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The Question of Efficacy

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Health Care in Eleventh-Century China

Part of the book series: Archimedes ((ARIM,volume 43))

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Abstract

Historians have tended either to avoid asking whether the therapies described in their ancient sources had any curative value, or to assume that they were effective to the extent that modern biomedicine can validate them. But today’s knowledge is not the only reliable criterion. This chapter, on the basis of recent studies in medical anthropology and sociology, observes that the success of therapy in every culture depends on three kinds of response by patients: the autonomous response (the tendency of the body heal itself), the meaning response (“the biological consequences of knowledge, symbol, and meaning”), and the specific response to biological, chemical, or physical intervention. The book’s analyses of therapeutic instances look for the first two responses (the third played only a small role in pre-modern therapy). It also notes that the medical disorders and even the symptoms of ancient China were different from those of biomedicine. Recorded judgments of the efficacy of care in the eleventh century came as regularly from members of patients’ families as from physicians. Examples suggest that in order to use biomedical knowledge productively, it is essential first to understand the sources on their own terms.

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Notes

  1. 1.

    See Spiro 1997, 40–41.

  2. 2.

    Moerman 2002, 16–21. For an example of its use by anthropologists see Whyte et al. 2002, 29.

  3. 3.

    An important clarification is Lock 2000, which emphasizes that normality is not a universal category. The mean depends on ethnic, social, cultural, and political circumstances which medicine usually ignores, often at some cost to the quality of treatment.

  4. 4.

    E.g., Shapiro & Shapiro 1997, 13–19, which on this basis claims that almost all the results of medical care everywhere before the mid 20th century were due to the placebo effect—a perfect example of misusing the term. On the vagueness of the distinction between specific and general action, see Csordas & Kleinman --> 1996.

  5. 5.

    See Liu Shoushan 刘寿山 1963 and subsequent volumes in the series.

  6. 6.

    Moerman 2000, 56. Feeling is a main aspect in Desjarlais 1992. In ancient Chinese documents sources that reflect patients’ perceptions rather than those of doctors are rare, mainly to be found in poetry. See, for instance, the poem cited in chapter 6, p. 146.

  7. 7.

    Moerman 2002, 4. This formulation is analogous to, but more clearly thought out than, the analysis of doctor-patient relations into “technology, caring, and values” in Payer 1988, 9.

  8. 8.

    Harrington 2008, 17.

  9. 9.

    See the overview in Waldram 2000.

  10. 10.

    Kleinman & Sung 1979, 24. On the cost of this dissatisfaction, see Eisenberg et al. 1993.

  11. 11.

    Burnham 1996, 23.

  12. 12.

    This paragraph is based on the reconstruction in -->Kaptchuk 1998a and 1998b. The quotation is from 1998b, 1724.

  13. 13.

    Kaptchuk et al. 2010; Kaptchuk 2013, esp. p. 331.

  14. 14.

    Kaptchuk 1998a, 1998b, all quotations from 1998b, 1724–1725. Pellegrino 1976 writes of the placebo effect as “closely related to the aura which surrounds ingestion of any chemical substance properly invested with healing powers by the ritual of prescribing” (p. 628).

  15. 15.

    Moerman 2002, 94.

  16. 16.

    Morris 1997, 188, 195, represents this third stance; for examples of the first and second in the same volume see, respectively, Shapiro & Shapiro and Price & Fields.

  17. 17.

    See, for instance, Kaptchuk et al. 2009, 388. Howard Spiro 1986, 227–228, calls the crucial characteristic loyalty to the patient.

  18. 18.

    Moerman 2002, 66.

  19. 19.

    For references and interpretation, Moerman 2002, 35–49; for responses to colors of pills in southeast India, Nichter 1980, 231.

  20. 20.

    See the extensive study in Lock 2005.

  21. 21.

    The classic study is Rubinstein & Brown 1984. Lock & Scheper-Hughes 1996, 67, discuss ADHD as an instance of recasting social frictions and miseries as “individual pathologies rather than as socially significant signs.” On NIH doctrine re ADHD, see National Institutes of Health 2012. For diagnosis rates in some other countries approaching those of the U.S., see Hinshaw & Scheffeler 2014.

    Payer 1988 gives other examples of important discrepancies in diagnosis and therapy between the U.S. and Western European countries. This exceptionally useful book does not reflect current practice, but no one has done a comprehensive study since. Ikels 1998 compares the experience of dementia in China and the U.S.

  22. 22.

    Moerman 2002, 72–83.

  23. 23.

    See, for instance, Price & Fields 1997, which even takes the last dichotomy seriously (pp. 133–134).

  24. 24.

    Renée Fox further correlates the decline of psychosomatics with that of psychoanalysis and the supplanting of pathophysiology by molecular biology (personal communication, 31 August 2011).

  25. 25.

    Aronowitz 1998, 51–52, in a historical analysis of ulcerative colitis. He lists several reasons for the demise of psychosomatic medicine.

  26. 26.

    The first sophisticated studies of these issues, still useful in many respects, are Kleinman & Sung 1979, Kleinman 1980, and Kleinman & Gale 1982.

    Some theoreticians condemn the use of the word “traditional” on the ground that it implies lack of change and thus of dynamism. I use the word simply as an antonym of “modern” when discussing patterns of practice. As this book makes clear, I believe Chinese society, and health care as part of it, was constantly changing in unpredictable directions.

  27. 27.

    See, for instance, the discussion of ritual in prognosis in Christakis 1999, 163–178.

  28. 28.

    I do not mean that doctors generally lacked confidence in their findings, but that their diagnoses of the same patient were more likely than today to disagree. The limits in their ability to cure also made them more attentive to prognosis than M.D.’s are today. On this topic see Christakis 1999.

  29. 29.

    For an eloquent discussion, see Kleinman 1988, 44–49.

  30. 30.

    In much of China and elsewhere in East Asia, members of all except wealthy families still tend to stay in the hospital to feed and care for the patient, as European families used to do.

  31. 31.

    National Association of Chronic Disease Directors 2007, 8.

  32. 32.

    The situation was often different from the fourteenth century on with women and children, since other family members often presented their ailments for diagnosis, but this was not normally the case for women ca. 1050.

  33. 33.

    There are a few useful monographic studies of popular therapy in Europe and the United States up to the nineteenth century, e.g., Beier 1987, Ramsey 1988, Brockliss & Jones 1997, Green 1994, MacDonald 1981, Pelling 1998, Porter 1985 and 1989, and Ulrich 1990. For an overview see Gentilcore 2004. Important more recent publications are Lindemann 2010 and Rankin 2013.

  34. 34.

    I realize that this term is no longer respectable, but it is less stiff than the bureaucrats’ “primary health care provider.” I was involved in a medical case in which it took a team of hospital physicians two weeks to learn that a case that they could not identify was typhoid.

  35. 35.

    Stein 1973, quoting p. 367.

  36. 36.

    Dunglison 1874, 416; Savill 1930, 498; more extensive discussion in Sivin 1987, 107–109.

  37. 37.

    Smith 2008.

  38. 38.

    Cunningham 2002, citing pp. 13 and 16 (the second quotation is italicized in the original). On searchers see Munkhoff 1999. For an analogous study, see MacDonald 1989. For significant differences between medical practice in Germany, France, England, and the U. S. in the late twentieth century see Payer 1988, 25.

  39. 39.

    Smith 2008, 183–186.

  40. 40.

    Zhu bing yuan hou lun 諸病源候論 --> , 33: 177b–178a. This book was superseded only by --> --> San yin ji yi bing yuan lun cui 三因極一病源論粹, ca. 1174.

  41. 41.

    For xulao see Zhu bing yuan hou lun, 3: 17a–4: 27b; xulao re, 3: 19b; xulao hanre, 3: 22b; xulao guzheng, 4: 23a–23b; xulao fanmen, 4: 23b; xulao ouni tuoxue and xulao ouxue, 4: 24a.

  42. 42.

    Zhu bing yuan hou lun, 24: 130a–134b.

  43. 43.

    Chang Che-chia--> 1998, 85–120. For the archives, see Chen Keji 1990.

  44. 44.

    See, for example, Grant 2003, chapter 3, and, on case records, Furth et al. 2007, especially part 2.

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    Nathan Sivin

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Sivin, N. (2015). The Question of Efficacy. In: Health Care in Eleventh-Century China. Archimedes, vol 43. Springer, Cham. https://doi.org/10.1007/978-3-319-20427-7_3

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