Asian Medicine and Globalization

by Joseph S. Alter

Overview

Medical systems function in specific cultural contexts. It is common to speak of the medicine of China, Japan, India, and other nation-states. Yet almost all formalized medical systems claim universal applicability and, thus, are ready to cross the cultural boundaries that contain them. There is a critical tension, in theory and practice, in the ways regional medical systems are conceptualized as "nationalistic" or inherently transnational. This volume is concerned with questions and problems created by the friction between nationalism and transnationalism at a time when globalization has greatly complicated the notion of cultural, political, and economic boundedness.

Offering a range of perspectives, the contributors address questions such as: How do states concern themselves with the modernization of "traditional" medicine? How does the global hegemony of science enable the nationalist articulation of alternative medicine? How do global discourses of science and "new age" spirituality facilitate the transnationalization of "Asian" medicine? As more and more Asian medical practices cross boundaries into Western culture through the popularity of yoga and herbalism, and as Western medicine finds its way east, these systems of meaning become inextricably interrelated. These essays consider the larger implications of transmissions between cultures.

Product Details

ISBN-13:	9780812238662
Publisher:	University of Pennsylvania Press, Inc.
Publication date:	05/27/2005
Series:	Encounters with Asia
Edition description:	New Edition
Pages:	200
Product dimensions:	6.10(w) x 9.10(h) x 0.90(d)
Age Range:	18 Years

About the Author

Joseph S. Alter is Professor of Anthropology at the University of Pittsburgh. He is the author of Gandhi's Body: Sex, Diet, and the Politics of Nationalism and Knowing Dil Das: Stories of a Himalayan Hunter, both available from the University of Pennsylvania Press.

Read an Excerpt

Chapter 1

Introduction: The Politics of Culture and Medicine
Joseph S. Alter

The chapters in this volume deal with the ways in which the body and bodies of knowledge are manipulated to produce coherence and health, broadly defined. They focus on forms of medicine that tend to be linked, in both practice and the imagination, to specific national entities: India, China, England, and the United States, most directly, but also Australia, Tibet, Japan, Singapore and Germany. And yet, in both practice and in the imagination, the manipulation of health in any one of these places, that involves ideas borrowed from any combination of the others—or from no clearly defined place at all—confounds the boundedness of these national entities. In other words, there is a powerful paradox manifest in the relationship between nationalism and transnationalism. This volume is designed to explore the nature of this paradox as it relates to medical practice and the development of medical knowledge.

Within the rubric of modernity it has become necessary, as Prasenjit Duara puts it, to "rescue history from the nation" (1995). The reason is that the legitimacy and power of nationalism is deeply vested in a particular construction of history. This construction is defined as an objective, authoritative, disinterested account of the past as such. It is, in part, the open endedness and inherent interpretability of the past that allows for it to be both captured and rescued; defined and redefined according to different priorities. In this sense history is, simply, a more flexible medium than culture. As anthropologists have pointed out, culture can also be captured and rescued. However, by virtue of present tense, empirical temporality the capture of culture—its strategic interpretation and manipulation—is often more covert than the capture of history. The heroic rescue of culture is championed overtly by those who claim value-free objectivity.

Culture and history come together at various points, and some of these points of convergence are much more prone to capture than others. Think of borders—what they mean, when they were drawn and what the convergence of signification and demarcation means with regard to a whole spectrum of things for which the lines on a map are not only not particularly relevant, but also distorting and disorienting. If history must be rescued from the nation, the convergence of history and culture—as well as each of these unto itself—must be rescued from a world of partitioned and bracketed nation states, and also from a world view, reflected in academia as clearly as in business, that is predicated on the fractured and highly politicized nationalist perception that this entails. There are serious problems, in other words, in thinking about a large region of the world such as Asia—and where, too, does that entity begin and end—as though its history and culture can be subdivided into the history and culture of geopolitical entities called China, India, Thailand, Korea and Taiwan, for example. And this is a problem even for those whose topic of study—Buddhism in the 10th century, let us say—obviously cross cuts the borders of both relatively old kingdoms and empires and modern states.

As more and more research is conducted on various medical systems in Asia by scholars from a range of disciplines, there is a tendency for the questions being asked to become more and more specific to the uniqueness of each particular case. This is good. We now know much more about medicine in China, Japan, Korea, Malaysia, Thailand, Sri Lanka, India and Nepal—to string a somewhat random list of countries together—than we did even ten years ago. But it is also unfortunate. The structure of scholarship is invidiously and often invisibly structured by the priorities of the state: funding for research is linked to government interests and is often channeled through state bureaucracies. This can inadvertently produce the illusion that there is a "tradition" of medicine linked to each of these political entities, even when part of the illusion is that that "tradition" has undergone change through contact with other such traditions. So-called Traditional Chinese Medicine and Ayurveda provide the most striking examples. The fact that Ayurveda is the medical system of India goes almost without saying—and that is precisely the problem—even though the history of its development took place only in various parts of what is now India, in parts of what is now Pakistan, Afghanistan, Nepal and Bangladesh, and through an exchange of ideas that is probably more extensive than the borders of any one of these states and even of all of them put together.

Even a cursory overview shows that there is a tremendous amount of historical, theoretical, applied, and practical overlap between key concepts in the various medical systems of Asia. The similarity of such principles as yin/yang and prak{{rudot}}ti/puru{{sudot}}a, qi and pr?{{nudot}}?, the three do{{sudot}}a and the four "Greek" humors, or the five evolutive phases and the five mahdbhdta elements in the respective traditions of East and South Asia almost seem to demand a cross-cultural comparative analysis. Similarly, various forms of "Western" medicine have been integrated into the practice of medicine to the east of wherever it is that the West is thought to begin, and this dynamic process of exchange has been important from the time of Scythian nomadism through to modern colonialism and the peripatetic introduction of German, Dutch, French, English and American medicine into various parts of Asia.

To date, however, the extensive and detailed analyses of Asian medical systems have tended to focus on the bounded regional form of practice within the framework of contemporary nation states. On the one hand there are studies of the introduction of Western medicine into specific countries. On the other hand there are studies of Chinese traditional medicine, Tibetan medicine, Malay humoralism, Japanese Kanpo therapeutics, and Ayurveda in India, Sri Lanka or Nepal, for example. Even Unani, or so-called Islamic humoral medicine, which in its span from the Middle-East to Southeast Asia seems to resist narrow, regional demarcation, has tended to be studied within the confines of sub-regional local practice.

There is no denying the fact that the local, regional, and national appropriation of medical traditions is a common and important framework within which theoretical and practical innovation has occurred. In the scheme of historical time, however, centralized state demarcation—at least on a regional scale—is a relatively recent development, and tends to obscure the way in which Asia, however that entity might be defined, is characterized by an integrated history of practice and theoretical innovation as concerns the development of medicine. Stretching from the periods of "classical civilization" up to the advent of European colonialism in West, East, Southeast and South Asia, history suggests extensive inter-regional contact and communication by way of trade, political conquest and religious proselytization. Beyond this, the seemingly more hegemonic and seamless forms of medical practice in the colonial and post-colonial periods also cross-cut regional and state boundaries in important ways.

This volume explores the nature of the tension between nationalism and transnationalism on a smaller, more geographically delimited scale. The focus is on the following key question: When, why and how is medicine linked to the social, political, religious and economic culture of a state, and when, why and how does it extend beyond these delimited, bounded frameworks of legitimation? In many ways this question is framed by institutionalized state politics—that which, quite literally, is established to police the borders. However, reflecting current developments in social theory and cross-cultural comparative analysis, this volume focuses on the nationalistic politics of culture rather than the politics of governments as such. It is focused on transnationalism as a cultural process rather than on the formal structure of economic trade or international relations.

Apart from the relatively numerous works on medical knowledge and practice in various specific regions of Asia, there is a small but significant body of literature that has clearly laid the foundation for an examination of the relationship between nationalism, transnationalism and medicine in Asia. First and most significant is the work of Charles Leslie, whose two volumes Asian Medical Systems (1976) and Paths to Asian Medical Knowledge (coedited with Allan Young) (1992) have implicitly if not explicitly defined the link between regional expressions of nationalism and health care. Both volumes are comparative and force a consideration of parallel and converging themes in the history and culture of medical systems that have become associated with different state entities. This theme, along with the question of medical syncretism—which foregrounds questions of transnationalism and globalization—is taken up by Waltraud Ernst in Plural Medicine, Tradition and Modernity, 1800-2000 (2002). Although many contemporary anthropological and sociological studies of local practice situate medicine in the context of globalization, Connor and Samuel's Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Societies (2001) is particularly noteworthy on account of the way in which each of the chapters problematizes the relationship between local and global manifestations of medicine and medical knowledge, and how the volume as a whole engages with medicine in the context of state entities, without presuming that the states in question exclusively defines the context of practice. By bringing together essays that focus on healing in the modern states of Korea, Malaysia, and India, healing on the margins of Malaysia, Indonesia, and China, and healing that involves Tibetan Medicine as practiced in China, Tibet and India—and by integrating a concern with both shamanic practice and institutionalized medicine—this volume clearly and effectively anticipates a direct and critical problematization of the link between medicine and nationalism.

Clearly colonialism and the study of medicine under imperial regimes forces a consideration of the intersection of ideas about the body, health and healing as these ideas intersect in the context of politicized culture. Beyond David Arnold's Colonizing the Body (1993) there is a rapidly growing literature in the field of colonial medicine and science studies (See, for example, Ernst and Harris 1999; A. Kumar 1998; D. Kumar 1991, 1995; Pati and Mark 2001). Two other edited volumes, Imperial Medicine and Indigenous Societies (Arnold 1989) and Disease, Medicine, and Empire (McLeod and Milton 1988) situate medicine within colonialism, pointing out—implicitly if not always explicitly—the connection between the flow of knowledge through various parts of the Empire and the connection therein between nationalism and proto-transnationalism. As several scholars have pointed out (Chakrabarty 2000, Dirks 1998, Duara 1995, Kelly and Kaplan 2001, Prakash 1996) historians of colonialism must work against the logic of imperialism by refusing to let the trajectory of modern nationalism define the structure of history. By doing this it is possible to critically examine events that were leading up to the construction of state and cultural boundaries, without presuming where those boundaries are drawn, what they contain or that the natural outcome was the formation of a thing called a state.

In his recent book The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (1999) Shigehisa Kuriyama directly takes on the question of how, when and on what terms it is possible to compare medical knowledge that is deceptively similar and linked both to the history of different regions and the history of contact between those regions. What is unique about Kuriyama's analysis, and why it is particularly significant here, is that it demonstrates how, apart from the sociology of practice—which is the primary concern of most anthropologists and historians of colonial medicine—medical theory is defined in the context of local practices that are influenced by the global flow of ideas and technology. As Kuriyama clearly points out, what seems to be identical in fact—the pulse or a concept of vital breath—can be radically different in interpretation, and this disjuncture even cross-cuts the "genetic kinship" between various theories and therapeutic techniques. For example, there may well be a direct, developmental link between bloodletting and acupuncture (1999: 204)—a link that also connects Europe and Asia through an exchange of ideas about etiology and cure—but this does not at all mean that either one in either place is conceptualized in the same way as it is in the other. There is, consequently, a critical tension, both in terms of theory and practice, in the different ways in which "traditional" Asian medicine is conceptualized as either "nationalistic" or inherently transnational. Stretched to its extreme this tension is reflected in questions that are probably impossible to answer, and thereby betray their own geopolitical bias—where does Greek medicine end and Chinese medicine begin? What sort of medicine does a physician practice when he is trained in the West—say Philadelphia—but gains experience that is integrated into practice while treating people in the East—say Beijing (See Brownell, this volume)?

Building on the ideas developed by these and other scholars, this volume is designed to examine the relationship between medicine and the national and transnational politics of culture in terms of two sets of thematic questions.

The first set of questions concern the production of medical theory. How does theory reflect the political culture of its production, and does this political culture reflect a concern for containment and control or dissemination, teaching and "popularization?" When medical knowledge moves "across borders"—between India and China (Alter), between China and England (Lo and Shroer), between India and the United States (Selby and Van Hollen), between British India and England (Habib and Raina), between England and British India and the Dutch East Indies and the Netherlands (Kumar), and between China and the United States (Brownell)—does it retain its character as the medicine of a particular region or state? If so, how and why?

The second set of questions focuses on the modern, transnational flow of knowledge, capital and people. Within Asia how do states concern themselves with the modernization of "traditional" medicine? How does the transnational hegemony of science enable or limit the nationalist articulation of alternative medicine in the context of specific states? How do discourses of science and "new age" spirituality facilitate the transnationalization of "Asian" medicine?

Alter focuses primarily on the first set of questions by looking at how a quintessentially Chinese mode of therapy—acupuncture—has been integrated, both in theory and practice, into an Āyurvedic framework. The modern development of a distinct theory of flyurvedic acupuncture is, in some sense, motivated by a clear sense of nationalism. Claims are made that the original theory of vital points and the manipulation of vital energy was developed in India and then taken to China by traveling scholar-monks in the late classical period. The basis for such a claim is thought to be a theory of marma articulated in various South Asian medical texts, the link between marma and nāḍī physiology, and a tradition of healing based on the manipulation of various different kinds of vital points, including, at least according to some, marma.

Beyond this, there is the complex question of technology and the relationship between needles and cauterizing tools on the one hand and the distinction between surgery and needling on the other. To what extent are these things the same and to what extent are they not? And then, how does the inherent ambiguity imbedded in the answer to this question structure the dynamic between nationalistic claims and transnational processes? Clearly there was contact between practitioners of medicine in what is now China and what is now India, and it is probable that there was a dynamic exchange of knowledge between scholars at any number of locations between East and South Asia. However, modern articulations of theory both recognize and deny this contact, and the more refined and complex a modern theory of flyurvedic acupuncture gets, the more clearly it reflects the paradox and irony of a kind of nationalism that depends on but seeks to transcend—or elide—a kind of transnationalism that makes it possible.

Lo and Shroer are also concerned with the first set of questions, focusing on shifts in theory and meaning in the development of ideas about xie in "traditional" Chinese medicine. How xie has been translated differently at different times in China and England provides for an analysis of the relationship between political culture and theory. In very broad terms xie can be translated as evil, hydropathy or perversity and means oblique, deviating and the opposite of zheng, that which is upright and straight. Although xie is linked to ideas about demonic possession and naturalistic illness, Lo and Shroer trace the earliest medical theories to social, political and moral ideas on ritual and philosophy in general, and—striking a Pythagorean cord—to music in particular. They show how the link between music, mood and behavior was problematized in the pre-modern period and how music and ritual served to subvert xie and promote harmony and balance.

Strikingly, a social and moral conceptualization of xie comes to inform medical theory as articulated in the Yellow Emperor's Inner Canon As deviant music causes counterflow qi that disturbs the emotions and disrupts the state, so xie in a medical context brings with it a way of talking about the body in moral terms, terms which associate parts of the body with socially disruptive behavior.In this, the state and the body are conceptualized in much the same way, and the two domains are linked metaphorically. Thus purgation, exorcism and exile are, in some sense, all theoretically connected. This linkage finds interesting expression in the Nationalist period as such, and also in the nationalism manifest in the Maoist regime. In the former, the principle of xie did not conform to ideas about the scientific modernization of Traditional Chinese Medicine, and was purged from the literature, so to speak. In the communist period the idea of xie, as it was linked to superstition and the evil of demonic possession, was labled feudal and disruptive and was exorcized from theoretical texts.

The link in xie between the body, the state and political culture, also finds expression and elaboration in the context of transnationalism. One dominant form of contemporary acupuncture therapy in England derives from a lineage of development—via Japan and Taiwan—wherein xie continued to be recognized as theoretically and practically important during the time when it was purged from practice in the PRC. In the context of modern England, the principle of xie tends to be interpreted not as evil per se, but as the malignant environment, and, at least by extension the "evil" of the state's environmental and economic policy, against which the body has to be protected.

Habib focuses on the history of flyurveda and Unani in late nineteenth and early twentieth century India when those involved in the nationalist movement were actively politicizing culture in general and the principle of swadeshi, or national self reliance, in particular. In this context P. S. Varier, Hakim Ajmal Khan and P. C. Ray came to be concerned with the modernization and revitalization of traditional Indian medical systems. Habib argues that early in the twentieth century Āyurveda and Unani came to be defined as traditional cultural systems, but also came to be identified as scientific systems that needed to be modernized. Verier, Khan, and Ray were involved in a complex process wherein the relationship between tradition and modernity was being worked out conceptually with reference to ideas about science and scientific theory. Thus, the key distinction between Āyurveda, Unani and biomedicine was perceived to be one of relative progress and development rather than one of categorical ontological difference. What was perceived to be required was an epistemological shift rather than any kind of paradigmatic change. This allowed for tradition to be modernized in terms of science, with the essential Indianness of tradition being clearly preserved.

To preserve the "Indianness" of tradition, Habib and Raina argue, the cultural importance of science as a sign of Europe was played down in the discourse of modernization, using the logic of science itself : its claim to value-free, objective neutrality. At the beginning of the twentieth century the development of a discourse about the modernization of traditional medicine in terms of science helped to establish three critical axes that later in the century came to be recognized as the primary things that need to be changed in order to bring about reform and revitalization—the stagnation of knowledge, poor quality education and training, and low-grade, poorly manufactured pharmaceuticals. While later in the century colonialism as such came to be blamed for the demise of traditional medicine along these axes, Habib and Raina point out that in the early part of the century the politics of culture was much more subtle. Although Verier, Khan, and Ray unselfconsciously looked to "western" science, they did so in a context wherein there was at least a degree of parity as reflected in Lord Hardinge's public recognition that modern medicine owed a debt to the medicines of India for "preserving knowledge" that was lost in Europe during the dark ages.

In general Habib and Raina clearly show how nationalism does not only find expression as ideology or dogmatic positionality but is deeply vested in broad, transnational exchanges of ideas and techniques, in particular ideas about the nature of science. With regard to medicine in particular, elemental, practical concerns about quality define the parameters of a debate about modernization that involves tradition.

Kumar reinforces and builds on many of the key points made by Habib and Raina by developing a comparative analysis of colonialism and medicine in British India and the Dutch Indies. He points out that although colonialism can be understood as a pervasive discourse of power, historians must not loose sight of the fact that in specific instances the development of medical knowledge—as one facit of this discourse—reflects "insecurity, amazement, curiosity and frustration" rather than the clear-cut certainty that one might associate with the larger, authoritarian project of imperialism. Kumar focuses on what might be called the sub-texts of specific forms of colonial practice and knowledge construction by comparing and contrasting Dutch and British experiences in South and Souteast Asia during the 18th and early 19th centuries.

He begins his analysis by pointing out that although the tendency now is to make a categorical distinction between Western and Non-western forms of medicine, this distinction was not that sharp until the relatively recent institutionalization of germ theory. Prior to 1880, one must focus as much if not more on the institutionalization of medicine as on ideological positionality regarding categorical differences in medical theory. Fallowing from this, early in the 19th century there was a degree of curiosity and amazment on the part of scholar/surgeons concerning the possible effectivness of new substances and novel forms of treatment.

One aspect of colonial practice that Kumar analyzes is medical training. He shows that in contrast to the Dutch, "the British in India had developed fine distinctions in terms of what to teach and whom to teach." In other words the politics of health care administration was, in part, an issue of control over knowledge, and the proper transfer of knowledge between colonized and colonizer. In this context he points out that both the British and the Dutch very effectively exploited the hierarchical forms of social organization in their respective areas of rule.

At the fin de sicle the situation concerning medical theory had changed significantly with revolutionary advances in tropical medicine following germ theory and the epidemiology of epidemics. In both British India and in the Dutch Indies this lead to more hegemonic forms of public health administration and more intensive—and politicized—efforts in the institutionalization of medicine. Significantly, however, there was frustration on the part of colonial scientists studying tropical medicine who felt as though their contextualized research was not being regarded as significant on account of being produced outside the centers of imperial authority, particularly London. As Kumar points out, there was also a degree of ambivalence on the part of colonial administrators regarding the role of philanthropic organizations. On the one hand they provided much needed funding for increased public health programs, but at the possible expense of the colonial government having to ceed a degree of political and economic control.

In both Southeast and South Asia, a politicized, indigenous response developed in tandem with the expansion of colonial policy and practice. In British India a nationalist discourse was clearly articulated in the latter half of the 19th century as an issue that linked medicine in to broader cultural concerns about self-rule and the value of tradition. This discourse took political form in the context of the Indian National Congress activism. In the Dutch Indies a nationalist discourse about medicine only developed after 1918 and did not have recourse to the same kind of "indigenous traditions" as Āyurveda and Unani. It was regard as a discreet problem of institutionalization linked to budgetary concerns and was debated in the People's Council that was established in 1918. Although this comparison would tend to place emphasis on the structural differences between the two articulations of nationalism, Kumar concludes his chapter with a discussion of the role of Dr. Soetomo who drew inspiration from Indian sources to negotiate the politics of culture defined by the circular intersection of colonial hegemony and the ideology of primordialism that it creates and recreates.

In her analysis of the use of "traditional" medicine for the treatment of HIV/AIDS in India, Van Hollen situates the contemporary nationalist debate within the context of colonial history. In the colonial context Āyurveda in particular came to be constructed through a complex engagement with biomedicine and the colonial use of biomedicine as a "tool of empire." Although many proponents of flyurveda argued for various ways in which it could be integrated with biomedicine, M. K. Gandhi articulated one of the most sustained and high profile critiques of biomedicine in particular, but also a critique of the very idea of medicine as such. As Van Hollen points out, Gandhi's critique of biomedicine reverberates through the contemporary nationalist discourse concerning the value of flyurveda. One of the issues that has become complicated in this discourse is that, largely as a consequence of flyurveda's growing transnational appeal—and global market value—the terms of legitimacy are becoming more complicated, and the criteria for distinctiveness, such as spirituality, holism and antimaterialism, less clearly reflected in theory and practice.

Contemporary nationalist debate centers on claims that Āyurvedic medicines can cure HIV/AIDS, and revolves around defenses of this claim against challenges put forward by NGOs, the Indian government, and various international groups. Various individuals who claim to cure HIV/AIDS with "traditional" medicine defend their claims in terms of both what they regard to be the proof of outcome—real cures—as well as on the basis of cultural authenticity. In this context, transnationalism confronts nationalism in terms of paradox. To claim validity against challenges from biomedicine those who claim to cure people living with AIDS must accept the very terms that give legitimacy to biomedicine. These terms "deconstruct" Āyurveda's primary link to the nation and national culture.

Following thematically directly on some of the points raised by Van Hollen and Lo and Shroer, Chen focuses on the discourse of science in contemporary China and the way in which the state and several different categories of qigong master engage in this discourse as it relates to both theories about the nature of qi and claims to efficacy and power. Drawing on Donna Haraway's conceptualization of "invisible standards" encoded in science as a knowledge systems, she focuses on how the Chinese government clearly has a nationalist interest in promoting science and scientific development in a broad range of fields. In part this is because science promotes development and progress, but also because science is both transparent and structured in such a way that it can be easily controlled and regulated. Conversely the Chinese government is nervous about individuals who are able to claim power—physical, metaphysical or social—by means that are thought to be supernatural. In this respect qigong masters present particular problems because the power they have to heal people has the effect of making them very popular and therefore potentially powerful. As Chen argues, the response of the state has been to try and enforce, as policy, a cultural distinction between scientific and unscientific qigong. Masters who wish to practice must be licensed, ostensibly to protect common people from the influence of superstition and xie cults by formalizing scientific qigong as zheng.

In its effort to make qigong scientific, the state is confronted with a paradox. While it seeks to control the power associated with qigong and the charisma of popular masters, the very process of science undermines the power it is meant to control, which is based on abilities and techniques that are inherently mysterious. Thus, licenses authorize and empower in terms of a state mandated nationalist discourse, but disempower on the level of popular discourse where cures are valued precisely because they are miraculous. Ironically, the discourse of science has, in effect, increased the popularity and power of some qigong masters whose refusal to be "scientized" is taken as proof of their authenticity. Furthermore, given the dynamics of globalization and the movement of people and information across national boarders, many charismatic qigong masters have left the country to build up larger, international followings. The development of a transnational discourse, intimately connected to "Chinese culture," undermines the states nationalist intent.

In many ways transnational qigong masters fit into the discourse and comodifed practice of so-called New Age health and healing. Selby examines this discourse with reference to Ayuryoga—a neologism of flyurveda combined with Yoga—in the context of the United States in general and its extreme localization in Austin, Texas in particular. As with Lo and Shroer and Alter in particular she is concerned with transformation in the meaning of terms and the logic in theory in the context of transnational decontextualization. Using Arjun Appadurai's cultural analysis of commodities, and the "social life" of commodities in circulation, Selby examines the way in which women's health as articulated in the classical Āyurvedic texts has shifted from largely physiological concerns with pregnancy, child birth and the production of healthy male heirs, to a loosely configured regimen of beauty and spa-based commodity consumption. As she points out, the merchandizing of Ayuryoga spa culture and the commodification of health and beauty products is very much a gendered enterprise "where everything gains an equivalence, and all combinations seem infinitely possible."

This fetishistic and endlessly mimetic process is clearly reflected both in the English translation of the classical texts—where "egg" and "ovum" are problematically used to gloss the Sanskrit terms for menstrual blood and female semen—and in a large and growing number of popular self-help books which interpret and reinterpret the classical texts as well as one another. What gets articulated in these texts is a series of paradoxes where do{{sudot}}ic gynecology and obstetrics is interpreted in terms of self fulfilment, consumer oriented individuality and the relative merits and beauty of different constitutional body types.

Topically following on the theme of how medicine is related to beauty, Brownell also focuses on the question of how meaning is grafted onto medical practice by analyzing plastic surgery in China. She turns the tables on the direction of transnational flow using John MacAloon's notion of "empty form" to show how bio-medicine like modern sports is what she calls an "empty frame:" both rigidly defined by the culture of science and yet very open to cultural interpretation of other kinds, particularly in the context of nationalist discourses. In this regard the development of plastic surgery as a distinctly Chinese form of medical practice reflects the same process as acupuncture being adapted to the conditions of Britain and Japan, or of its being analyzed and practiced with reference to Āyurvedic theory in South Asia.

Brownell situates plastic surgery in the context of modern Chinese history and the demand for reconstructive surgery during the war with Japan. Focusing on the career of Song Ruyao who was sent to the University of Pennsylvania Medical School in 1943, she shows how plastic surgery shifted from a concern with the reconstruction and repair of wounds during the Korean war and the Cultural Revolution—when it was already considered bourgeois—to a concern after 1979 for cosmetic surgery and the double eyelid procedure in particular. As Brownell points out, "[m]ore so than many other medical subfields, cosmetic surgery presents a challenge to the universalist assumptions of biomedicine." Concepts of beauty vary cross-culturally and the techniques of surgery must be adapted to match these concepts within the context of variation in facial anatomy. Thus cosmetic surgery can be seen to be distinctly linked to cultural concerns, and, as Brownell shows, to a nationalist discourse where it has become "plastic surgery with Chinese characteristics." Claims are made that certain Chinese techniques are better, that Chinese surgeons are better at certain procedures, and that the double eyelid is not an attempt to look more European but a procedure that enhances Chinese beauty.

In addressing the two sets of questions outlined above each of the following chapters is framed by an overarching paradox: medicine by definition is conceptualized in terms that are more directly linked to principles of nature—disease, physiology and the technology of cure—than to principles of culture. Needless to say, the principles of nature are not organically natural. They are only constructed as such. But it is very significant that medicine is, at base, a very practical, pragmatic and ultimately utilitarian endeavor. It is all about life and death, and most certainly not just in a metaphorical sense. This is what distinguishes it from art, music, and literature among most other cultural things. And yet medicine is infused with culture and the politics of culture. The paradox is that as medicine is more deeply implicated in the politics of culture the act of politics often involves ever more elaborate claims being made about the organic, natural nature of medical truth, and claims about the universal efficacy of one kind of medicine as against another.

What all of the chapters in this volume clearly show is that power is neither simply institutionalised, nor manifest as pure ideology, as can be the case with nationalism among a host of other cultural practices. In an important way the significance of medical knowledge is measured against the health of a specific person manifesting specific symptoms who is endowed with a rich and meaningful concept of self. This makes medicine a kind of social fact that mitigates against pure ideology, abstract theory, and formal policy. What I mean is that medicine is a social and cultural phenomenon wherein abstract theories—about acupuncture (Alter), Ayurvedic gynecology (Selby) the plastic manipulation of physical beauty (Brownell), qi (Chen), deviant airs (Lo and Shroer), the "cure" of AIDS with herbal drugs (Van Hollen)—are theories whose ultimate justification is not the integrity of culture, however that is defined, but the integrity of the person upon whom medicine is practiced. The justification may not be direct and immediate, but medicine that is not effective in some way can ever develop into a system of medicine as such. In an important way this fundamental physiological materialism—and radical, reductive particularism—makes it impossible for medical systems to suffer the fate of other systems—economic ones, for example—wherein the product of social labor is fetishized as a thing apart from social labor unto itself as a thing of preeminent value.

An interesting angle to take on this is to "read backwards," as it were, from the bodies of citizens, or the practice of specific physicians, to look at the way in which the state seeks to control bodies that it cannot quite control, either by institutionalizing laws or by developing ideologies. It is precisely because it is the embodied person who is the ultimate object of medical treatment, that the state is unable to fully control the body of the citizen in terms of medical knowledge and the production of knowledge by individuals.

All of the chapters engage with the problem of modernity and specific, transnational transformations in the relationship between medicine and politics that can be linked to modernity. Transnationalism is a function of modernity since it is the nation—rather than some other entity such as an empire a city state or a clan community—that must be "transed." Consider the case of a cosmetic surgeon in China who trained in the United States but practices medicine in China. Consider the popularization of Ayuryoga and Āyurvedic gynecology. Consider the case of Frank Ros in Australia inventing—or perhaps just reinventing—a theory of flyurvedic acupuncture, and the example of flyurvedic acupuncturists in India constructing their practice in relation to both ancient Indian texts and contemporary discourses about the nature and relative authority of ancient Chinese sources. Is all of this categorically and structurally different from what was going on when scholars from various parts of what is now China engaged with scholars at Nalanda, in what is now India, in the 8th century? Clearly "Science"—with a capital S—must factor into this, but the question is how and to what degree. With regard to the 8th century the question is, at least in part, how and to what degree did Buddhism—with its manifestly fixed capitalization—link Asia together, and to what extent did it not?

Clearly one thing which distinguishes transnationalism and globalization from the exchange of ideas between different parts of the world several centuries or more ago is the rapidity of exchange, the sheer volume of things in circulation—with an emphasis on both volume and circularity—and probably both a degree of critical consciousness about the process itself as well as a certain looseness or flexibility in interpretation and creative synthesis. There is also probably a more pervasive sense of an xiety about authenticity, coherence and the control of knowledge—which is, again, where the politics of culture comes most explicitly into play. Regardless, the uniqueness of transnationalism as a modern dynamic is primarily manifest in the way in which nationalism seeks to control culture. One can imagine an ancient chain of links in medical knowledge connecting what is now China to what is now Greece or India with little concern for problems of "cultural integrity," but great concern and interest in what was new, innovative and effective. Medical knowledge was, of course, jealously guarded. But it was probably not regarded as belonging to a place and "a people" so much as to a particular person with clearly manifest skills. The premodern politics of medical knowledge seems largely to have been an issue of individual reputation and patronage. Consider that "Greek medicine" does not roll off the tongue very smoothly, or find its way into print as easily, as does the phrase Galenic or humoral medicine. References to the writings of Galen, Hippocrates and Aristotle indicate a concern with the discrete delineation of knowledge rather than its abstract, impersonal, systemic homogenization. The classical texts of Ayurveda are known in terms of their authors, even though the level of agreement is such that one can, obviously, speak of an abstract system of medical knowledge over arching the specific contributions of Caraka, Suśruta and Vagbhat. The point is that systematicity takes on a life of its own, and becomes politicized as such, in the context of modernity.

The fact that nationalism promotes the idea of systemic medical insularity draws attention to a very general question that has to do with a kind of hegemony that is built into transnationalism in general and the transnational dynamics of post-colonial academic scholarship in particular. It is a question that all of the chapters in this volume ask, but do not seek to directly answer. As such it is a question that opens the way to future scholarship.

The question is this: Can we better engage with the forms of knowledge that are impacted in modernity by suggesting that, at least on some level, one of the problems with modernity—including colonialism, as well as much more—is that it has imposed the whole category of medicine as such on Asia? Most certainly this question must not lead back to a position of ethnocentric skepticism about the lack of efficacy and theoretical coherence manifest in Asian therapeutics. Rather the point of posing the question is to think through what has come to be defined as medicine in Asia. The point is to destabalize the very idea of medicine, and dislocate it from what might be called axial status in the domain of culture-that-concerns-the-body. As many of the chapters show, what counts as medicine blurs into other things—martial arts, beauty regimens, alchemy, aesthetic surgery, diet, and yoga. Therefore, odd as it may sound, perhaps "medicine" does not provide the best framework for understanding the history of medicine or the cultural construction of medical knowledge.

This is not the same as saying that biomedicine does not provide the framework, for that is quite obvious. But the very idea of medicine—the category itself—might count as one of those "invisible standards" that Donna Haraway refers to in her critique of academic discourse in the history and philosophy of science.

The body and concepts of embodiment can serve as a way to think about medicine out side the strictures of medical logic. But in many cases things that relate directly to medicine extend beyond the body. Zoology, botany, cosmology, alchemy, and, of course, religion and philosophy come to mind. Common sense would dictate that medicine is the logical framework for contextualizing a history of medicine. But what is it that produces this sense of common sense? It is most certainly convenient to talk in terms of medicine, but convenience reflects a high degree of homogenization. Perhaps medicine—regardless of its utilitarian structure and function—is a derivative category of thought. And perhaps a problem with using the body as an alternative frame of reference is that it, too, poses the question of value in narrowly utilitarian and practical terms, or even in terms where priority is placed on the phenomenology of experience—being cured, for example—rather than on something which seeks to go beyond experience with regard to the problem of ordering and reordering the world.

With this in mind it is possible to think about the dynamics of medicine in the context of nationalism and transnationalism as animated by a more complex set of factors than the simple, structural opposition—or hybrid synthesis—of tradition and modernity. In this formulation medicine in Asia can be understood to be defined, problematically, by the bracketing force of medicine itself—conceptualized across time as a naturally delimited system dealing with illness and disease—as against a history of health that encompasses much more than questions of disease etiology, diagnosis and therapeutic cure. As historians have noted, medicine and the development of medical knowledge has often been very closely linked to philosophy. It also has close links to religion. There are links also between medicine and sport; medicine and war; medicine and botany, among a host of other things.

But another way of thinking about this is to see the "links" as diagnostic of a problem in modern delineation. Perhaps the links can be reconceptualized as shifting, discursive centers, rather than as fixed points of overlap or intersection. In any case, nationalism is, in some ways, concerned with the centering of medicine as medicine—be it Āyurveda, TCM, Biomedicine, or some permutation of these plus others, and be it modernized or traditionalized—where as transnationalism, in highlighting links or possible links, either destabalizes medicine as a category or complicates its structure, function and meaning. Of course nationalism often "feeds off" of transnational processes, just as transnationalism picks apart nationalist constructs. But what is involved in questioning the commonsensical status of medicine as medicine here is to shift attention away from the formal change in the nature of medicine as such and to focus on the structural change in the relationship of things that are thought to be linked to medicine, but are better conceptualized in terms of health, very broadly defined—including such things as wealth on the one hand, as well as practices that directly involve magic, spirituality and the supernatural, on the other.

The unfortunate situation has been that for decades, if not a century or more, medicine in Asia—and Asian medicine in particular—has struggled to gain legitimacy as medicine by excluding precisely these things. Arguably the methods of science, in both discourse and practice, have been used to make claims of legitimacy, even if one form of legitimacy is to claim for the medicine in question the status of an alternative science to the science that emerged out of the European enlightenment. To question the status of flyurveda or TCM as medical systems—and not just question their relative efficacy and systemic integrity—might be regarded as the ultimate postmodern insult added to the injury of colonial and post-colonial Orientalism.

However, in an important way the point of critique and cultural criticism is reversed, in the sense that the purpose of questioning the status of TCM and Āyurveda as medical systems is not to question their legitimacy or champion the cause of mysticism against rationalism—as some New Age advocates have done—but to point out the contingency of medicine itself as a disciplinary entailment of the Enlightenment that very ineffectively captures, and ultimately distorts, the way in which what has come to be called Āyurvedic medicine and Traditional Chinese Medicine define what should be counted as health and well being.

With this in mind one can better appreciate the extent to which the cases analyzed by Brownell and Van Hollen—where biomedical categories loom largest—are cases where the trenchantly disease oriented, cure-driven, remedial structure of biomedicine fails to capture what gets counted as biomedicine: plastic surgery and a "cure" for AIDS. If plastic surgeons manipulate aesthetic ideals; if classical Āyurvedic texts describe regimens to produce immortality; if TCM and Āyurveda are as directly linked to sex as they are to pathology; and if the izheng/xie polarity involves but extends beyond the body, then perhaps it is necessary to theorize health in terms of truth, beauty, pleasure, wholesomeness and supernatural power, rather than in terms of sickness, suffering, death and disease.

Clearly this entails much more critical scepticism than uncritical New Age optimism. Although New Age practitioners have engaged in all manner of novel distortion and crass commercial exploitation—but so, to, have many others—the likes of Deepak Chopra and Vasant Lad are able to make their claims to better lives through healthy living precisely because the legitimization of Asian medicine through discourses of science has made it possible to transform discourses of health into comodified regimens of medicalized self-help. Most significantly, self-help is made relevant to public health in a context where stress, drug addiction, bad eating habits and inadequate exercise are understood as medical problems of great importance. Whereas Deepak Chopra and others are, I think, completely wrong in terms of how various dimensions of Asian medicine are relevant to health in the New Age—since their concern is with self-help and is always incipiently remedial, their focus invariably on contingent problems to be overcome rather than possibilities as such, and their interpretations both selective and rather superficial—they are absolutely right in seeing in these "medical systems" much more than counts as medicine.

But the point here is not so much to criticize the New Age paramedicalization of life-style as to suggest that a new critical perspective on what has been called Asian Medicine—and, indeed, the practice of medicine in Asia—shows how the development of biomedicine from Greek and medieval humoralism might be understood as progress by way of exclusion rather than progress through a shift in paradigm, the development of new theories and a more refined understanding of how the body works in relation to nature. In essence the point is to show how medicine as a conceptual category produces and reproduces a narrow and rather unhealthy understanding of what counts as health, and not just with reference to the practice of medicine, but with reference to life as such. Given that medicine has subsumed the knowledge that produced it, it is difficult to appreciate the extent to which Galen, Caraka, Suśruta and Chao Yuanfang might have conceptualized health in ways that were not strictly inhibited by the logic of healing. This is not at all to romanticize this conception of health, but to look at it from the vantage point of philosophy, in the original Pythagorean sense of that term.

What this allows for is to take seriously, in a new and more comprehensive way, such things as plastic surgery in China, Āyurvedic acupuncture, Ayuryogic cosmetics, attempts to find an Āyurvedic cure for aids, and attempts to give modern legitimacy to "traditional" medicine. Otherwise the conceptual framework of medicine makes serious cultural analysis impossible by forcing, in the final instance, the question of efficacy and proof. Instead of thinking about Asian medicine as the Asian form of medicine as such, perhaps it is better to conceptualize what has come to be called Asian medicine as being various experimental techniques concerned with embodied life and longevity. Consider alchemy, and the embodiment of alchemy that is found in yoga and qigong. With reference to this, medicine as a conceptual category can be thought of as a pragmatic, body oriented copy of techniques designed to transform nature itself. It is a copy in the sense that clinic-based healing is a metaphorical instantiation, or fragmented mimetic reproduction, of immortality. It is, therefore, not so much that Asian medicine is not really medicine, as some Orientalist scholars evinced, or that it is ineffective quackery, as many practitioners of biomedicine continue to claim, but that medicine as such is a devolved form of alchemy. To the extent that science elides the mimetic relationship between alchemy and medicine it has caused a profound transmutation in the logic of health all over the world.

This is not to make any historical argument about the developmental relationship of alchemy and medicine, but rather to focus on each in relation to the other as conceptual categories that involve health, the body and the transformation of nature. To do so helps avoid the problematic conceptualization of Asian medicine—even in Asia—as alternative medicine. The question of difference, which remains important, is subsumed within difference itself: alchemey as different from medicine but applied to all medicine. In many respects an inclusive framework of alchemey also helps to get past the problematic of Science as the modern yardstick for measuring medical legitimacy—its gold standard or touch stone, so to speak. Even more significantly, this gets past a conceptualization of so-called "alternative sciences," which begs as many questions as does a theory of alternative modernities (Kelly 2002). To adapt John Kelly's recent formulation concerning modernity, alchemy provides a framework for medicine that is alternative to science itself. To be alternative to science, rather than simply "alternatively scientific," makes that that has come to be called Asian medicine less affected by a sense of the sublime that seems of stick to the concept of science itself, despite—or perhaps on account of—its claim to reason, rationality and brut-fact empiricism.

Clearly many practitioners of medicine in Asia would disagree. But the formulation is designed less to challenge their claims than to shed light on the problems they confront in trying to modernize "traditional" medical systems within the culture of a state—the terminology itself signaling the logical contortions involved. Clearly practitioners of biomedicine would take issue with being called devolved alchemists, even on the level of conceptual categorization. But it is useful, I think, to think about major advances in medical science as indicative of a more meta-physical quest for immortality and perfection. There is "magic" in gene therapy, liver transplantation and in the methods used to find a cure for Alzhiemers. But it is a transnational perspective on real magic—what some qigong masters claim to be able to do; an herbal "cure" for AIDS; exorcism, for example—that can help to make such as statement as this meaningful and interesting, as against letting it stand as a cliche; as a metaphorical entailment to be subsumed within the reverential sublime of science-beyond-comprehension. Nationalism enforces difference—this medicine in relation to that—whereas transnationalism can be the articulation of difference itself.

The chapters in this volume clearly point in this direction by suggesting, either directly or indirectly, that there are limits to the way in which medicine can be understood as medicine or science understood as science. The politics of culture—manifest in both nationalism and transnationalism—has made it virtually impossible to talk about Asian medicine as anything but medicine, and as medical knowledge as anything other than science. To explore the various dimensions of this politics, as the contributors to this volume have done, makes it possible to take the next step: question the very hegemony of the conceptual category itself. Is there such a thing as medicine?: To ask the question is, if I may use a term that falls somewhere between capture and rescue—the verb tropes with which I began—to chart a route of escape from a whole series of false or problematic dichotomies that have plagued the analysis of health, healing and the body in Asia.

Table of Contents

1. Introduction: the Politics of Culture and Medicine
2. Ayurvedic Acupuncture—Transnational Nationalism: Ambivalence About the Origin and Authenticity of Medical Knowledge
—Joseph S. Alter
3. Deviant Airs in "Traditional" Chinese Medicine
—Vivienne Lo and Sylvia Schroer
4. Reinventing Traditional Medicine: Method, Institutional Change, and the Manufacture of Drugs and Medication in Late Colonial India
—S. Irfan Habib and Dhruv Raina
5. Health and Medicine in British India and the Dutch Indies: A Comparative Study
—Deepak Kumar
6. Nationalism, Transnationalism, and the Politics of "Traditional" Indian Medicine for HIV/AIDS
—Cecilia Van Hollen
7. Mapping Science and Nation in China
—Nancy N. Chen
8. Sanskrit Gynecologies in Postmodernity: The Commoditization of Indian Medicine in Alternative Medical and New-age Discourses on Women's Health
—Marta Ann Selby
9. China Reconstructs: Cosmetic Surgery and Nationalism in the Reform Era
—Susan Brownell

Editorial Reviews

"An important collection of studies on a significant group of topics. . . . It deserves to be widely read."

Journal of the Royal Anthropological Institute

"An important collection of studies on a significant group of topics. . . . It deserves to be widely read."—Journal of the Royal Anthropological Institute

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