Boundaries and classification: the cultural logic of treating foreign medicine

The paper examines why foreign medical systems are often initially perceived as dangerous when they enter a new cultural context, and how they become accepted. It situates the question within contemporary global exchanges of medical knowledge (e.g., WHO’s Global Centre for Traditional Medicine and the 2023 Summit) and historical flows accelerated since the Age of Sail. In the United States, acupuncture has gained legal recognition in most states, yet TCM faces barriers due to evidence-based standards, limits on indications, and regulatory hurdles for Chinese herbs. Conversely, in developing contexts biomedicine has met cultural resistance and has been used to critique globalization and modernity. The study argues that, beyond politics, economics, and power, culture and classification play central roles in acceptance. Using boundaries as an analytical concept, it posits that the entry of foreign medicine disrupts local classificatory systems, generating “dangerous medicine” imaginaries. To explore this, the paper analyzes two cases with large-scale introductions across pronounced cultural differences: Western medicine in China (16th–19th centuries) and TCM in the US (19th–20th centuries). It adopts emic nomenclature appropriate to each historical context (e.g., “Western medicine” vs. “Chinese medicine” in China; “TCM” vs. “regular medicine” in the US) and clarifies that regular medicine historically included heroic treatments while irregular practitioners emphasized vis medicatrix naturae. The study’s purpose is to clarify how cultural boundaries and reclassification processes shape the perceived danger and eventual legitimation of foreign medicine.

The paper synthesizes three strands of boundary-related scholarship to frame medical transmission and acceptance:

• Professional/science boundaries: Professions and science demarcate insiders/outsiders and science/nonscience through boundary work (Gieryn, 1983). Biomedicine often claims formal authority over efficacy standards (e.g., RCTs), yet real-world efficacy is contextually constructed and intersubjective (Craig, 2012; Greenhalgh & Zhang, 2020). Boundaries also exist within CAM fields (Brosnan, 2017), and interactions between experts and publics matter (Lei, 2021). In Israel, formal policy draws strict boundaries privileging biomedicine, while informal practice shows mutual respect with CAM (Mizrachi & Shuval, 2005).
• State ideology boundaries: Medicine is entwined with political projects and sociotechnical imaginaries (Jasanoff & Kim, 2009). In China, state-led boundary reconfigurations elevated native “tu science” over foreign “yang science” during Mao-era policies (Fu, 2017), fostered Soviet-aligned medical adoption (Yu, 2020), and more recently raised techno-nationalist concerns (e.g., precision medicine, genomic sovereignty; Au & da Silva, 2021). The state promotes TCM modernization to overcome external boundaries (Unschuld, 2018) and positioned TCM during COVID-19 within scientific/nonscientific redefinitions.
• Symbolic cultural boundaries: Stemming from anthropological work on categorization (Durkheim; Durkheim & Mauss, 1963), symbolic boundaries distinguish “us/others” and mark purity/danger (Douglas, 2002; Kristeva, 1982; Lamont & Molnár, 2002). Everyday categorizations are often unconscious and culturally situated (Edelmann, 2018). Boundary crossings can be construed as dangerous and elicit reclassification or reinforcement of distinctions. These concepts illuminate the socio-cultural labeling of foreign medicine as dangerous and its ties to identity, morality, and social order (Fiske, 1998; Wayland, 2004; Gold & Clapp, 2011).

The study employs historical anthropology, analyzing publicly available historical sources without new data collection. For China (16th–19th centuries), it examines missionary letters, Chinese officials’ memorials, intellectuals’ diaries, and writings of Chinese medical practitioners, with close attention to Zhang Xichun’s integrative work. For the US (19th–20th centuries), it analyzes period news reports and medical reviews depicting TCM, supplemented with occasional contemporary reports to show continuity. The approach traces how foreign medicine was framed as dangerous across physical, moral, political, and social dimensions; how local classification systems (e.g., four qi and five tastes in China; science/nonscience in the US) were disrupted; and how reclassification strategies (TCMization of Western medicine; scientificization of TCM) enabled legitimation.

• Foreign medicine often appears as “dangerous medicine” upon border crossing, not only due to perceived bodily risks but also moral, political, and social anxieties.
• China (16th–19th c.): Western medicine, entering with Catholic missions, was entangled with rumors of immoral conduct (e.g., alleged use of drugs to control believers, sexual misconduct), political threat (subversion of Confucian hierarchy and loyalty), and social harm (plague rumors, poison gas). Despite therapeutic successes (e.g., quinine), suspicion persisted. Western medicines were hard to place within the Chinese classificatory system of four qi and five tastes, rendering them “strange,” and reinforcing Hua–Yi distinctions and beliefs in fundamentally different bodies needing different medicines.
• United States (19th–20th c.): TCM was portrayed as dangerous or barbaric: acupuncture depicted as physically abusive (e.g., sensationalized reports of very long needles), animal-derived drugs characterized as disgusting, practitioners accused of deception or lawbreaking, and TCM linked to political otherness (aristocracy/dictatorship; later, Orientalist associations with communism). Chinese immigrants were often framed as public health risks, reinforcing national hygiene/identity boundaries.
• Disordered classification as root cause: In China, laboratory-made chemicals did not fit four qi/five tastes; in the US, TCM treatments lacking anatomical/physiological explanations were deemed unscientific, extending medical boundaries into civilizational judgments (e.g., China as “unenlightened,” TCM as witchcraft).
• Reclassification enables acceptance and legitimacy: • TCMization of Western medicine: Chinese physicians reinterpreted Western drugs within four qi/five tastes. Example: Zhang Xichun classified aspirin as an acidic, cool-tasting substance and combined it with traditional therapies (e.g., plaster) for fever, integrating it into Chinese prescriptions. • Scientificization of TCM: Chemical/pharmacological validation provided security and acceptance in the US. Example: ephedrine extraction (1887) transformed Ma Huang’s status; US ephedra imports rose from 0 (1925) to over 1,000,000 pounds (1928). Contemporary ambivalence persists: even when studies suggest benefit (e.g., acupuncture for GERD), lack of systematic scientific proof limits standard adoption.
• Science functions as a classification system performing cultural work; the science/nonscience boundary is culturally constructed and helps manage everyday social order and national identity.
• Practical implication: Acceptance hinges on culturally resonant reinterpretations; crossing boundaries without reclassification generates dangerous medicine imaginaries that deter use, even for effective treatments.

The findings address the core question of how and why foreign medicines are initially perceived as dangerous and how they become locally legitimate. When foreign therapies disrupt entrenched classificatory schemas (four qi/five tastes in China; science/nonscience and anatomical knowledge in the US), they trigger symbolic boundary defenses that map onto moral order, political allegiance, national identity, and social hygiene. The dangerous medicine label thus reflects boundary maintenance rather than purely biomedical risk. Legitimacy emerges through reclassification in local terms: by translating Western drugs into Chinese categories (TCMization) or translating TCM into scientific categories (scientificization). These processes perform cultural functions—offering moral and political reassurance and integrating foreign practices into existing social orders—while also shaping markets (e.g., ephedra imports) and regulation. The study underscores that efficacy is socially negotiated and context-dependent; classification systems, including science, are not neutral but embedded in cultural projects. Recognizing these dynamics can inform strategies for responsible integration of foreign medical practices by anticipating boundary concerns and facilitating culturally meaningful reinterpretations.

Foreign medicine’s entry into local societies often destabilizes existing cultural classification systems, transforming medical boundaries into markers of identity and fueling imaginaries of dangerous medicine. Even safe and effective therapies may face hesitation without cultural reinterpretation. Reclassification—via TCMization of Western medicine in China or scientificization of TCM in the US—functions as a cultural ritual that renders foreign medicine safe and acceptable, providing not only therapeutic but also social and political security. The study highlights that scientificization efforts today serve both explanatory and cultural-security roles, and that concepts of boundary and dangerous medicine remain instructive for promoting medical communication and integration.

• The analysis does not cover all medical communications; e.g., fewer dangerous medicine imaginaries are evident in Sino–other Asian exchanges until Japan’s adoption of science.
• Even Sino–US exchanges were not uniformly constrained by dangerous medicine narratives; TCM sometimes flourished despite exclusionary policies.
• The paper does not examine in detail the 20th-century acceptance of Western medicine in China or the political and economic drivers behind it (addressed elsewhere, e.g., Lei, 2014).