Book Review: What Is Medicine? Western and Eastern Approaches to Healing

By Paul U. Unschuld

Reviewed by William R. Morris, PhD, DAOM, LAc

Key Words: medical history, medical epistemology, Chinese medicine

A sociologist by training, Paul U. Unschuld has expanded his professional roles to that of sinologist and historian. Currently professor and director of the Horst-Goertz Institute for the Theory, History, and Ethics of Chinese Life Sciences, Charité Medical University-Berlin, Unschuld has authored many influential works on Chinese medical history such as Medicine in China: A History of Pharmaceutics and Huang Di Nei Jing Wen: Nature, Knowledge, Imagery in and Ancient Chinese Medical Text, both from UC Press. His works on the Nei Jing and the Nan Jing have influenced a generation of Chinese medical scholars in the West. His sociology background and role as a medical historian in the German University system prepare him well to explore the question: What is medicine?

As a sociologist, Unschuld presents a constructivist point of view which assumes that people build their knowledge of reality from the interaction of their experience and their ideas – and for Unschuld, medicine is no different. Thus, new practices in medicine are built from the beliefs of the social system in which a medical practice takes place.

In this work, Unschuld distinguishes medicine from noumanistic and spiritualistic healing practices and compares and contrasts medical scientific beliefs from the East and West in a historical triptych stretching back 2,000 years. In essence, Unschuld has created a tour de force that explores Eastern and Western medical practices, their history, and social construction. Therefore, one might read this book if seeking knowledge about medical history in the East and West and also to understand thinking processes in medical practice. This book works through medical anthropology as much as it does history and epistemology.

In ancient Greece and China, physicians observed the fact that people healed by themselves. In the canons of Chinese medicine, natural healing is only discussed in the Treatise on Damage bu Cold (Shang Han Lun). Further, the Chinese literature contains no discussion spontaneous healings. However, in ancient Greece, these notions of self-cure have existed for 2,000 years up to today. The external physician is necessary only if the inborn physician didn’t work, and the physician was to observe and intervene only if necessary: Natura Zanat Medica Cura.

Unschuld suggests that medicine is the attempt to understand and manipulate disease on the basis of science i.e., the development of science is a sole prerequisite to the development of medicine. What is science? He contends that it is the assumption that there are natural laws acting independently of person, time, or place, and that humans can recognize these laws. Unschuld believes that understanding these laws is sufficient to understand the universe and human existence in it, and that the development of medicine requires this set of assumptions. That is, science is the prerequisite to the development of medicine.

The basic questions that Unshuld pursues beyond “What is medicine?” are: Why do new thoughts emerge? Why are they adopted? And why are they convincing? How will people consider the concept 100 years from now?

In terms of politics, the Chinese world view that set the stage for the development and flourishing of medicine in China during the Han Dynasty (c. 001 CE) says that the images are in part connected to the efforts of the great unification that took place after the Warring States period.  Thus, Chinese medicine as we know it emerged in a unified empire whereas Western medicine developed in the Greek political environment that valued local and individualized government. In terms of process and relations, then, the tendency of Western medicine to explore objects in detail took place in distinction from the Chinese tendency to look at the whole.

Unschuld discusses China, where Confucianism, Legalism, and Taoism formed the three socio-political currents that affected thoughts and beliefs about medical practice. These are critical to understanding the medical practices of the era. Confucians state that man is basically “good-natured” and that this goodness needs to be reinforced through education, musical training, and behaviors appropriate to class with its rights and rules. If everyone behaves appropriate to class, there should be no problem. The emphasis was on strict sets of social norms for every social activity. Daoist philosopher, Chuan Zi, provided the basis for 2,000 years of imperial philosophy rooted in Confucian legalism. The movement emphasized control over man using strict laws rather than emphasizing good behavior. They did, however, promote education on a high order. Taoists emphasized ignoring rights, laws, and education, as they are all manmade, placing constraint on the people. Men will react, and this is why we have this mess. They said let’s look at nature—we don’t need laws, rules, and punishment. No manmade morality or laws.

Contrary to these three unifying threads in China, Greece sought to shut out monarchal rule. According to Unschuld, it was this very distinction in the sociopolitical climate between early Greece, the polis and the unified state of China the provided the metaphorical backdrop to the development of the medical worldviews. Part of Chinese society arrived at the belief in the necessity of social law, and the Greeks were focusing on the rights of the individual. In Greece the social dimension of law was established first, then natural law. Later, the in the Tang Dynasty, Chinese culture presented a complex pluralistic life compared to the simple depressed nature of European life in the Middle Ages.

Unschuld relates the story of Emperor Tian Chi Huangdi who conquered regions that used different writing, weights, cart track sizes. Within ten years he unified measures which increased commerce. The flow of goods, people, and money were served by the standardization. This is why the government established zang – the depots to store grains. Here we see the importance of zang and other terms. This example is a projection of the concept of circulation, a notion that was not able to be proved in China 2000 years ago, but this is what we see today, for example, in our understanding of the circulation of blood.

What Is Medicine? Western and Eastern Approaches to Healing provides a refined reading experience. Unschuld’s abilities in English, German and Chinese allows for a level of both depth and clarity in his writing style. In essence, Unschuld has created a work that is useful for both medical history and epistemology. His detailed account of the progression of European medical thought in comparison the development of Chinese medical thought is a must read for those who would explore medical history as it pertains to practice. This book could well be a resource in medical history courses.

What Is Medicine? Western and Eastern Approaches to Healing by Paul U. Unschuld
Berkeley, CA: University of California Press
September 2009
ISBN: 9780520257665
Paperback, 256 pages