Historical epistemology and the making of modern Chinese medicine

I

Introduction

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Historical epistemology and the making of modern Chinese medicine

Howard Chiang

The history of Chinese medicine is undergoing a sea-change. Scholars have engaged independently and collectively in re-imagining the discipline, contextualizing it in an unprecedented way within a broader context of the translation, transmission, and global circulation of knowledge.¹ This is in many ways a new and exciting field, informed by questions that are meant to explore the emergence of different ways of knowing in and beyond modern China, rather than taking the existence of a tradition for granted.² Though much groundbreaking work is resulting from this transformation of the field, no single volume has consolidated, synthesized, and presented this new history to a wide and non-specialist readership. Historical Epistemology and the Making of Modern Chinese Medicine showcases the work of an international and interdisciplinary company of scholars working at the forefront of the new history of Chinese medicine, creating a dialogue with the broader community of historians and philosophers of science. By addressing the questions of historical continuity and rupture, of epistemic heterogenization and hybridization, and of the global and regional transformations of Chinese medical knowledge, this book combines the philosophical concerns of epistemology with the cultural politics of transregional medical formations. It argues that the historical study of Chinese medicine in the modern period must be at once philosophically sensitive and transnational in scope.³

Historians of western science and medicine have produced a flourishing literature around the idea that even the most basic elements of knowledge-making have histories. Under the rubrics of historical epistemology, historical ontology, epistemological history, and applied metaphysics, path-breaking scholars such as Lorraine Daston, Arnold Davidson, Ian Hacking, and Hans-Jörg Rheinberger have demonstrated that many of the most timeless-seeming of the ideas that we use to understand the world are in fact contingent, having emerged from and gained grounding in particular historical contexts.⁴ Among this group, Daston has provided the most explicit definition of historical epistemology: the history of the categories that structure our thought, pattern our arguments and proofs, and certify our standards for explanation.⁵ Their work on the construction and transformation of concepts of evidence, scientific objectivity, and personhood has fundamentally reoriented the terrain of the history and philosophy of science and medicine, proving to be an indispensable source of inspiration for a new generation of scholars. Despite this, however, scholars of East Asian science and medicine have not had the chance to come together and direct similarly inspired questions toward reappreciating the foundations of their own intellectual discipline. In doing so, the following chapters advance historical epistemology in fresh ways that de-center its presupposed Euro-American universality.

This anthology emerged from an awareness that a growing number of scholars of modern Chinese medicine were independently beginning to raise questions about core concepts that had long characterized work in their field, but had not had the opportunity to share their work in a collaborative setting. Co-organized by Carla Nappi, Volker Scheid, and myself, a resulting international conference was held at the University of Westminster in London in August 2010 that invited historians working at the cutting edge of scholarship on East Asian medicine to engage with the philosophical concerns of epistemology, the thick descriptive modes of critical analysis, and the tools of cultural studies. A selection of the conference papers – those focusing on Chinese medicine in the modern context – has been revised considerably in the intermittent years and forms the basis of this collection. The chapters each raise and debate questions, problems, and insights concerning the foundation and evolution of Chinese medical knowledge, such as through parsing out and re-examining critically its most fundamental elements – of object, text, tradition, disease, locality, efficacy, narrative, and the body – as opposed to taking Chinese medicine as a given and coherent category, in order to inspire new questions and directions in the field.⁶

This book is divided into three sections. The first set of essays explores the role of objects in the modern transformations and global circulation of Chinese medical knowledge. The concept of object is invoked here in the sense of material objects but also of the object of knowledge, both of which are understood as interconnected elements in the enumerations of objectivity in modern science and medicine.⁷ The second cluster of essays examines the various kinds of struggle for cultural authority in the development of Chinese forensic and medical sciences since the Republican period (1911–49). The last section of the volume revisits the questions of metaphysics and ontology in a transnational frame for the study of the historical conditions of Chinese medicine’s existence in the post-Mao era. Unfolding in a loose chronological thread, the chapters embody overlapping themes that easily supersede the sectional headings, but they are organized and presented in a way whereby the later essays feature a stronger culmination of the thematic strands emerging from the earlier parts of the book.

Since landmark studies in historical epistemology rarely navigate outside the intellectual landscape of western science and medicine, this book aims to broaden the theoretical-methodological approach of science studies by exploring the rich cultures of Chinese medicine, thereby adding a new dimension to its history and practices of knowledge-making. Meanwhile, scholarship emerging in recent decades from the growing field of East Asian Science and Technology Studies (EASTS) offers a timely opportunity to bring the history and philosophy of science to bear more closely on one another for inter- and intra-Asian regional inquiries and beyond.⁸ This volume takes the rich theoretical insight of postcolonial EASTS seriously, pronouncing innovative, robust, and critical perspectives on historical epistemology in a transnational framework through the themes of objects, authority, and existence.⁹ But before we delve any further into the main themes of the book, we must first consider the meaning and historical context of historical epistemology itself.

Historical epistemology in context

Historical epistemology emerged in the last two decades or so as a distinct area of scholarly inquiry at the intersections of continental philosophy, analytical philosophy, and the history, anthropology, and social studies of science (including medicine). During the 1990s, an early strand of historical epistemology explored the question of what constitutes evidence across scientific and non-scientific disciplines, from literary criticism to history to biology. The classic reference here is Questions of Evidence: Proof, Practice, and Persuasion across Disciplines (1991), coedited by James Chandler, Arnold Davidson, and Harry Harootunian. Advocates of historical epistemology in science studies subsequently turned their attention to expanding on key concepts such as break, contingency, paradigm, language, episteme, genealogy, objectivity, style, and the concept of concept itself.¹⁰ These key terms have served as pivotal building blocks in the development of historical epistemology as a field and an approach. That is to say, these concepts in some form have always played a central role in historical and philosophical inquiries into science and medicine. But it is only within the past two decades that scholars have begun to single them out and make them cohere around this new mode of analysis labeled historical epistemology.

There are several variations of historical epistemology developed around the question of being (historical ontology), the economy of knowledge production (moral epistemology), the use of images (visual epistemology), the role of things (material epistemology), and the salience of gender (feminist epistemology). Major historical epistemologists whose work has contributed to these alignments and methodological crystallizations include Arnold Davidson, Ian Hacking, Lorraine Daston, Peter Galison, Mary Poovey, Bruno Latour, Hans-Jörg Rheinberger, and, we might even add here, Donna Haraway.¹¹ When this group of scholars first used the expression historical epistemology, they meant to convey a general concern with broad or organizing concepts that have to do with knowledge, reason, argument, objectivity, rationality, evidence, and even fact and truth. These concepts that sound so basic, grand, and natural, like free-standing objects without history, they argue, are in fact highly contingent – the meaningfulness of these ideas having developed and gained grounding only in specific historical contexts. By challenging the seemingly constant and timeless status of these rudimentary but pivotal dimensions of scientific thought and practice, historical epistemologists stress contingency and situatedness – both chronologically and spatially – over ahistorical constancy.¹²

Henceforth, a crucial feature of historical epistemology, especially as exemplified by the various research projects undertaken by Daston and her collaborators, takes into account the coming into being and passing away of objects of scientific study, which, they have shown, actually change significantly over time.¹³ Many of Daston’s contemporaries – from Davidson to Haraway – have drawn inspirations from the writings of Michel Foucault, who was deeply influenced by the work of Georges Canguilhem and Gaston Bachelard, among other French philosophers. But before we turn to the 1960s, a crucial decade during which French theory was creolized around the world and helped establish the conceptual foundations of what we call historical epistemology today, let us reach further back in time to understand the earlier intellectual developments in the history and philosophy of science as constituting the epistemic basis for the watershed sixties.¹⁴ My goal here is to integrate the various genealogical groundings of historical epistemology. After sketching out the intellectual context from which historical epistemology emerged, I will go on to argue against the sociological framework of medicalization and for historical epistemology as the most adequate approach to historicizing the emergence and transformations of Chinese medical objects, authority, and existence.

Situated within a deeper historical perspective, the origins of historical epistemology can be traced to the late nineteenth century, when positivism in science invited a mounting measure of criticism. Interestingly, this early turn to historicizing epistemology, or ways of knowing, began with critical reflections on the work of scientists by scientists themselves. The Berlin physiologist Emil du Bois-Reymond took the lead in disputing the foundations of the basic concepts with which the nineteenth-century mechanical paradigm of scientific knowledge operated.¹⁵ The Austrian physicist Ernst Mach similarly asserted that "The science of mechanics does not comprise the foundations, no, nor even a part of the world, but only an aspect of it.¹⁶ In the late nineteenth and early twentieth centuries, the French philosopher of science Émile Boutroux expanded on the idea of contingency to break up the determinism of classical mechanics;¹⁷ the mathematician-physicist-engineer Henri Poincaré, Boutroux’s brother-in-law, espoused a moderate notion of conventionalism as a new mode of scientific self-reflection that challenged an all-embracing metaphysical system;¹⁸ and the Viennese sociologist Otto Neurath spoke of the logical structure of [scientific] theories and the ways in which history of science could help explain how they may develop."¹⁹

Given the predominant scientific background of these turn-of-the-century authors, it is important to note that the development of historical epistemology has relied on the mutual influences of academic philosophy and the sciences: that is, the maturation of historical epistemology did not simply depend upon the sophistication of a branch of the former discipline alone. Over the course of the twentieth century, the new interest in historicizing epistemology was characterized by a shift from finding out the most adequate method of conducting objective science (and experiments more specifically) to the careful investigation of what scientists did and how that directly shaped the object of their knowledge and practice, which was no longer deemed as historically transcendental or presupposed as an a-priori norm. As Hans-Jörg Rheinberger has noted, The question now was no longer how knowing subjects might attain an undisguised view of their objects, rather the question was what conditions had to be created for objects to be made into objects of empirical knowledge under historically variable conditions.²⁰ As the century drew to an end, the term historical epistemology had been popularized by a new generation of historians and philosophers of science; quantum theory had long brought the natural sciences out of an ontological positivism that dominated classical physics; and scientists in general had come to acknowledge and readily accept a new scientific multiculturalism – the necessary coexistence of multiple forms and disciplines of the hard and soft sciences.²¹ Indeed, this was the result of generations of debate about the feasibility of the goal of a unified science that reverberated throughout the century.²²

Although the realignment of agency in scientific knowledge production with respect to the subject–object relation can be said to have begun in the fin de siècle, it took a decisive turn after the global shock brought about by World War I. For the first time, popular attitudes toward scientific progress, the general ambivalence toward scientific development as a means of social construction or destruction, and the entangled relationships between science and technology, science and industry, and science and humanism all came under vehement re-evaluation and reached a crescendo after 1918. In the 1920s and 1930s, these large-scale reassessments not only reoriented Marxist externalist historians of science to dig deeper into the social, political, and technological conditions for the production of scientific knowledge, as represented by the works of Boris Hessen and Henryk Grossmann;²³ the far-reaching repercussions of the Great War also led to an intensification of the internalist approach, which came to conceive of scientific development beyond the mere accumulation of facts and knowledge, but ultimately, and most significantly, in terms of revolutionary breaks.

Key contributions to this internalist shift in the interwar period came from the work of the French philosopher of science, Gaston Bachelard, and the Polish immunologist and theorist and sociologist of science, Ludwik Fleck. In his book, The New Scientific Spirit (1934), Bachelard argued for the existence of an epistemological break between expert scientific knowledge and everyday common sense, a division for which what he called epistemological obstacles played an important role.²⁴ He described scientific development as a process of realization. What mattered most to observation and empirical knowledge, according to Bachelard, was not scientific reality (or what science is), but what science can be. He also picked up on the idea of historical contingency from earlier writers to highlight the recurrent feature of scientific discovery: that is, the truths of yesterday always become the errors of today. The appearance and disappearance of the scientific status of truth translate into an eternal change over time, a repetition embedded within what can be conceived more generally as the historicity of science itself.²⁵

This historicity of science also undergirded the writings of Fleck, for whom the concepts of thought style and thought collective formed central components of modern scientific practice. By thought style, Fleck meant a style of thinking that prepares the members of the same thought collective to be directed toward a uniform perception of scientific fact. Through the mutual exchange of ideas or intellectual interaction within a thought collective, scientific fact is no longer the starting point of observation, but historically generated only through a habit of perception shared by the same community of a style of knowing and understanding. Fleck elaborated on these ideas most substantively in his seminal essay, The Genesis and Development of a Scientific Fact (1935).²⁶ The concept of thought style, suggesting a nodal point of epistemic convergence, would later be appropriated by Thomas Kuhn in his proposition of normal science by recasting thought style as the gradual internalization of external signals of resistance.²⁷

Again, both Bachelard and Fleck developed their ideas in the aftermath of the scientific shock that quantum theory brought on to classical physics. After World War I, the series of new findings that centered on the uncertainty principle, following Niels Bohr’s orbital theory of electrons, questioned the relationship between the observer and the observed in scientists’ perception of atomic phenomena like never before. Even the quantum physicist Werner Heisenberg himself conceded, The scientific method of analyzing, explaining, and classifying has become conscious of its own limitations, which arise out of the fact that by its intervention science alters and refashions the object of investigation.²⁸ As a result of this challenge to classical physics, one could no longer avoid the existence of theoretical alternatives, even in the hard sciences. In their respective efforts to historicize epistemology, Bachelard and Fleck expounded a theory of knowledge-formation that maintained the established scientific fact in a state of permanent provisionality and constant lack of closure.

After Bachelard’s and Fleck’s revisionism, the development of historical epistemology took another epic turn in the post-World War II period with the publication of Thomas Kuhn’s The Structure of Scientific Revolutions (1962).²⁹ Although the appearance of this landmark study proved to be a watershed episode in the history and philosophy of science, Kuhn, an American physicist, wrote the book at a time when other scientists and influential philosophers across the Atlantic had already touched on issues that would become central to his own thinking.³⁰ For example, one cannot ignore Karl Popper’s critical rationalist philosophy (especially as articulated in his 1935 book, The Logic of Scientific Discovery); Edmund Husserl’s attention to the role of writing in the formation of novel meaning (a theme that would later resurface in the deconstructionist theory of Jacques Derrida); or what Ernst Cassirer called a cultural object, whose coming-to-be and going out of existence gave the physical itself new functions and meanings.³¹ Similarly, one might add here that the connections Martin Heidegger drew between a scientific object and the broader project by which such an object was circumscribed specified a procedural relationship that determined the accessibility and, by extension, intelligibility of why and how certain objects become objects of scientific reasoning.³²

Closer to Kuhn’s time, Stephen Toulmin applied the concepts of variation and selection from evolutionary biology to his understanding of science as an ensemble of ideas and techniques with constantly shifting aims and preoccupations.³³ The kind of historical philosophy of science that Toulmin envisioned combined the historian’s habit of chronicling with the philosopher’s task of formal theorizing. Even in the radical relativism of Paul Feyerabend’s thinking, logical analysis of science promised only failures, because it could never register a fundamental anti-reasoning across all stages of scientific standardization: unreasonable, non-sensical, unmethodical foreplay … turns out to be an unavoidable precondition of clarity and of empirical success.³⁴ Above all, Kuhn’s work cannot be understood in isolation from the notion of revolutionary break developed by the French historian of science Alexander Koyré. For Koyré, there was nothing self-evident about the achievements of Galileo and Descartes, because their accomplishments would have been viewed as completely false or even absurd in antiquity or the Middle Ages. Although his revolutionary break stretched across two centuries, Koyré’s focus on the kind of historic cleavage that characterized the findings that culminated in the Scientific Revolution bespoke the gradual turn in the historiography of science to engage with conditions that the early modern era had left behind – conditions under which modern natural science arose.³⁵

Informed by existing ideas about the recursive formations of cultural objects and revolutionary breaks, Kuhn defined historical periods of scientific breakthrough in terms of what he called paradigms, which he understood to be historically successive and incommensurable with one another. Using the classic example of the Copernican Revolution, Kuhn contended that Copernicus’ contemporaries were quite correct and reasonable to dismiss his sun-centered cosmology of the universe, because it lacked credibility then. The normal science based on the Ptolemy or geocentric model (earth at the center) would gradually become strained only when Galileo introduced his novel ideas of (planetary) motion based on new astronomical observations, followed by Kepler’s maneuvers to arrive at the law of equal areas concerning orbital movements. Finally, with the three laws of motions, Newton’s unifying attempt championed the paradigm shift that had begun with Copernicus, Galileo, and Kepler.³⁶ Simply put, certain themes in philosophy of science that were developed over the course of the first half of the twentieth century, such as the permanent absence of closure of scientific facts and the conditions that had to be established for an object of knowledge to consolidate its scientific status, now took center stage in Kuhn’s reworking of the conventional understanding of scientific progress, something that Kuhn himself never dismissed entirely but continued to view in terms of an evolutionary model of historical epochs.

As such, by the time that debates surrounding structuralism and poststructuralism raged in the 1960s, starting in Paris but eventually reaching most corners of critical studies, a tradition of historical epistemology had already been established within a transatlantic cultural milieu. France stood out in particular, given the influence of Bachelard’s work, dating to the interwar period, but also because his successor in the chair of history and philosophy of the sciences at Sorbonne, Georges Canguilhem, in turn had a far-reaching influence that cannot be underestimated on such French philosophers as Michel Foucault, Jacques Derrida, and Louis Althusser. Unlike Bachelard, who had come to the history of science from physics, chemistry, and mathematics, Canguilhem focused his work on the history of medicine and the life sciences. What distinguished Canguilhem from earlier historians and philosophers of science, quoting Rheinberger, is that his work represented a form of conceptual history that can also be understood as a history of the displacement of problems which must be reconstructed in their historical context, viewing history of science, quite elegantly, itself as an epistemological laboratory.³⁷ Canguilhem’s historicization of concepts of normality and pathology in medicine also set him apart from his contemporaries in that his approach clearly differentiated the object of science from the object of the history of science.³⁸ Both externalists and internalists had fallen short on reflecting on the specificity of their object: while staunch externalists did not provide room for science to stand as an object with a life of its own, internalists tended to proceed without a clear distinction between their own object and the objects of the science they investigated.

Therefore, when Foucault delineates four thresholds for the discursive formation of knowledge in The Archaeology of Knowledge, Canguilhem’s fingerprints are readily apparent:

The moment at which a discursive practice achieves individuality and autonomy, the moment therefore at which a single system for the formation of statements is put into operation, or the moment at which this system is transformed, might be called the threshold of positivity. When in the operation of a discursive formation, a group of statements is articulated, claims to validate (even unsuccessfully) norms of verification and coherence, and when it exercises a dominant function (as a model, a critique, or a verification) over knowledge, we will say that the discursive formation crosses a threshold of epistemologization. When the epistemological figure thus outlined obeys a number of formal criteria, when its statements comply not only with archaeological rules of formation, but also with certain laws for the construction of propositions, we will say that it has crossed the threshold of scientificity. And when this scientific discourse is able, in turn, to define the axioms necessary to it, the elements that it uses, the propositional structures that are legitimate to it, and the transformations that it accepts, when it is thus able, taking itself as a starting-point, to deploy the formal edifice that it constitutes, we will say that it has crossed the threshold of formalization.³⁹

With this clever scheme of different registers of knowledge-formation (though lacking definitional precision to some critics), Foucault allowed himself to associate particular earlier approaches to the history of science with a perspective that focused on certain thresholds. Traditional histories of science, oriented toward the study of the mathematical and physical sciences, tended to operate above the threshold of formalization with its narrowed preoccupation with the normative dimensions of this specific type of discourse. The historical epistemology of Bachelard and Canguilhem was carried out at the threshold defined by scientificity. For Foucault, Bachelard’s notion of epistemological break that divided scientific from everyday knowledge is perhaps the most exemplary of this type of history of science, pointing to this very threshold. Finally, Foucault’s own archaeological analysis, or what he described as the "analysis of the episteme,"⁴⁰ was meant to direct its attention to the thresholds of positivity and epistemologization, the latter being similarly emphasized in Kuhn’s paradigm approach, which also gave the threshold of formalization its due.

Beyond the social turn of medicalization

Placing the boundaries of science and medicine at the center of historical inquiry, the French tradition of historical epistemology since Canguilhem has not only brought to the fore the internal logic of epistemology with a new focus on the medical and human sciences, but has also typified the kind of richly layered and historically grounded analysis that is absent in the sociological study of medicalization, an analytical framework that propelled a social turn in science studies starting in the 1970s.⁴¹ In 1966, Foucault first commented on the medicalization of society in The Birth of the Clinic:

The two dreams (i.e., nationalized medical profession and disappearance of disease) are isomorphic; the first expressing in a very positive way the strict, militant, dogmatic medicalization of society, by way of a quasi-religious conversion and the establishment of a therapeutic clergy; the second expressing the same medicalization, but in a triumphant, negative way, that is to say, the volitization of disease in a corrected, organized, and ceaselessly supervised environment, in which medicine itself would finally disappear, together with its object and raison d’être.⁴²

Foucault seems to suggest that inherent in medicalization lies a self-displacing logic – in order to penetrate social experience, medicine itself would finally disappear, together with its object and reason for existence.

This quote clearly spells out an important feature of medicalization: it denotes a process of change over time. Perhaps for this reason, Foucault employs medicalization as an explanatory concept in his historical analysis of the emergence of the modern clinical medical perception with the rise of pathological anatomy in Europe. Since then, however, the rubric of medicalization has been appropriated and deployed more frequently by sociologists of medicine. As evident in the subtitle of the definitive book, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (2007), written by Peter Conrad, one of the first sociologists to popularize the concept, medicalization refers to a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness or disorders.⁴³ For Conrad, what deserves scholarly attention is not whether any particular problem is really a medical problem, but the social underpinnings of this expansion of medical jurisdiction and the social implications of this development.⁴⁴

In order to serve some analytical purpose, medicalization has a number of distinctive features. Foremost, medicalization deals with definition. To interrogate the historical and social implications for how an entity, a problem, or a type of experience becomes defined in medical terms, described using medical languages, understood through the adoption of a medical framework, or treated with a medical intervention, one must disregard its medical status as given and acknowledge that it needs to be defined as such. This appreciation of the defining aspect of medicalization thus also allows for the possibility of de-medicalization and re-medicalization. In other words, medical categories can expand, contract, and re-expand. The preconditions for de-medicalization, according to Conrad, entail that a problem must no longer be defined in medical terms and medical treatments no longer deemed as appropriate interventions. Masturbation and homosexuality are stellar examples of categories of experience that have undergone de-medicalization.

Meanwhile, the shortcomings of the medicalization thesis have been illuminated most clearly in the various projects of Canguilhem and Foucault to historicize the discursive formation of knowledge at the intersections of biology, medicine, and the human sciences. This is because sociological studies of medicalization have tended to neglect the epistemological developments in the history of medicine. Although medicalization denotes a process, it rarely questions the epistemological status of what counts as medical. In addition to the social implications of medicine, historians of medicine are equally interested in the changing definitions of health and diseases. For instance, consider Conrad’s discussion of homosexuality as a classic example of de-medicalization. Since the American Psychiatric Association (APA) removed homosexuality from its list of mental disorders in 1973, Conrad interprets the significance of this historical gesture as a decisive moment of de-medicalization. Central to this decision, scholars such as Conrad, Ronald Bayer, and John D’Emilio would argue, was the role of gay social activists, who forged a collective political consciousness in the late 1960s and early 1970s and pressured the psychiatric standards of human sexual expression.⁴⁵ In this respect, what hinges the entire medicalization and de-medicalization processes of homosexuality – or, to be more precise, what is medical about homosexuality – is its official psychiatric status defined by the medical profession. Moreover, the engine of change is understood primarily in terms of social factors.

However, the approach of historical epistemology could help us see that such a general explanation of the mental health profession’s changing view of homosexuality by referencing social pressure alone is incomplete, especially given that some psychiatric experts themselves had already begun to modify their clinical understanding of homosexuality by relying on the mid-century scientific findings of the sexologist Alfred Kinsey.⁴⁶ In fact, even the juxtaposition of liberal-minded psychiatrists against conservative psychoanalysts of this period on the ground of a single epistemic frame of science is grossly insufficient. Historian John Forrester has convincingly argued that psychoanalysis differs from other branches of evidence-based medicine and human sciences because statistical evidence does not constitute the leading conceptual architecture of its mode of argumentation.⁴⁷ Similarly, the normalizing arguments about homosexuality advocated by Kinsey’s research group were constructed within a statistical metric of normalcy that sharply contrasted with a clinical metric of normalcy that underpinned physicians’ long-standing practice of the case-study methodology. So the progressive psychiatrists were not necessarily more scientific than the psychoanalysts per se, but their conceptualization of sexual normality simply belonged to a different conceptual scheme with its own set of theoretical and methodological preoccupations that gradually challenged the old. With respect to psychiatrists’ evolving view of homosexuality, what we witness over time is thus a historical shift in the norms of clinical truth – from one that found the case-studies method sufficient for distinguishing the pathological from the normal to one that became increasingly grounded in the statistical notion of normalcy and socio-populational approaches.⁴⁸ In the medicalization and de-medicalization of homosexuality, we witness an example of historical epistemology in action.

Since the 1980s, a number of philosophers of science whose writings defy the straightforward distinctions of continental philosophy, analytical philosophy, and the history of science have appropriated the concept of style from Fleck and turned it into styles of scientific thinking (Alistair Crombie), styles of reasoning (Arnold Davidson), and styles of scientific reasoning (Ian Hacking). Referring to mathematical deduction, taxonomic inquiry, hypothetical modeling, experimental exploration, statistical reasoning, and historic-genetic thinking, Crombie asserts that We can establish in the classic scientific movement a taxonomy of six styles of scientific thinking, distinguished by their objects and their methods of reasoning.⁴⁹ Whereas Crombie’s historical analysis tends to favor continuities over change, both Hacking and Davidson have adopted the opposite approach. Hacking calls moments of discontinuity in the history of each of the scientific styles crystallization, while Davidson’s study contrasts two opposing styles of reasoning chronologically and points to the late nineteenth century as the pivotal moment for the emergence of sexuality, a concept that has its own unique space of epistemological articulation and historicity but has tended to be conceived as a universal experience across time.⁵⁰ Still, taken together, this group of historical epistemologists agrees on the idea that with each style of science, we are not then introduced to a new type of object and a new method of reasoning. Instead, each style is constituted of the method and the type of objects with which it is concerned. These reformulations are intended to delineate different systems of knowledge and emphasize the epistemic ruptures among them, in ways not unlike how I have stressed the differences between the statistical and the clinical conceptual schemes of sexual normality in the mid-twentieth-century United States. The reformulated analytical potential of style therefore correlates to not only Bachelard’s epistemological obstacles, Kuhn’s paradigm, and Foucault’s episteme, but also, we might add here, Gerald Holton’s themata, Paul Feyerabend’s incommensurability, Pierre Bourdieu’s habitus, anthropologists’ culture, philosophers’ language, and the idea of mentalités championed by the Annales School.⁵¹

If we return to Foucault’s quote from The Birth of the Clinic, it is evident that what he was referring to is not the kind of medicalization/de-medicalization process understood in Conrad’s sociological terms per se; rather, he is highlighting two notions of productive power – one positive and another negative – that work together to govern the coming into being of a medical condition socially, historically, and, above all, epistemologically: certainly through the formal establishment of medical institutions, but also through the subtle consolidation of new socializable subjectivities that emerged out of a rearrangement at the level of epistemic knowledge (savoir), rather than accumulated, defined, adjusted knowledge (connaissances). Distinguishing this (Foucauldian) approach of historical epistemology from sociological studies of medicalization is important, because the history of modern Chinese medicine is replete with examples that can be misread too easily as evidence for the social processes of medicalization. A central goal of this book is to revise that misrecognition by bringing to light the rise of new structures of knowledge around the epistemological transformations of Chinese medicine in the nineteenth and twentieth centuries. Having established the heuristic value of historicizing the emergence and rearrangement of knowledge à la Foucault, Hacking, and Davidson, we have come full circle to the contemporary method of historical epistemology with which we began.

The objects of modern Chinese medicine

A central premise of this book is that the history of modern Chinese medicine is filled with many worlds of knowledge and cannot be conceptually subsumed within one homogeneous world. As Elisabeth Hsu, Kim Taylor, and others have shown, the concept of traditional Chinese medicine (TCM) was invented and nationalized in the early Maoist period (1949–76). As a system of medical theory and practice, TCM was defined in national textbooks mainly as a response to the particular social, political, and economic context of the 1950s and 1960s, which helped determine the selection of politically appropriate fragments from classical sources for the creation and standardization of a medical system that would come to be widely recognized as a coherent field known as TCM.⁵² The 1990s marked another turning point in the historical development of TCM, echoing the broader trends in China’s political economy in its post-socialist quest for neoliberal global integration.⁵³

Yet, even assuming fundamental historical discontinuity, the historical remaking of Chinese medicine in the modern period nevertheless relies on established theoretical foundations of earlier periods and draws from them to give credence to its newly invented association with the concept of tradition.⁵⁴ This collection of essays is meant to capture the history of modern Chinese medicine in light of the large-scale transformations it underwent in the nineteenth and twentieth centuries, including the interaction of Chinese medicine with western biomedicine, its invented transformation into TCM, and the history of its globalizing trajectories. These transformations featured decisive epistemological breaks, yet, at the same time, those breaks were undergirded by fundamental continuities that framed the turning points between what came before and after. In short, the old worlds informed the new yet were never identical to them.

The first part of this volume builds on and extends a long-standing tradition of inquiry within historical epistemology that contextualizes objects of scientific interest. Specifically, this opening section investigates the historical conditions under which certain objects of Chinese medical knowledge, meaning, and practice emerged, transformed, and, in some instances, disappeared. It also adopts a decidedly transnational approach, focusing in particular on the construction of those objects that moved across geo-national boundaries. Kuang-chi Hung’s chapter, which examines Ginkgo biloba as a medical commodity in different places and times, sets the overall tone of this section and volume as a whole. Hung demonstrates that our contemporary popular perception of ginkgo as a mental enhancer is the contingent result of centuries of thinking about the herb that converged and diverged in varying parts of the world