A Qin Bowei Anthology: Clinical Essays
Master Physician Qin Bowei
Translated and Edited by Charles Chace and Zhang Tingliang
Paradigm Publications, Brookline, MA, 1997
Softback, 223 pages, £16.00

Fluid Physiology and Pathology in Traditional Chinese Medicine
Steven Clavey
Melbourne & Edinburgh, Churchill Livingstone, 1995
Hardback, 330 pages, £39.50

(Reviewed by Volker Scheid, EJOM Vol. 2 No. 5)

For reasons both professional and personal it gives me great pleasure to review the above titles. Professionally, because I count them among the ten most important texts on Chinese medicine yet to have been published in the English language. Personally, because one of my teachers is a student of Qin Bowei and I thus feel a connection, however tenuous, to the great scholar physician, some of whose essays have been translated by Charles Chace and Zhang Tingliang and compiled into a book entitled A Qin Bowei Anthology.

Qin Bowei was born in 1901 in the vicinity of Shanghai into a family of physicans and artists. At the age of eighteen he enrolled at the Shanghai Medical School established by Ding Ganren (1865-1926), one of the most influential physicians of the late Imperial and early Republican era. Ding Ganren was a representative of the Ding family which in turn is counted among the Meng he tradition in Chinese medicine, a group of four families from Jiangsu Province to which belonged some of the most important and influential physicians of the late Imperial era.

Being blessed not only with an impeccable pedigree but also with ample intellectual and artistic talent and what appears to have been an indomitable constitution, Qin Bowei became actively involved in the practice, transmission and professional organisation of Chinese medicine from the 1920s up to his death in 1970 at the age of 69. He was one of the foremost scholars of Chinese medicine of his time who published voluminously. He was an exceedingly accomplished doctor whose great artistry is reflected in beautifully composed prescriptions that achieved their effects often with very small dosages of drugs. He was an inspiring teacher to which the accounts of his students bear witness. And he was a tireless advocate of Chinese medicine who, from the mid 1950s onward, worked as an advisor to the Chinese Medicine Bureau at the Ministry of Public Health.

Charles Chace and Zhang Tingliang have selected for translation in this volume seven essays and three case histories which introduce to a Western audience for the first time the work of this important figure in the recent history of Chinese medicine. The former are taken from Qin Bowei yiwen ji (The Collected Medical Writings of Qin Bowei) a collection of essays, lecture notes and letters published posthumously by some of Qin Bowei's students. They include papers on the differential diagnosis and treatment of liver disorders, fever, cough and oedema as well as discussions on the use of medicinals in prescriptions, the issue of supplementation and the eternally vexed problem of the gate of life (mingmen). The case histories have been taken from Zhongguo xiandai mingzhongyi yi'an (Essential Case Histories of China's Famous Contemporary Physicians of Chinese Medicine) a collection of case histories by the foremost representatives of modern Chinese medicine published under the auspices of the Ministry of Public Health in 1990. These deal with the treatment of cardiac pain, fever in leukaemia and water disturbance.

Together, these essays and case histories establish Qin Bowei as an extremely well read scholar physician who attempts to build a medicine able to meet the demands of his day by way of a synthesis between in-depth interpretation of classical literary sources and his own clinical experience. The essay entitled 'Discussion of Liver Illnesses', which according to the translators is intended to form the centrepiece of the collection, is a beautiful example of this style of inquiry. Qin begins with a critical comparative analysis of conceptual terms, which helps the reader to penetrate much deeper into the patho-physiology of liver disorders than the simplistic patterns so familiar from introductory textbooks. Yet, it is precisely discussions such as this which formed the tacit background to the construction of these self-same patterns by the compilers of textbooks in the 1950s and 60s. Readers will find particularly enlightening the erudite differentiation of liver depression (gan yu) and liver qi horizontal counterflow (heng ni), as well as the explanation of liver yang vacuity which is lacking from most Western textbooks. The essay continues to discuss in similar depth the primary symptoms of liver disorders, treatment strategies for their regulation, commonly used prescriptions and the various medicinals appropriate for treating liver illness.

Qin Bowei's essays thus succeed to simultaneously deepen one's theoretical understanding and to enrich one's clinical skills. They do so, however, not without some effort on behalf of the reader. While the translators and editors have made every effort to present the material in an easily accessible manner, Qin's style of writing and reasoning and the sheer volume of background knowledge on which he draws make this a text with which the reader needs to engage and not one that can just be read.

A biography of Qin Bowei, written by two of his students, prefaces the main texts. Here we learn of Qin Bowei not merely as an accomplished physician but also as a poet, calligrapher, painter and chain smoker whose various skills and interests all contributed to the formation of what he was and what he did: from his writing of books on the back of cigarette packages to his mixture of pragmatism and book learning, and his practice of medicine as a form of art.

The weakest point of the volume for myself is the translators' introduction. This attempts to analyse Qin Bowei's place in Chinese medical history but makes two mistakes which damage the overall argument. First, the translators appear to fit Qin's work into preconceived notions of Chinese medicine (notions that divide, for instance, a heterogeneous and ambiguous classical Chinese medicine in the Imperial era from a systematic TCM after liberation), rather than to engage with what presents itself in the life of their subject. Second, they insist on seeing medicine as a system of ideas which are realised in practice rather than as a way of being which involves ourselves and what we are. As a result, rather than opening new vistas onto Chinese medicine's recent past, their analysis presents as an unending series of contradictions. Within the space of three pages, TCM is referred to as 'a homogeneous blend of styles' and an 'official' system of which Qin Bowei was a chief architect, yet 'Western perceptions of a monolithic TCM orthodoxy' are simultaneously described as 'an illusion' and opposed to the individualised styles of physicians such as Qin. Qin Bowei's preference for precise terminological definitions is termed idiosyncratic and said to be 'found in few contemporary authors', yet we also read that all modern Chinese writings are characterised by a 'lack of ambiguity.' Qin is described as 'an old world Chinese doctor', yet one who can 'fluently articulat[e] himself within the framework of modern TCM.'

Anyone who has examined more of Qin's writings will discover there not only that his own thinking, terminology and practice changes over time (sometimes in very subtle ways), but also that many of his contributions to important debates (such as that on pattern differentiation and treatment determination or bianzheng lunzhi) did not make it into 'official TCM.' Some additional research may have stimulated, perhaps, a deeper questioning of conventional categories. It certainly would have produced a more comprehensive and useful bibliography than the present one, which lists merely one title by a man who apparently wrote over 60 books and numerous essays totalling ten million characters.

My final criticism concerns the editing of the book. The names of some Chinese texts cited are translated while others are rendered in Pinyin. No explanations are given regarding any of the medical works or authors cited by Qin Bowei making it difficult for readers not intimately familiar with Chinese medical history to make sense of these. 'Translator's Comments' and diagrams and tables composed by the translators are inserted into the original text often without clear demarcations. A little more attention to detail and a little more research thus would have significantly improved both the readability and the value of the book. That said, I recommend it not merely to experienced practitioners intent on deepening their knowledge but to all students of Chinese medicine in the West. Here, at last, is an opening (however small) onto the complex and complicated world of contemporary Chinese medicine beyond the textbooks and for that I am more than grateful to both translators and publishers.

Steven Clavey's Fluid Physiology and Pathology in Traditional Chinese Medicine is a similarly significant text and for similar reasons. The book is not merely a translation or compilation of material from primary or secondary Chinese sources translated for a Western audience, but a contribution to Chinese medicine in its own right - a discussion of a specialised subject (fluid physiology and pathology) which draws at once on a deep familiarity with the medical archive and considerable personal experience in the clinic. The result is a discussion which is profound in its insight, intellectually stimulating in its conclusions, masterful in its transmission of medical knowledge and filled to the brim with clinically relevant information.

Having introduced the basics of fluid physiology in Chapter 1, Clavey proceeds to discuss their various disorders in Chapters 2 to 10. These include chapters on the fluids of the five zang organs, sweat, urine, oedema, thin mucus, phlegm, damp and damp-heat. Each chapter deepens our understanding of physiology before engaging in detailed presentations of pathology, differential diagnosis and therapeutics. Case histories, drawn from the classical and modern Chinese literature as well as from the author's own experience complement the theoretical discussions and exemplify their value for clinical practice.

While we encounter citations from the classical literature throughout the text, there are special appendices for those interested in a more detailed understanding of original sources with special emphasis being placed on phlegm theory. Clavey introduces not merely some of the major contributors to the development of phlegm therapeutics but provides detailed translations from original works. This effort works both as a valuable introduction and as a context which establishes Clavey's own contribution to the topic. This contribution is both one of presentation (where Clavey excels through his clear language, style and the systematic organisation of his material) and one of original insight. Clavey argues, for instance, that the bie shi function of the triple burner in relation to the yuan qi should not be understood as that of a 'special envoy' (i.e. as the envoy of the yuan qi emerging from between the kidneys), but as that which makes separation happen (i.e. the triple burner makes the yuan qi separate into its different uses around the body).

The book is by no means an easy read, however, and certainly not one that offers quick fix solutions to difficult clinical problems. It is a book which demands serious and careful study, not least of its many and detailed footnotes which contain some of the most valuable material. It rewards the reader with an abundance of new insight and a continual deepening of what one already knows. Hence, although its therapeutic section is geared predominantly towards herbalists, it works, too, for those who practise acupuncture as their main therapy. For even if not all herbal treatment strategies are immediately (or at all) translatable into acupuncture prescriptions, herbal therapeutics are grounded in the same understanding of physiology and pathology. Thus, although much remains implicit rather than being made explicit, I recommend the text as an essential compendium also for all acupuncturists, whether students or experienced practitioners.

It remains to note only one minor query and one big question. As to the former, I was amazed by the curious absence of an index (an inclusion of which should be a priority for any second edition). With respect to the latter, I wonder why it has taken three years for this book to be reviewed in EJOM and even then only because I asked for it. This may have something to do with the publishers not sufficiently promoting the book but something, too, perhaps with the audience. There appears to exist a big market for well researched and presented introductory textbooks, but not equally as much interest in texts that demand but also give more. If that is true, what does this tell us about our claims of representing Chinese medicine in the West?

Clavey's own analysis in the introduction to his book eloquently describes this dilemma. He states that in the face of the gaps existing in our understanding 'claims that we are able to 'adapt Chinese medicine to the West' may be an heroic expression of confidence, but are almost certainly premature.' Eschewing the orientalist rhetoric of other well known authors yet advancing our understanding by painstaking analysis and exegesis, Clavey demonstrates, nevertheless, that it can be done - though it requires, in his own words again, much 'hard work'.

Volker Scheid
Volker Scheid has recently completed a PhD in medical anthropology at the University of Cambridge, which examined the plurality of Chinese medicine in contemporary China. He practises acupuncture and herbal medicine in Eastbourne and London.