Foreword - by Volker Scheid

Chinese medicine in China is referred to as "Chinese medicine" (zhongyi). Transferred to the West it changes into "traditional Chinese medicine" (TCM). Whence this emphasis on tradition, we might ask. The immediate historical events surrounding this choice are easy to trace and take us to China in the 1950s. Charged with promoting their medicine also abroad once it had been declared a national treasure a group of Chinese translators felt this might more easily achieved if the adjective "traditional" was prefixed to the indigenous designation. The label was accepted - in the main uncritically - and proved to be a potent force in the promotion of Chinese medicine.

The more important second question is what this judicious assessment of Western sensibilities says about ourselves and our relation to Chinese medicine. I believe that the label "TCM" has been so successful because by offering a double negation it holds out a treble promise. TCM offers itself up be non-Western and non-modern at the same time but also, and that is the crucial point, as somehow universal and therefore more easily acquired by ourselves. What could be more appealing to Westerners searching for alternatives to their own way of running the world who do not, when all is said and done, want to give up their own identity?

In the long run, however, one cannot have one's cake and eat it. Just as the rest of the world needed to westernize in order to utilize Western biomedicine, we will only ever become meaningful participants of the Chinese medical community by becoming more Chinese. The first step in this direction would be to let go of the "T" in TCM, to consider it not as an asset but as a problem. And there are, indeed, many problems associated with being traditional.

Western critics of Chinese medicine, for instance, point out that unlike science, imagined as progressive and open to positive change, traditional knowledge is closed, impervious to critique and therefore, of necessity, inferior. Within the Chinese medicine community we face the problem of tradition in other ways. As we become more familiar with what we assumed to be one tradition, we discover that it is, in fact, made up of many different traditions, schools of thought, and lineages of transmission. How should we relate ourselves to this plurality? How do we know what is important and what is not, what to develop and from where to start?

But how to take this step considering that we have invested so much of our identity in the "T" in TCM? The best place, I suggest, is to accept that tradition is, in fact, a problem and not a solution, or more precisely a problematique. A problematique is what the sinologist and historian Benjamin Schwarz refers to as recurring issues in human history and culture. It is what the modern Chinese, drawing on Marx, Lenin and Mao Zedong, call a contradiction (maodun) and diagnose in every patient and situation. It is to apply the tools of our trade - yin and yang and the knowledge of ongoing transformation and an awareness of permanent change - not only to our patients but to ourselves and to what we do.

Chinese physicians themselves have long been aware of the problematique at the bottom of their tradition, the contradiction at the heart of their medicine. One the one hand, the medical classics were the foundation of all medical practice. On the other, the myriad manifestations of illness, newly emergent diseases, and the changing nature of humans and society forever seemed to go beyond what the classics had to offer. The manner in which physicians reacted to this probelmatique has been as varied and diverse as the illnesses and disorders they sought to cure. Some believed that the problem was insufficient understanding of the classics by moderns, others that it was the insufficiency of the classics in relation to the modern. Some argued for more scholarly discourse, others for the primacy of empiricism. Gradually, a number of rhetorical formulas emerged around which a medical community could define itself in spite of continued diversity of opinion on almost all concrete issues: "Study the ancients without getting stuck in the old" (shi gu er bu ni gu); or "Medicine is opinion/intention" (yi zhe yi ye).

I believe it is this shared orientation to commonly experienced problems rather than an insistence on specific ideas or techniques on which any living tradition (with a small "t") is founded. If for biomedicine this shared orientation implies getting rid of the old to make way for the new, for practitioners of Chinese medicine it has always meant to reinterpret the old so as to fit it more effectively to the contexts of our lives. This attitude is rooted in empiricism and sensitivity to the present as much as in scholarship and respect for the past. And it is this attitude that has for many centuries allowed for the development of tradition without the danger of ever losing it.

If we in the West wish to contribute to this process, to become a true part of the tradition we so visibly claim to represent, we need to accept that innovation and development, whether on the level of individual practice of Chinese medicine as a whole, must proceed from the ancients before it can leave them behind.

Elisa Rossi and Laura Caretto show us in exemplary fashion how this might be done. First, they restore time and plurality to tradition by providing us with detailed expositions about the development of disease concepts and therapeutic approaches drawn from a wide reading of classical sources. Unlike modern textbooks, who flatten this diversity by citing from these texts as if they had all been written at the same time by authors who all shared the same ideas, readers are thereby drawn into the problematiques of psycho-spiritual disorders viewed from the perspectives of Chinese medicine. They gain a profound understanding of the actual depth of our tradition but also of its debates and unresolved issues as different authors disagree with each other about fundamental points. We are thus forced to make up our own minds in order to decide what is best for our own patients.

Also clinically, Rossi provides guidance but do not press us into accepting their views. Treatment protocols and point selections are presented as hypotheses rather than as being set in stone or delivered to us from on up high. Drawing on their own clinical experience and that of others the authors draw readers into a process of reflection that requires of them ultimately to make their own choices.

Finally, once more most unusual in a contemporary Chinese medicine text, Rossi and Caretto provide space for other contemporary authors, specialists in their own fields, to supplement the main text through additional essays. Again, the reader is informed but not presented with a single and singular system of ideas.

"Shen" is therefore more than an acupuncture textbook or a clinical manual for the treatment of psycho-spiritual disorders. By relating their personal clinical experience to a profound engagement with the medical archive of Chinese medicine, the authors have created a model for how to develop Chinese medicine in the West. This is an important achievement.

Shen index