Traditional Chinese medicine is often portrayed as an enduring system of therapeutic knowledge that has become globalized in recent decades. In Other-Worldly, Mei Zhan argues that the discourses and practices called "traditional Chinese medicine" are made through, rather than prior to, translocal encounters and entanglements. Zhan spent a decade following practitioners, teachers, and advocates of Chinese medicine through clinics, hospitals, schools, and grassroots organizations in Shanghai and the San Francisco Bay Area. Drawing on that research, she demonstrates that the everyday practice of Chinese medicine is about much more than writing herbal prescriptions and inserting acupuncture needles. "Traditional Chinese medicine" is also Made and remade through efforts to create a preventive medicine for the "proletariat world," reinvent it for cosmopolitan middle-class aspirations, produce clinical "Miracles," translate knowledge and authority, and negotiate marketing strategies and medical ethics. Zhan emphasizes that unexpected encounters and interactions are constitutive of the irreducibly complex and open-ended worlds of Chinese medicine. She proposes an ethnography of "worlding" as a means of engaging and illuminating emergent cultural processes such as those she describes. Rather than taking cultural difference as the starting point for anthropological inquiries, analyses of worlding reveal how various terms of difference-for example "traditional," "Chinese." and "medicine"-are invented, negotiated, and deployed translocally.
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About the Author
Mei Zhan is Associate Professor of Anthropology at the University of California, Irvine.
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OTHER-WORLDLYMAKING CHINESE MEDICINE THROUGH TRANSNATIONAL FRAMES
By Mei Zhan
Duke University PressCopyright © 2009 Duke University Press
All right reserved.
Chapter OneGET ON TRACK WITH THE WORLD
"Cynthia," the name by which she was known to foreign students and trainees, was an acupuncturist at the Shuguang Hospital of Traditional Chinese Medicine in Shanghai. She was less known for her medical expertise, however, than for being an avid reader of newspapers. She was not a big follower of headline news-whether it was about the reforms to reduce or even eliminate state subsidies of healthcare, or about the structural unemployment that swept across state-owned enterprises at the end of the 1990s. Instead, her focus was the newspaper's real estate section, and the advertisements of upscale residences were her passion. Cynthia was getting married, and she wanted to buy a home.
It came as little surprise, then, that the most engaging conversation I ever had with Cynthia was not about traditional Chinese medicine but about homes in Palo Alto, California. A few days after that conversation she showed me a newspaper advertisement of her dream home, Jinqiu California Garden, a gated community of luxury condos developed by a Hong Kong real estate company in the suburb of Shanghai. Cynthia read the advertisement out loud to me: "Jinqiu California Garden offers you a California-style living space, as well as a healthy, wealthy, elegant lifestyle. As part of our 1999 Lunar New Year's special events, we offer our homeowners a one-day free clinic where they can consult famous traditional doctors about health problems." Turning to me, she said, "California lifestyle and traditional Chinese medicine-what a strange combination! But I'd love to be their resident acupuncturist!"
What makes the production of a healthy, wealthy lifestyle, crystallized in an imagined California, an effective marketing strategy in Shanghai's real estate market? At first glance this question points in the direction of global connections and imaginations that not only extend well beyond the city of Shanghai but also seem to elude the boundary of the nation-state. However, the phenomenon of Jinqiu California Garden, both in its marketing strategy and its market allure, cannot simply be explained as a case in which the local is penetrated by, absorbed into, and thereby reconstituted by global capitalism: after all, how do we explain why California in particular sells in Shanghai? More strikingly, why does the inclusion of a traditional Chinese medicine clinic, which is a highly unusual feature in Shanghai's residential neighborhood, add to and even authenticate Jinqiu California Garden's "California" appeal?
Contrary to Cynthia's view, those who have lived in California in the past twenty years probably would not find acupuncture and herbal medicine, the two main components of traditional Chinese medicine, completely alien concepts and practices. Indeed, when I tell friends in the San Francisco Bay Area about my research on traditional Chinese medicine, many of them eagerly tell me, "You should interview my acupuncturist!" The popularity of traditional Chinese medicine is also reflected in and produced through mass media across the United States. In the last two decades, images and discussions of acupuncture and herbal medicine have been seen in magazines ranging from Esquire to the Harvard Magazine. The popular men's magazine Esquire, for example, featured the actor David Duchovny from the television sci-fi series The X-Files on the cover of its May 1999 issue. In The X-Files Duchovny plays an FBI agent who dedicates his life to the pursuit of space aliens and other paranormal phenomena. The cover of the magazine sported an image of Duchovny adorned with acupuncture needles protruding from head and face-under which the caption read "David Duchovny's Death-Defying Acts." Traditional Chinese medicine and other forms of complementary and alternative medicines have received just as much if not more attention from popular media in the San Francisco Bay Area. The March 1997 issue of the magazine San Francisco Focus featured on its front cover an image of a regular plastic prescription bottle with its cap off, out of which spilled ginseng, ganoderma lucidum (lingzhi), astragalus membranaceus (huangqi) and a variety of other Chinese herbs. Above this striking image was the sensational title of a special report: "Take Two Herbs and See Your Acupuncturist in the Morning: Alternative Medicine Goes Mainstream."
The images and anecdotes offered above provide a window onto translocal formations that are more imaginative and effervescent than what can be subsumed under the umbrella of globalization. They call for ethnographic and analytical strategies that do not assume a priori a singular "global era" within which the ethnographies of local lives and translocal movements are to take place. Instead, they point toward ways in which differences are produced through-rather than in spite of-cosmopolitan aspirations and global ambitions. In this chapter I begin to introduce an ethnographic analysis of how traditional Chinese medicine is made and remade through multi-sited, multidirectional, and sociohistorically contingent projects and processes that also produce visions, understandings, and experiences of racialized, class-girded worlds. To do so, I focus on two historical moments in the worlding of traditional Chinese medicine: the first moment took place from the 1960s to the early 1970s and the second from the 1990s to the present. I chose these two moments to highlight the discrepant worldmaking projects that not only shape the worlds we inhabit but also challenge any uniform, abstract, or transcendental sense of global spatiotemporality.
From the 1960s to early 1970s, during the cold war era, the Chinese government organized the export of traditional Chinese medicine as a quintessentially Chinese, low-cost, low-tech, preventive medicine suitable for healthcare in Third World countries, especially those in Africa. The proliferation of traditional Chinese medicine as a preventive medicine for the rural poor helped envision and produce a "proletariat world" that China strove to champion. Beginning in the early 1980s, however, this traveling route of traditional Chinese medicine-as well as the vision and salience of the proletariat world-was eclipsed by other routes and worlds. By the 1990s, as China continued its economic and social reforms to "get on track with the world" (yu shijie jiegui), the transnational trafficking of traditional Chinese medicine would take place most intensively between China and North America, Europe, and East Asia. Meanwhile in the Bay Area and in California more broadly, traditional Chinese medicine as a naturalistic, preventive medicine has evolved out of Chinatown and departed from its counterculture trajectories of the 1960s. Today it is a mainstream, urban, middle-class practice, deeply enmeshed in the commodification and consumption of health and medicine (see chapter 2).
Shanghai-based practitioners become aware of this shift in preventive medicine through transnational travel encounters, professional journals, mass media, and new information technology. In clinical practices and in everyday life, they forge new professional and social alliances and networks in reinventing traditional Chinese medicine as a new kind of preventive medicine. They do so by locating traditional Chinese medicine at the cutting edge of modern medical science and an emerging "cosmopolitan medicine," and by associating the consumption of traditional Chinese medicine with a middle-class lifestyle. This entails redefining the scope of health conditions on which traditional Chinese medicine focuses, as well as fashioning a particular clientele at home and abroad-an emerging middle class that aspires to be "white." In particular, practitioners and entrepreneurs of traditional Chinese medicine have invented a new medical concept called "subhealth" (yajiankang) to characterize the state of health of the urban and, especially, young middle class. Within this context it is not so paradoxical, after all, that the inclusion of a traditional Chinese medicine clinic within a gated community should accentuate the latter's appeal as a California-style, upper-middle-class living space in Shanghai.
In the pages that follow I navigate a journey that goes back and forth between China and Africa, Shanghai and San Francisco. In doing so, I highlight the discrepant cosmopolitan dreams and aspirations that have produced specific kinds of knowledges, patterns of difference and solidarity, and particular spatiotemporalities of emergent worlds. As Aihwa Ong and Donald Nonini (1997:12) point out, much of the literature on late capitalism and postmodernity is limited to Euro-American societies and thus runs the risk of taking particular social formations and experiences as universal. Ong and Nonini instead trace what they call an Asia-Pacific "Chinese transnationalism"-the historical roots of which reach back into the eighteenth century. Centering around diasporic Chinese communities, this "ungrounded empire" also encounters various forms and narratives of nation, capitalism, modernity, and cosmopolitanism. Yet in spite of its encounters with "global capital," Chinese transnationalism remains a "distinctive postcolonial formation" and "a culturally distinctive domain" (4). I find this analysis important for finding alternatives to the Euro-American-centered view of late capitalism, as well as demonstrative of how the deployment of Chineseness can be a strategic intervention in the universalistic discourse of globalization.
Like Ong and Nonini, I am interested in exploring alternative forms of globalization and cosmopolitanism. I am less invested, however, in Chinese cosmopolitanism as a culturally distinctive alternative to Euro-American-centric global configurations. Rather, I focus on how specific forms of cosmopolitanism emerge through uneven translocal relations that require the rethinking of what counts as local and what counts as global. In reviewing the history of cosmopolitanism and colonialism in Southeast Asia, Pheng Cheah (2006) identifies two types of Chinese cosmopolitanism: a mercantilist cosmopolitanism that is promoted by European colonial policies but misread as Confucianism; and a fiercely patriotic and revolutionary cosmopolitanism that, having contributed to Chinese nationalism and anticolonial struggles around the opening of the twentieth century, is now invoked by the Chinese state to attract overseas capital and expertise. Rather than rely on cultural distinction, Cheah questions the singularity and Chineseness of Chinese cosmopolitanism by exploring cosmopolitanisms as situated and transformative historical formations. Just as attentive to translocal fields of power but with an emphasis on China's new cosmopolitan projects, Lisa Rofel (2007) coins the phrase "cosmopolitanism with Chinese characteristics" that foregrounds the "self-conscious transcendence of locality, and the domestication of the world by way of renegotiating China's position in the world" (111). The reinvention of China entails a reinvention of the world. These discussions bring into focus that, first, the distinctiveness of Chinese cosmopolitanisms has less to do with cultural logic or essence than it does with the contingent outcome of specific translocal power fields. Second, the global figures in cosmopolitan imaginaries serve as a point of reference rather than a ready-made overarching framework. It follows that, third, cosmopolitanisms are grounded in, and in turn reproduce and transform, particular forms of disparities and differences. In light of these critical reflections on Chinese cosmopolitanisms, my aim here is to examine how shifting terms of difference-especially the deployment of race and class-are embedded and articulated through various cosmopolitan, world-making projects. The worlding of Chinese medicine conjures cosmopolitan dreams and aspirations from disparate locations. In so doing it promises the transcendence of locality and yet remains deeply entangled in discourses of race and class that render these aspirations anything but transcendental-be it Jinqiu California Garden or the proletariat world that Chinese medicine was to serve.
"Serve the People of the World"
On August 7, 1950, at the first National Conference of Health of the newly founded People's Republic of China, Mao Zedong declared that China's healthcare policy should "serve workers, peasants, and soldiers, focus on prevention, and promote the solidarity of Chinese and Western medicines." These words were soon turned into China's official healthcare policies. In their implementation, these policies emphasized combining basic biomedical and traditional Chinese medical practices for the prevention of infectious diseases afflicting the working people and for an inclusive coverage of healthcare. In June 26, 1965, on the eve of the Cultural Revolution (1966-76), Mao further declared that China's healthcare should focus on poor peasants in rural China, to whom biomedicine remained largely unavailable in spite of the dominance of biomedical hospitals in large cities. In China this new declaration is referred to simply as the "6.26 Instruction."
These policies had a profound impact on the practice of traditional Chinese medicine. First, beginning in 1956, by adopting the institutional, pedagogical, and clinical standards of biomedicine, state-run traditional Chinese medicine colleges and hospitals came to replace family clinics and small academies (Farquhar 1994; Leslie 1977; Taylor 2005). At the same time, local priests and itinerant healers were ordered to abandon their "superstitious" or "unprofessional" practices and thus were excluded from the official version of traditional Chinese medicine.
Moreover, even though Mao declared in 1954 that traditional Chinese medicine is "our motherland's treasure house," many Chinese-especially urban Chinese-still saw it as backward and inferior to biomedicine. A state-initiated campaign to scientize traditional Chinese medicine lasted through the 1960s. A People's Daily editorial on October 20, 1954, spelled out the content of this campaign. Its immediate goal was to develop a body of basic theories that could then be rectified by scientific methods, especially through experiments. At a broader level, traditional Chinese medicine was posited as a quintessentially "Chinese science" that was distinctive from "Western science" and needed to be integrated into modern science and medicine. According to the editorial, traditional Chinese medicine should play "a supplementary role" in modern medicine and that this modern medicine "should reflect the uniqueness of China's geography and climate, the uniqueness of Chinese herbs and their applications, and the uniqueness of the life and work of the Chinese of all ethnicities." Yet, the editorial continues, because traditional Chinese medicine truly is science, albeit a Chinese science, it deserved to be universalized and shared by the world.
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Table of Contents
Preface and Acknowledgments ix
Part 1 Entanglements
1 Get on Track with the world 31
2 Hands, Hearts, and Dreams 63
Part 2 Negotiations
3 Does it Take a Miracle? 91
4 Translating Knowledge 119
Part 3 Dislocations
5 Engendering Families and Knowledges, Sideways 145
6 Discrepant Distances 175