User:CWH/Paul Unschuld

Paul Ulrich Unschld (b. August 19, 1943 Lubań, Silesia, Germany) is a German sinologist and historian of medicine known for his scholarship on the history and practice of medicine in traditional China, his translations of historical texts, comparative studies, the ethics of medical practice in China and the West, and broader studies for the public. In 2006 he became founding Director, Horst-Goertz-Institute for the Theory, History, and Ethics of Chinese Life Sciences at Charité – Universitätsmedizin Berlin.

Unschuld joins those scholars who distinguish today's "Traditional Chinese Medicine" (TCM) from "medicine in traditional China". Unschuld explains that his goal is to understand Chinese medical practice and conceptions of health and disease in their historical contexts. What is called "Traditional Chinese Medicine" (TCM) is not thousands of years old, but was constructed in the late twentieth century using selected traditional terms. He disagrees with scholars and practitioners who focus on elements in traditional medical practice that seem to lead to a modern science instead of considering the full range of thought and practice. He respects Chinese medical practice as sophisticated and instructive, dismisses those who see it as little more than folk remedies or charlatanism and who attribute successes to the placebo effect, but does not see it as an alternative to the industrialized and chemicalized medicine that dominates medical practice in the West. Unschuld criticizes Chinese and Western popular books for selective use of evidence, choosing only those works or parts of works that seem to lead to modern medicine and ignoring those elements that are ineffective or dangerous.

Training and early career
Unschuld was born 19 August, 1943, in Lauban, Silesia, (then Luban, Poland). He began his studies at the Ludwig-Maximilians-Universitaet (Munich University) School of Pharmacy in the 1960s. Since he knew Russian, he decided that in order to understand both sides of the Sino-Soviet dispute, he needed to know Chinese, as well. Since it was not then possible to research medical care and pharmaceutical supplies in the People's Republic, he and his wife Ulrike went to Taiwan. There he was introduced to Chinese historical pharmaceutical literature and interviewed more than a hundred traditional physicians and pharmacists.

Unschuld's first academic position was in the United States, as assistant professor at the Department of Behavioral Sciences, Johns Hopkins University, with a joint appointment in the Department of International Health at the School of Hygiene and Public Health. In 2006 he became Director of the Research Institute for the History of Medicine at Ludwig-Maximilians-Universitaet. He became a Fellow at the Institute for Advanced Studies in Berlin 1998-1999 and was vice-president of the German-Chinese Medical Association 1984-2004. In 2008 he was elected President of the International Society for the History of East Asian Science, Technology and Medicine.

Fields of research and publication
Traditional China had no unified or dominant "Traditional Chinese Medicine" but a group of competing and changing theories and practices. Scholars and writers who differ in approach and findings generally agree that pre-modern forms of Chinese, Arab, Indian and so-called "Western medicine" had much in common. Before the emergence of scientific medicine and the development of biomedicine and germ theory of disease in the late 19th and early 20th century, each of these traditions had roughly equal power to diagnose, comfort, and heal. The medical anthropologist Charles Leslie writes that each of these traditional medicines was grounded in systems of correspondence that aligned human society, the universe, and the human body into an "all-embracing order of things". These systems provided, Leslie continued, a "comprehensive way of conceiving patterns that ran through all of nature" and "served as a classificatory and mnemonic device to observe health problems and to reflect upon, store, and recover empirical knowledge". They were also "subject to stultifying theoretical elaboration, self-deception, and dogmatism."

Medicine in traditional China
Unschuld's first major books in English were History of Chinese Medical Ideas (1985), History of Pharmaceutics (1986a), and Nan-Ching: The Classic of Difficult Issues (1986b). These initial translations CCCBBB

Unschuld first laid out general principles. In the Introduction to History of Medical Ideas, Unschuld explained how his approach differed from earlier work in the field of Chinese medical history. On the one hand were those, especially Joseph Needham, whose Science and Civilisation in China presented Chinese science and medicine as leading towards modern science and gave Taoism credit for major advances. Needham's work was transformative but had the drawback of searching out elements that could be deemed "scientific" and neglecting Confucian literati, Buddhists, and folk religious practices. On the other hand, Unschuld wrote, others, such as Manfred Porkert, saw Chinese medicine as a humanistic counter to modern Western medicine's reliance on technology. He suggested in a review of Porkert's Theoretical Foundations of Chinese Medicine, the the author "from time to time departs from his role as a historian of science and unnecessarily (but understandably) takes on the role as an advocate of the paradigms he so admirably describes." Nor is it true, Unschuld went on, that these paradigms underlie all Chinese medicine or that they are the therapeutic disciplines that supply today's China with its most common remedies.

In a 1988 review of the field, the historian of Chinese science Nathan Sivin praised these three volumes as "broadly conceived, perceptive, and original in important ways." He added, however, that, the 1985 History of Chinese Medical Ideas was "based on few primary sources, does not draw on much of the best scholarship, and is simplistic in analysis...." Sivin in 1990 called them "reconnaissances" and "remarkable for the originality of the questions that they raise and the breadth of disciplines that they bring to bear on them." Their usefulness, however, was "severely limited" by "patchy research and hurried thinking." The chapters about therapy in the History of Pharmaceutics volume were limited to the bencao literature, without using the larger body of prescription literature, and drew on sometimes unreliable secondary sources.

Sivin raises questions of theory and approach. One is that Unschuld's histories of thought and pharmacology volumes do not take up clinical efficacy, that is, whether a therapy works. Sivin conceded that many recent historians assume that a classical therapy works if there is an absence of evidence that it does not. Sivin argues that Unschuld is wrong to divide Chinese medical tradition into theory and practice; physicians, Sivin holds, went back and forth between the two, lookin for guiding principles that were shaped and shaped by practice. Sivin agreed that central concepts such as yin-yang and Five Phases were not defined objectively; sometimes they did describe observed bodily functions, at other times they were not defined by observation but by associations of words. But Sivin criticized Unschuld's dissatisfaction that these theories were not observational, since deducing from theory allowed practitioners to choose nearly any therapy that they liked. That is, Unschuld wanted theories to yield objective criteria that would predict how effective a treatment would be, but Sivin objected that the theories were not created for this purpose. Unschuld's own examples, Sivin points out, show that correspondence concepts grew from a combination of deduction from general principles and clinical induction.

Sivin also objects to Unschuld's overemphasis on social causation and reliance on abstractions such as Confucianism, Taoism, and Buddhism, which follows Joseph Needham's example of using broad terms in vague ways.

Unschuld disagrees with the common translation of the term qi as "energy," and instead uses "finest matter influence" or "influence." (Vol One p. 72) Sivin objects that in some situations "energy" can be as good a translation as any, and that more confusion is created by other translations, such as air, breath, vapor, spirit, material force, energy, matter-energy.

Joseph Needham, although Unschuld clearly stated his difference of approach with Needham in the book, praised it, with some qualifications.

Huangdi Neijing|Huang Di Nei Jing Su Wen
Unschuld and his colleagues produced a multi-volume study and translation of the Huang Di Nei Jing Su Wen, a title that they translate as "Huang Di's Inner Classic: Basic Questions". The work had been known as the earliest surviving text on Chinese medicine, but earlier translators had not understood the history and nature of the text. Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text (2003), the first of four volumes, presented the textual history and problems of origins, dating, and authorship. One reviewer wrote that "it is in every way a work that adheres to the principles of classical philology", that is, an "exquisitely detailed and exhaustively analysed point-for-point account of the seminal terms and concepts that make up the Huang Di Nei Jing Su Wen," adding that "in comprehensiveness and philological integrity there can be no match for this volume ...." The authors use generations of Chinese and Western scholarship to establish that the received text is MMM

Li Shizhen, Bencao Gangmu
Another major, multi-part study focused on Li Shizhen's 16th century encyclopedic compilation of roots and herbs, Bencao gangmu. One supportive but careful review XYZ

Handwritten texts of everyday practice
Unschuld developed an interest in relations between the classic medical theories and the everyday practice of healing among the common people. When he and his wife begn their studies in Taiwan in the 1970s, they collected handwritten medical manuscripts that showed family and itinerant healer practices that did not appear in elite medical writings, and when they later studied on the mainland they found them in abundance in local markets. They eventually collected more than 1,000 examples, a collection that Unschuld and his colleagues edited, published in 2013. He told an interviewer that he was struck by the difference between the practices in these documents and the theories in elite printed sources. These everyday documents show almost no use of yin-yang or five phases theory, which depend on correspondence theory, for instance, but do show hitherto unknown practices, such as devices to end pregnancies.

General studies
Medicine in China: Historical Artifacts and Images (2000), aimed at the public and non-specialists, combined photographs and illustrations with informative essays. Ruth Rogaski's review called it a "gorgeous volume" and especially welcomed the inclusion of high and folk traditions, magic, and popular religion, which helped explain the social context of healing, as well as more familiar literati textual traditions. The photographs of pill bottles each inscribed with the name of the apothecary, remind readers that medicine was a commercial activity.

The Preface of Traditional Chinese Medicine: Heritage and Adaptation (2018) explains it is a "concise summary of the history of medicine in China, its close connection with Chinese culture in general and with Chinese politics in particular," also showing the "departure of TCM from its historical origins."

Medical ethics
The problem of medical ethics has concerned Unschuld for decades. His Medical Ethics in Imperial China (1979), translated and enlarged from the 1975 German original, explored how Confucian dominated imperial China dealt with the problems created when professonal expertise gave power to elites while alienating the majority. The arguments he found in imperial China were relevant to current discussions in China and the United States.

Comparative medical systems
The medical anthropologist Charles Leslie sees a common set of challenges in understanding popular or "folk" medicine, as opposed to Biomedicine, also called modern, scientific, or Western medicine. Medicine Unschuld entered into a long-term scholarly discussion of what Western medicine could learn from other systems, in what respects they were comparable, and whether it should be granted equal status with modern biomedicine - as being based on scientific fact. the question is asked: Should Chinese medicine be subject to verification by the methods of Western biomedicine, and if so, which part(s) of Chinese medicine meet that standard?

''What Is Medicine? Western and Eastern Approaches to Healing'' (2009) distinguishes betweeen "healing", that is, cultural practices that promote wellness or well-being, and "medicine", which depends upon science and the laws of nature. He argues that a historical breakthrough from healing to medicine took place in both ancient China and ancient Greece in times when chaos in the political system led to a search for order. The breakthrough came from changes in society and politics. The historian of science Sir Geoffrey Lloyd, a specialist in ancient Greece, praised the book for recognizing the variety of traditions of healing in both civilizations, but felt that Unschuld's political explanation was too narrow. Lloyd said it was "highly controversial" to even see the notion of "laws of nature" as existing in antiquity, and therefor it was a "shortcoming" in Unschuld's argument to credit social and political notions of law and order with being the key stimulus for the emergence of similar ideas in medicine.

Chinese medicine in contemporary China and the West
Unsculd is clear on the "departure of TCM from its historical origins," but Donald Harper points out that Unschuld still presents Chinese medical practice as sophisticated and instructive. Unschuld criticizes both the Chinese government's recent promotion of selected historical Chinese health and medical practices in order to create global soft power and the Western mis-use and misunderstanding of TCM. Harper points to Unschuld's summary sentence that an "unbiased familiarity with the advantages of conventional medical approaches and with those elements of China’s historical medicine that are worth retaining will perhaps facilitate a new medical culture. In this, therapies would all be measured by their contributions to the well-being of patients and not by their enforcement of biased ideologies.” (141)

This academic approach, writes Ian Johnson, makes Unschuld "a difficult figure for China to embrace", for he has done little to advance the Chinese government’s agenda of promoting Traditional Chinese Medicine as soft power and he describes the state-subsidized translations of medical classics as “complete swindles”, done with little care, and with only a political goal in mind. When an interviewer asked about the efficacy of Chinese medicine and whether it should be covered by medical insurance, Unschuld replied that "If people want to try it, they should be free to do so, but not at taxpayer expense," adding that he himself has never tried it.

Responses and evaluations
Paul Buell wrote that Unschuld and Joseph Needham's took different but legitimate and well-established approaches. Needham is "comparative", examining China's past from the point of view of worldwide technological and scientific development, while Unschuld is "sinological", and looks at pharmaceutics "exhaustively in a Chinese context in exclusively Chinese terms." The advantage of Needham's comparatism is that it allows a quick evaluation of a Chinese topic, but it also has led to ethnocentric approaches by using Western rather than historical Chinese assumptions. Unschuld's sinological approach, Buell continues, "not only evaluates traditional China from a Chinese point of view but also offers a methodologically highly reliable product", that is, in choice and understanding of difficult texts, whose results can be used as "a firm basis for comparative purposes by others (the reverse is rarely the case)." The disadvantage is that a pure sinological approach can also result in "pedantic, obscure scholarship with meaning only to the few."

One practitioner criticized Unschuld, along with Joseph Needham and Ted Kaptchuk, for not seeing traditional Chinese medicine as effective. He wrote that Unschuld saw Chinese medicine as "magical" (rather than scientific) and, although he conceded that Unsculd does not use the word, as "pseudoscience".

Surveys and introductions

 * InternetArchive HERE; 25th Anniversary edition with a new preface; 2010 ISBN 9780520266131.
 * Internet Archive HERE
 * Internet Archive HERE
 * Internet Archive HERE

Edited translations



 * Zhang Zhibin and Paul U. Unschuld, eds., (2015) Dictionary of the Ben cao gang mu. Vol. 1, Chinese Historical Illness Terminology. Oakland: University of California Press. Pp. 764. $150.00 Hardback, ISBN 9780520283954.
 * Hua Linfu, Paul D. Buell, and Paul U. Unschuld, eds., (2017) Dictionary of the Ben cao gang mu. Vol. 2, Geographical and Administrative Designations. Oakland: University of California Press. Pp. 466. ISBN 9780520291966.
 * Zheng Jinsheng, Nalini Kirk, Paul D. Buell, and Paul U. Unschuld, eds., (2018) Dictionary of the Ben cao gang mu. Vol. 3, Persons and Literary Sources. Oakland: University of California Press. ISBN 9780520291973.

Articles, chapters, reviews

 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen
 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen
 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen
 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen
 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen
 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen
 * Excerpted introduction from the translation of the Huang Di nei Jing Suwen