Elisabeth Hsu
Cambridge University Press, 1999
Hardback, 312 pages, £40
Paperback, 312 pages, £14.95

(Reviewed by David Mayor, EJOM Vol. 3 No. 3)

I found The Transmission of Chinese Medicine an enthralling book, and would thoroughly recommend it to anyone involved in the teaching or learning of Chinese medicine in all its rich variety. The author, an ethnographer and fellow in the history of Chinese science at Cambridge University, plunged headlong into her own learning of three very different aspects of this richness during a stay in Kunming in 1988-89 (including the turbulent months around the crushing of the people's movement in Tiananmen Square).This book, filled with scholarship and human insight, and with its succulently coloured and textured cover, is the result.

Elisabeth Hsu describes in beautifully written detail her experiences of the secret transmission of qi gong with healer Qiu, the personal transmission of knowledge with learned doctor Zhang (interpretation of a classical medical text) and the standardised transmission of TCM at the Yunnan College of TCM. As she emphasises again and again, different terms (e.g. qi) may mean quite different things in such very different contexts, and it is in the process of transmission that seemingly similar terms are honed and refined to give these experienced meanings their variety.

Her descriptions of Qiu's household, her own and his other students' experiences of qi, are fascinating. At a time in the West when everything we do seems to have to be scientifically/evidence based, I found it refreshing to read Qiu's words that (as any traditional acupuncturist knows) 'qi gong is done by imagination, not by force, it's as simple as that,' and to be reminded that critical evaluation can actually be counterproductive (there is no Absolute in ideas). The focus on balance, process and harmony in this form of healing brought me back to a feeling of my own roots.

Zhang's personal knowledge was not so much transmitted through verbal, direct teaching, but (sometimes arriving almost as a revelation) through application and experience. Textual aphorisms acquire meaning through practise, knowledge cannot be 'explained', doctrine is 'prescriptive"'and 'polysemous' (with many meanings), not something monolithic apart from the clinic.

The standardised transmission of TCM goes with its institutionalisation, modernisation and 'scientisation, but even here among the questionnaires and technical detail, Elisabeth Hsu is able to enliven her descriptions of the TCM College and its denizens. This part of the book helped me greatly to understand the Chinese need to 'fit into the whole' rather than express personal desires or viewpoints (whether this whole be the family, the College or larger society), and also to understand, sadly, how TCM has to a very great extent been built on a scientific foundation rather than being allowed to grow organically from more traditional origins. Students at this College were high school graduates in the natural sciences. Those whose parents were traditional doctors were not encouraged; many would have preferred initially to study western style medicine; much of the curriculum was anyway devoted to this.

Most importantly, in standardising TCM it has become a 'descriptive' theory, distinct from practise. Elisabeth Hsu writes most perceptively about this in the context of pulse diagnosis, about the division between what is learned audiovisually and then applied tactilely. Sensitivity to a many levelled recognition of patterns (the 'body ecologic') in TCM gives way to a more focused vision that emphasises the anatomical and material aspects of the body in unambiguous terms. Her discussions of how yin yang has been completely reinvented in terms of Mao's dialectics, or the Five Phases as Five Substances or Organs, are salutary. Her parallels between what she terms the 'organ clusters' and the physical divisions of the College itself are both amusing and enlightening. However, how traditional doctrine is increasingly being revamped along the lines of western biomedicine or dialectics, how for instance the notion of an all-pervasive shen is disappearing in favour of its interpretation simply as 'mind', is disturbing.

Hsu's words that 'efforts at standardising the transmission of knowledge and practice seem bound to give rise to a divergence between the proclaimed standards and their implementation' may be uncomfortably prophetic when applied to the predicaments in which traditional acupuncture finds itself in the West. As she concludes, 'the standardisation of traditional and the professionalisation of alternative medicines may well preserve the technical terminology of those medicines but not their performative significance.' As a result, both practitioner and client may be disempowered. These are serious consequences that need to be seriously considered in the current debates on standardisation of acupuncture practice in this country.

David F Mayor
David Mayor originally trained in traditional acupuncture at the Leamington College. However, his earlier academic scientific training and interests have always meant he has strong leanings towards the science as well as the art of acupuncture. He is currently preparing a textbook on electroacupuncture for the publishers Churchill Livingstone.