translocal movements, displacements, and refigurations” (2009: 7). Her paralleling experiences in biomedical and traditional hospitals in San Francisco and Shanghai highlight the complications associated with the worlding of Chinese medicine. As Chinese medicine is constantly worlded and reshaped through interactions with biomedicine, the inherent differences between the language of biomedicine and that of traditional Chinese medicine surface, impeding efficient communication between students from countries relatively unfamiliar with traditional forms of medicine and the practitioners they strive to learn from. While at the Shanghai University of Traditional Chinese Medicine (SUTCM), Zhan often heard complaints from students that “Chinese medicine is too vague, soft, and ‘difficult to explain’… and that the biomedical training… is not up to the standards of the biomedical universities”, and consequently the university’s professors were “often dissatisfied with the attitude and competence of their younger students, and… are troubled by what they see as a lack of commitment, interest, and intellectual vigor from the students” (Zhan 2009: 79). By gaining opinions from both students and faculty, Zhang is able to account for opinions from both sides of the divisive conflict that affects traditional schools of medicine in China. Furthermore, these two views suggest that the hurdle exists on both the younger, biomedically accustomed generation’s and the older, veteran practitioner’s sides. The former suffers from difficulties in adapting from a rooted background in Western medicine, while the latter looks upon such natural struggles with disappointment. While the grounds of division lie on a lack of shared cultural ideology, even a solution that draws on common ground outside of the biomedical and traditional Chinese medical cultures fails to bridge the gap between the two, “obstruct[ing] instead of facilitat[ing] understanding and raises doubts about Chinese medicine rather than clarifies it” (Zhan 2009: 77). Zhan’s firsthand observations at the SUTCM serve as an example of how two ideologies’ commonalities may be amplified through metaphor but end up complicating difficulties and further estrange those involved. In contrast, Becker demonstrates how metaphor can help repair the identities of those who face social isolation and emotional pain due to their infertility, claiming that the application of metaphor “serves as a mediator for change, enabling individuals to reestablish a sense of connection with cultural norms and the social order, while obscuring cultural paradoxes and unresolvable dilemmas” (2011: 404). Though metaphor may serve as a way to cope with grief and forge a new identity, in the case of cultural disparities it complicates matters further by attempting to build on shaky common ground. In the sphere of traditional Chinese medicine, it is ironically within the dynamic scope of worlding that both “dreams and nightmares are made” (Zhan 2009: 88).

Another paradox intertwined with the worlding of Chinese medicine that puzzles me is the marginalization of traditional Chinese medicine by Western medicine despite shared meanings between the two practices. These commonalities are exposed on the individual, not institutional, level, inspiring one to question the real basis behind such exclusion. While talking to an herbalist in Shanghai, Zhan realizes that “the marginality of Chinese medicine has transformed everyday efficacy into something… miraculous” (2009: 108), citing the disparity in the perception of the two ideologies as the cause of such a distorted view of Chinese medicine. The same skewed perception of alternative forms of medicine was demonstrated by FRONTLINE/World’s journalist, T.R. Reid, when he visited India to receive Ayurvedic treatment for his shoulder. In an interview accompanying the documentary of Reid’s healing journey, Dr. Manohar, a director of research at an Indian pharmacy, offered insight on this phenomenon: “Ayurveda and Western medicine originated in entirely different cultural paradigms, which nurtured radically different world views. So, the basic difference lies in the epistemology, the very approach to knowledge-building” (Manohar n.d.). His comment about the root of the differences lying in separate worlds of epistemologies both parallels and sheds light on why medical pluralism is obscured in countries whose healthcare systems are dominated by Western medicine. Undoubtedly for alternative forms of medicine, the difficulties in gaining a foothold in the healthcare service arena stems from an inability to share an equal standing with biomedicine in the eyes of clients and fellow healers. Often, practitioners of Chinese medicine receive the medical equivalent of “leftovers” from clinics such as victims of biomedically resistant cancer, chronic depression, and asthma (Zhan 2009: 51). While Chinese medicine may not be directly about global health issues such as “mental health and inequality” (People’s Health Movement 2011: 6) and “infectious diseases” (World Health Organization 2012: 85) outlined in the WHO’s World Health statistics or Global Health Watch 3, traditional Chinese medicine is involved in the treatment of these chronic cases of noncommunicable diseases, which accounted for 63% of “the estimated 57 million global deaths in 2008” (World Health Organization 2012: 34); traditional Chinese medicine is very active as a player in the field of global health issues. The paradox of the marginalization of Chinese medicine accompanies the fact that through the process of cultural translation, shared values between traditional and modern medicine are magnified and understood. Dr. Huang of the Acupuncture Department of the Shanghai College of Traditional Chinese Medicine (SCTCM) communicates deftly with students and gains respect from her biomedical peers by connecting the definitions involved in acupunctural epistemology with that of biomedical terms (Zhan 2009: 133-139), establishing rapport in the face of the hurdles provided by worlding of Chinese medicine. As Chinese medicine is worlded and forced to change and adapt through transnational encounters such as those Dr. Huang face, the common meanings between all forms of medicine become the basis of cooperation and growth. Furthermore, the worlding process paints practitioners of Chinese medicine such as Dr. Huang as both traditional and modern as they preserve the original colors of their work in the diagnosis and treatment components of epistemology while integrating the novelty of biomedical terminology. Though cultural translation is not inherent and requires some background knowledge between practices, its existence serves as a landmark of the process of evolution that Chinese medicine has undergone due to worlding.

   

The concept of worlding also reshapes the dynamics at work outside of the hospital scene, transforming the gender roles that have historically provided a framework for the practice of Chinese medicine. The traditional practice is largely rooted in the patrilineal line of a family, with “Chinese family ties, especially male bonding, provid[ing] the social networks for the… modes of knowledge transmission that distinguish traditional Chinese medicine from the standardized mode of knowledge transmission in biomedicine” (Zhan 2009: 151). Even the word for “master” in Chinese (师父, shīfu) is composed of the characters for both “teacher” and “father”. Though before reading Zhan’s ethnography I was already familiar with the concept of patrilineal customs in East Asian culture, I didn't expect translocal interactions to displace such rooted precedents. After hearing from her uncle’s experiences with French acupuncturists in Europe, Liu Hanchao, who practiced acupuncture for forty years after graduating from the SCTCM, decided to pursue a career in traditional medicine. The effect of worlding influenced her decision in two ways; Liu’s decision to study traditional Chinese medicine instead of biomedicine stemmed from a cosmopolitan perception of the practice, not a desire to preserve the historical culture associated with it. Furthermore, in her uncle’s passing of information to a female member of the family, she succeeded in partaking in the traditionally male dominated circle of benefits from family relationships. Though Liu’s career exemplifies the effect worlding has on gender roles in Chinese medicine, it’s important to note that worlding did not equalize male and female genders in the sphere of Chinese medicine, but merely added another dimension to the practice’s concept of gendered kinship ties. Paralleling how we learned in lecture that the sociohistorical context of an era exercises a large influence on the ideology of a medical practice, as the dynamics of Chinese medicine change, so will the effect of worlding on its gender roles. At the most, the worlding of Chinese medicine exerts just one influence of many on the practice’s culture.   

         Ironically, traditional Chinese medicine is anything but traditional. At the very least, Zhan’s Other-Worldly serves as a platform of understanding, introducing those who aren't deeply familiar with anthropological concepts to the idea of a multidimensional relationship between Chinese medicine and the rest of the world. Beneficiaries of reading this ethnography span a wide range of individuals from doctors and those interested in the international movement of ideologies to those who have sought Chinese medical treatment and may be interested in the interactions between societies. The most prominent strength of Zhan’s ethnography lies in its culmination of a holistic viewpoint. Almost anyone can draw meaning from the plethora of perspectives offered in this book; the opinions of doctors, patients, students of both biomedical and traditional Chinese medicines, families, groups, institutions, and conferences paint a truly transnational picture of worlding. The major weakness of this ethnography is not as much an imperfection as it is an inspiration. Though at times I wanted solutions to the paradoxes of worlding, not just analysis, from Zhan, I realized that the nature of worlding in its constant motion would render any solution ineffective over time. The social reproduction of Chinese medicine occurs on a multidimensional plane—traditional Chinese medicine is everything but traditional. Furthermore, the worlding of Chinese medicine is very involved in the relationship between biomedicine as a medical hegemony and ideologies of traditional medicine. As it is involved in the complications and successes in medicine that unfold and resolve themselves over time, it also transforms dynamically.  

Allison Kuo 

Bibliography:

Becker, Gay.

     2011  Metaphors in Disrupted Lives: Infertility and Cultural Constructions of 

         Continuity. Medical Anthropology Quarterly, New Series, Vol. 8, No. 4, Conceptual              

         Development in Medical Anthropology: A Tribute to M. Margaret Clark (Dec., 1994), pp. 

         383-410. Blackwell Publishing. 

Borofsky, Rob.

     2011  Why a Public Anthropology?. 1st edition. Center for a Public Anthropology.  

Manohar, Ram. 

     n.d.. “Extended Interview: Dr. Ram Manohar”. By Reid, T.R.. FRONTLINE/World, PBS,   

        n.d..http://www.pbs.org/frontlineworld/stories/india701/interviews/extended.html (accessed 

        November 10, 2012).

People’s Health Movement, Medact, Health Action International, Medicos International and Third World Network.

     2011  Global Health Watch 3: An Alternative World Health Report. London: Zed Books Ltd.  

World Health Organization.

     2011  World Health Statistics 2012. World Health Organization.  

Zhan, Mei.

     2009  Other-Worldly: making Chinese medicine through transnational frames.  

        Durham: Duke University Press.