Forgotten Disease
Illnesses Transformed in Chinese Medicine
Hilary A. Smith

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Contents and Abstracts
Introduction
chapter abstract

This chapter summarizes why biomedical translations of old Chinese disease concepts are problematic. It introduces the Chinese disease name foot qi (jiao qi) and gives examples from three different periods to show how differently the name has been used over the course of Chinese history and why beriberi is an incomplete translation. The chapter then describes three contributions the book makes to current historical scholarship: it defends the "framing disease" approach to disease history and extends it to Chinese concepts; it helps create a more nuanced picture of how modern Chinese and Western medicine coevolved, supplanting an older idea that they were diametric opposites that collided in the early twentieth century; and it questions the notion that Western imperialism improved health in modernizing East Asia. By introducing past ways of thinking about the body, the book also encourages a critical, comparative perspective on current medical knowledge.

1 Foot Qi in Early Chinese Medicine
chapter abstract

This chapter introduces foot qi (jiao qi) as it was understood when it first appeared in books in the fourth century. Foot qi first appeared in a drug formulary called Emergency Formulas to Keep Up One's Sleeve by Ge Hong, where it appears as a regionally bounded disease common south of the Yangzi River, to which migrants from the north were especially vulnerable. The chapter explores how political circumstances combined with classical medical beliefs about regional constitutions to make foot qi seem like a disease that threatened out-of-place bodies. The chapter also argues that foot qi's early history shows it to have been a commonly used disease name with a lot of flexibility and ambiguity.

2 Competing for Medical Authority over Disease
chapter abstract

This chapter shows how literate doctors in medieval China, both those employed by the government and those practicing privately, attempted to claim knowledge about foot qi (jiao qi) that surpassed that of laypeople. It centers on two seminal texts in Chinese medicine: Chao Yuanfang's Sources and Symptoms of All Disease and Sun Simiao's Formulas Worth a Thousand in Gold. Their attempts to redefine foot qi reveal how competitive the unregulated medical marketplace of Sui and Tang China was; learned physicians, whom many today erroneously believe to have had the most authority, faced challenges to their authority from rivals and even from patients and patients' friends and relatives. The chapter also shows that medieval foot qi was a chronic disease that could repeatedly afflict a wealthy and powerful patient over a long period of time, making it a particularly visible site where competition among healers played out.

3 Simplifying and Standardizing Disease
chapter abstract

This chapter shows how the drug formularies produced by an active Chinese government in the tenth and eleventh centuries standardized and simplified the definition of foot qi (jiao qi) that learned doctors had created. The formularies, linked to a new system of public pharmacies, facilitated self-treatment and removed elements of diagnosis that only a classically educated physician could perform. Physicians complained that official formularies dumbed down diagnosis of all disease, especially foot qi. In the twelfth and thirteenth centuries, private printers abridged the official formularies, and the spread of woodblock printing technology enabled knockoffs to be cheaply disseminated and become widely influential. These formularies produced the only features of classical foot qi that were later incorporated into the modern concept of beriberi—the idea that the disease came in wet, dry, and fulminating types—revealing a similar reductive, standardizing impulse in both Song dynasty and modern biomedicine.

4 The Northerner's Dietary Disorder
chapter abstract

This chapter examines a major change in the understanding of foot qi (jiao qi) in the twelfth century. Li Gao (Li Dongyuan), one of the most famous physicians of the Jin-Yuan period known for innovation in Chinese medicine, added a new "northern" etiology to the old idea that foot qi was caused by environmental poisons entering the body through the skin, which he saw as a "southern" type of the disease. He thought northerners had tighter pores than southerners and were less susceptible to environmental poisons but more vulnerable to ailments caused by eating and drinking too much rich food and alcohol. Northerners' foot qi was thus a dietary disorder. The chapter argues that this changed understanding reflects the new prominence of ideas about northern and southern constitutions in Chinese medicine, influenced by the long political division of north from south China between the tenth and fourteenth centuries.

5 Getting Rich and Getting Sick
chapter abstract

This chapter argues that writings about foot qi (jiao qi) in fifteenth- through nineteenth-century China show the effects of rising prosperity on both health and the medical occupation. Late-imperial sources, including the new case-records genre, reveal a disease resembling modern gout, consisting of intermittent foot pain and swelling. Doctors perceived this as the dietary foot qi first described in the twelfth century but argued about whether it was exclusive to northerners as their predecessors had suggested. The significance of northern and southern identity had waned now that China was politically reunified, but less-elite healers still claimed knowledge about regional constitutions, diseases, and therapies to assert special authority. Scholars writing about foot qi generally ignore sources from this period because the ailment they describe does not match beriberi, the officially recognized definition of foot qi today, but the chapter rejects such a present-centered approach.

6 Creating Beriberi in Meiji Japan
chapter abstract

This chapter examines the late nineteenth-century Japanese epidemics of the vitamin deficiency disorder beriberi, which Japanese doctors identified as epidemics of foot qi (pronounced kakke in Japanese). Previous histories have presented the association between kakke and the disease beriberi as the discovery of a truth: that foot qi was really a thiamine deficiency that had long plagued East Asia. This chapter argues instead that the nineteenth-century beriberi epidemics were historically new and were caused by Meiji Japan's modernization on a Western model, including changes to foodways. Because practitioners of kampō (classical Sino-Japanese medicine) had lower status and support in Meiji Japan than Western-style doctors, it was the latter who redefined this old disease concept for the modern age. The redefinition reflected Western imperialism, not only because it dismissed indigenous ways of understanding disease but also because imperialism had made thiamine deficiencies more common to begin with.

7 Foot Qi's Multiple Meanings in Modern East Asia
chapter abstract

This chapter examines how a modern biomedical interpretation—that foot qi was really the vitamin deficiency beriberi—was accepted by the Chinese elite in the early twentieth century, even though there had never been a beriberi crisis in China as there had been in Japan. It argues that it was because of Western medicine's prestige that modernizers in China accepted Western disease concepts as the "true" definitions of Chinese medicine disease names. Subordinating traditional disease concepts to Western ones devalued Chinese medicine by making it seem that only Western medicine could properly diagnose and treat disease; consequently, foot qi nearly disappeared from Chinese medicine. Laypeople, however, continued to apply the name to an ailment more relevant to them than beriberi, namely athlete's foot. And interest in other nonberiberi meanings of classical foot qi has recently revived. The chapter thus highlights the persistent diversity of ideas in East Asian medicine.

Conclusion
chapter abstract

The conclusion summarizes why it is important to approach modern translations of old Chinese disease names as this book has approached foot qi: as the products of social, political, economic, and intellectual factors, rather than as transparent discoveries of biological truth. Such an approach undermines the false impressions that Chinese medicine is a monolithic tradition unchanged over several thousand years and that its ideas and practices have always been antithetical to those of Western medicine. It also questions the assumption that the diseases Westerners found in Asia in the late nineteenth and early twentieth centuries were timeless features of life there, miraculously ameliorated by Western medicine's innovations. And it allows us to appreciate premodern ideas about illness that may help us face emergent diseases today. This approach is especially important now as the terminology of Chinese medicine is being standardized to facilitate its globalization.