Boundaries and classification: the cultural logic of treating foreign medicine

The World Health Organization's (WHO) increasing focus on traditional medicine highlights the ongoing global exchange of medical practices. However, the acceptance of foreign medicine is complex and often fraught with challenges. This paper investigates the cultural factors influencing the reception of foreign medical systems, focusing on two historical examples: the introduction of Western medicine into China (16th-19th centuries) and the introduction of Traditional Chinese Medicine (TCM) into the United States (19th-20th centuries). The study uses the concept of "boundaries" as an analytical framework to understand how the introduction of foreign medical systems disrupts established local classifications of medicine, leading to perceptions of danger and resistance. The integration of foreign medicine necessitates a process of cultural reinterpretation and reclassification within the local system. The paper argues that this process reveals the cultural construction of scientific boundaries and their influence on the acceptance or rejection of medical practices. The choice of these two periods and countries is based on the large-scale introduction of Western medicine to China and TCM to the US, representing distinct cultural contexts with similar responses to foreign medical systems. The paper adopts an emic perspective, utilizing the terminology prevalent in each specific historical period and cultural setting. This includes using terms like "Western medicine" in the context of 16th-19th century China and "regular medicine" in reference to the prevailing allopathic system in 19th-20th century America, highlighting the varied nomenclature used for similar medical practices across time and place.

Existing literature on the spread of medicine across cultures often examines political, economic, and military influences. This paper builds upon these perspectives by emphasizing the crucial role of cultural factors. Studies on the boundaries of professions, science, and knowledge are discussed, highlighting how the concept of "boundary work" is used to define and protect professional domains. The research explores how the boundaries of science are negotiated in discussions of allopathic medicine and CAM, showing the varying levels of formal and informal acceptance. The influence of state ideology on the acceptance of medicine is analyzed, illustrating how political factors shape the boundaries and perception of medical systems (e.g., the "tu science" and "yang science" distinction in Maoist China). This paper also delves into the concept of symbolic boundaries in cultural categorization, drawing from anthropological studies to understand how cultural distinctions and categorizations create social boundaries impacting the reception of foreign medical practices. The literature underscores the significance of cultural categorization and collective emotions in shaping attitudes toward medicine.

This research utilizes a historical anthropological approach, examining primary historical sources to understand the reception of foreign medical systems in both China and the United States. For the introduction of Western medicine into China (16th-19th centuries), the study draws upon missionary letters, official memorials, diaries of Chinese intellectuals, and writings by Chinese medical practitioners. The work of Zhang Xichun, a significant figure in the integration of traditional Chinese and Western medicine, is particularly examined. For the introduction of TCM into the United States (19th-20th centuries), the research relies on historical news reports, medical reviews, and contemporary articles to reconstruct the attitudes of mainstream American society toward TCM. The analysis focuses on identifying recurring themes and patterns in the cultural responses to these introductions of foreign medicine, analyzing how existing categorization systems were challenged and how subsequent re-categorizations led to eventual acceptance or rejection of these medical practices.

The study reveals that the introduction of Western medicine into China and TCM into the United States both evoked the image of "dangerous medicine." This perception wasn't solely rooted in the fear of physical harm but encompassed moral, political, and social dimensions. In 16th-17th century China, the association of Western medicine with Catholicism fueled suspicion, with rumors of harmful rituals and unethical practices contributing to negative perceptions. The introduction of Western medicine was also seen as a threat to Confucian ethics and social order. Similarly, in the US, TCM faced skepticism due to perceived dangerous treatment methods and the use of animal-based medicines viewed as barbaric. The suspicion of TCM extended to ethical and political concerns, with some associating it with authoritarian regimes. The study highlights that the image of "dangerous medicine" arises from the disruption of local cultural classification systems. In China, the difficulty in categorizing Western medicines within the existing framework of "four qi and five tastes" reinforced negative perceptions. The inability to explain TCM within the scientific framework of American society similarly fueled skepticism, associating it with backwardness and ignorance. The core findings underscore that the path toward acceptance of foreign medicine lies in its reclassification within the local cultural system. In China, this took the form of "TCMization," where Western medicines were explained using the existing framework. In the US, the "scientification" of TCM was necessary for its acceptance. This process of recategorization not only addressed concerns about efficacy but also alleviated cultural anxieties and promoted a sense of security.

The findings demonstrate that the rejection of foreign medicine is not solely due to its potential for physical harm but is profoundly shaped by cultural factors. The disruption of existing classification systems creates a sense of uncertainty and fear, leading to the labeling of foreign medicine as dangerous. The successful integration of foreign medicine requires a process of cultural assimilation, involving the reinterpretation and reclassification of the foreign system within the existing cultural framework. This study emphasizes the culturally constructed nature of scientific boundaries and their influence on the acceptance of medical practices. The "TCMization" of Western medicine in China and the "scientification" of TCM in the US illustrate the need for cultural adaptation in successful medical exchange. This research contributes to a deeper understanding of cross-cultural medical exchange and the complex interplay between culture, science, and the acceptance of new medical systems. The paper underscores the importance of considering cultural context when promoting the adoption of medical practices across boundaries.

This study highlights the critical role of cultural factors in the acceptance or rejection of foreign medicine. The disruption of established classification systems and the resulting perception of "dangerous medicine" necessitate a process of cultural reinterpretation and reclassification. The successful integration of foreign medical systems requires not only demonstrating their efficacy but also adapting them to fit within the existing cultural framework. Future research could explore other instances of cross-cultural medical exchange to test the generalizability of these findings and further investigate the specific mechanisms of cultural assimilation in medical practices. Further studies exploring the nuances of cultural and scientific boundary negotiation could lead to more effective strategies for facilitating the global exchange of medical knowledge.

This study focuses on two specific historical case studies—Western medicine in China and TCM in the US—and may not be fully generalizable to all instances of cross-cultural medical exchange. The limited scope of historical sources may also restrict the extent of analysis. The complexity of the socio-political landscape surrounding medical practices in each case also necessitates more in-depth analysis beyond the scope of this particular study. Furthermore, the paper primarily focuses on cultural factors, acknowledging the need for further research exploring the interplay of economic and political factors in shaping the acceptance of foreign medical systems.