Prescriptions for Virtuosity: The Postcolonial Struggle of Chinese Medicine By Eric Karchmer, New York: Fordham University Press. 2022. pp. 272.
California Institute of Integral Studies (CIIS)
Focused on clinical practice in contemporary Chinese medicine (CM), Prescriptions for Virtuosity explores how contemporary CM education and clinical practice are ultimately postcolonial innovations shaped by struggles against the domination of Western medicine since at least the early twentieth century. The book draws on Eric Karchmer’s five years of medical school and clinical training at Beijing University of Traditional Chinese Medicine (TCM) and its teaching hospitals, combined with extensive ethnographic and archival research, oral history, and interviews with high-profile senior doctors. Karchmer tells a complex yet intimate story that not only engages critically with important CM works published since the 1990s—through hermeneutic interpretations of historical materials—but also calls for a new theoretical framework and methodology in the field of medical anthropology.
The book consists of analysis of three popular dualistic preconceptions about Chinese medicine: (1) “Western medicine treats acute illness; Chinese medicine treats chronic illnesses”; (2) “Western medicine treats structural pathologies; Chinese medicine treats functional pathologies”; and (3) “Western medicine diagnoses disease; Chinese medicine diagnoses patterns of disharmony” (25–26). These three complementary dualisms embody the epistemic shift and clinical transformation in CM since the 1950s, and they reveal profound postcolonial process of purification and hybridization through state-regulated institutional inventions of modern TCM colleges and hospitals. Few scholars have explicitly discerned the postcolonial character of the field of Chinese medicine. Partly concurring with well-known scholarship—such as that by Judith Farquhar (1994, 1996), Volker Scheid (2002, 2007), and Sean Hsiang-lin Lei (2002, 2014) on Chinese medicine from the Republic Era (1912–1949) to the post-1949 People’s Republic Era—Karchmer contends that a new hybrid Chinese medicine “is achieved, perhaps ironically, by privileging Western medicine and marginalizing Chinese medicine” (213). The most complex and important argument in the book (taking the space of three chapters) is Karchmer’s investigation of how “pattern discrimination and treatment determination (bianzheng lunzhi)” became the quintessential methodology of clinical practice through the editing of CM textbooks in the 1960s. He notes that this is “a recent, and indeed remarkable, invention of the Communist era. I consider it the ultimate postcolonial technology, enabling Chinese medicine to survive in a world dominated by Western medicine” (177). Ironically, most of the contemporary Chinese medicine doctors and students Karchmer encountered during his extensive ethnographic study believe, albeit often with agonizing conflicts in clinical practice, that the spirit of bianzheng lunzhi is more than 2000 years old.
In response to the challenges of apparently contradictory views of CM, Karchmer applies a hermeneutic study of key TCM terms and concepts, such as zheng (證) and bing (病). Chapter 3 disentangles the meanings of zheng by translating it as presentation and pattern, respectively, to illustrate the changed connotations before and after 1949. The same Chinese character zheng was used to mean external signs of illness, such as in fang-zheng (formula presentation, 方證) and bing-zheng (disease-presentation, 病證), in the Republic Era. Therefore, it should be distinguished from pattern, which is exclusively designed to bianzheng (pattern discrimination, 辨證) in contemporary TCM discourse. Another fascinating hermeneutic interpretation is applied to the “two bodies” of Chinese medicine and Western medicine that are simultaneously incommensurable and analogous in the longtime debates among CM doctors. In chapter 2, four images of the Chinese medical bodies (classic, Republican Era, and contemporary, Figures 10–13) are compared to show the impact of Western anatomy and the geographic imaginaries of double bodies. The striking image of Bao Tianbai’s 1937 lecture notes on anatomy (81) reveals the underlying shift in how CM doctors relate to Western anatomy, from a confident attitude of converging with the Western anatomical body to defending the Chinese medical body as ontologically distinct and incommensurable with the Western medical body. These historical hermeneutic translations and interpretations are the most illuminating moments of a book that not only clarifies previous misinterpretations by many scholars but also points out challenges and new approaches in the field of medical anthropology. Another striking strength of Prescriptions for Virtuosity is its storytelling style and vibrant ethnographic vignettes that depict various locations, from college classrooms to hospital outpatient clinics and inpatient wards, all of which are rarely accessible to Western researchers. Karchmer’s descriptions of his interactions and conversations with Chinese medicine classmates, professors, friends, supervisors, and interviewees are captivating and often hilarious, despite involving rather technical discussions about Chinese medicine.
While the book is engaging and illuminating, there are a few weaknesses. First, virtuosity, as indicated in the title of the book, is an important concept (if not a counterpart of bianzheng lunzhi) for the effective clinical practice of Chinese medicine. Although present in the discussion of several clinical cases that show how doctors of virtuosity are able to miraculously transcend the constraints of the three dualisms, the concept of virtuosity and its corresponding Chinese characters could have been elaborated more. Readers without Chinese medicine backgrounds might not appreciate the significance of virtuosity embedded in those cases. Nonetheless, the prescription for virtuosity sheds light on the rather gloomy postcolonial moment of Chinese medicine and even brings hope to the junior Chinese doctors who are often confused by the divides between Chinese and Western medicines in everyday clinical practice. It is found in the advice given by a senior doctor at the end of the book: “In order to overcome one’s confusion one had to learn how to achieve virtuosity” (218).
One other weakness is that this book mainly focuses on internal Chinese medicine and omits other clinical modalities, such as acupuncture and moxibustion, which usually rely more on distinct diagnosis and treatment methods, such as meridian theories, rather than the viscera patterns of internal medicine. Western acupuncture practitioners might want to know what historical transformations happened to acupuncture in the postcolonial struggle, although they might surmise the possible parallels from the critical analysis of TCM textbooks.
In conclusion, this book is essential and indispensable for scholars, practitioners, and students of CM. Its central strength, which is the captivating ethnographic descriptions of and scintillating theoretical remarks on the cultural history of CM, makes this volume easily attractive to a wide readership beyond medical anthropology, including Chinese and East Asian studies faculty who are teaching undergraduates. Many of Karchmer’s provocative arguments built through postcolonial theories command the attention of all scholars interested in a novel approach to the vicissitudes of radical cultural and political changes in modern China.