Cultural Encounters in Medicine: (Re)Constituting Traditional Medicine in Taiwan under Colonization, Modernity, and Exchange

Hung-Yin Tsai

Dissertation submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of

Doctor of Philosophy In Science and Technology Studies

Saul E. Halfon, Chair Matthew R. Goodrum Bernice L. Hausman Rebecca Hester

July 13, 2021 Blacksburg, Virginia

Keywords: traditional medicine, medical modernity, colonization, medical resistance, cultural encounter

Copyright 2021, Hung-Yin Tsai

Cultural Encounters in Medicine: (Re)Constituting Traditional Medicine in Taiwan under Colonization, Modernity, and Exchange

Hung-Yin Tsai

ABSTRACT

Today we have many alternative medicines, not a few of which connect back to aboriginal cultures. Some of these alternative medicines were born under the influence of European imperialism, as they were not “alternative” until modern empires and modern medicine came to these distant regions. The present study begins with a broad question: how did conceptions of the relationship between modern Western medicine and traditional local non-Western medicine come to be? To explore the historical origins of these two conceptions, I focus herein on Japanese colonial Taiwan (1895–1945), where modern medicine became dominant while traditional medicine also flourished. My research finds that the historical realities of colonial Taiwan were not reflected in the progressive narrative of medicine. According to this narrative, modern medicine became dominant around the world while traditional medicines were swept into the ash heap of history because only modern medicine was the true, effective science of preventing, diagnosing, and treating physical ailments. The history of colonial Taiwan teaches us a much different lesson: practitioners of traditional medicine there were a significant part of the public health system during the colonial period. For example, they rallied against the plague in the late 19th century, diagnosing and treating patients when antibiotics had yet to be developed. Even so, the island witnessed an institutional medical shift, in which licensed practitioners of modern medicine deified modern medicine and denigrated traditional medicine, labeling the latter “primitive” and “non-medicine.” In response, practitioners of traditional medicine produced new narratives aiming to challenge this colonial boundary between medicine and non-medicine. These practitioners’ fundamental argument was that traditional medicine, though epistemologically different from modern medicine, was still legitimate medicine. From this effort, we now have the widely held belief today that both modern medicine and traditional medicine are legitimate, but distinct, medicines. This historical outcome of colonial resistance occurred worldwide. In my study, I identify the social, political, and colonial contexts of medical resistance in Japanese Taiwan, revealing their roots in issues related to inequality, distrust, economic affordability, and conceptions of body and health care.

Cultural Encounters in Medicine: (Re)Constituting Traditional Medicine in Taiwan under Colonization, Modernity, and Exchange

Hung-Yin Tsai

GENERAL AUDIENCE ABSTRACT

In this study, I explore conceptions of modern and traditional medicine through a historical lens, and break down two related myths: the first myth is the progressive narrative of modern medicine, which holds that modern medicine became dominant because of its medical superiority; and the second myth is the narrative held by extremist supporters of traditional medicine, who insist that only millennia-old traditional medicine can resolve human ailments without giving rise to untoward side effects and exorbitant costs. I show that, in the case of Japanese colonial Taiwan (1895–1945), both modern and traditional medicine flourished. The history of colonial Taiwan shows us that modern medicine on the island became dominant for two main reasons: first, the public health system successfully dealt with epidemics, which were the most significant threat to life at that time; and second, the colonial government recognized only modern medicine and labeled traditional medicine a non-medicine despite relying on its practitioners in the pre- antibiotic age. The history of colonial Taiwan also shows us that traditional medicine is not “old wisdom” unchanged for thousands of years. Beginning in the 19th century, practitioners of Taiwanese traditional medicine re-constituted it for colonial consumption, arguing that traditional medicine was also true medicine, though epistemologically distinct from modern medicine. This conception of traditional medicine has since informed many current views of traditional medicine. In 2018, the World Health Organization (WHO) published the eleventh revision of the International Classification of Diseases (ICD-11), which, for the first time, featured a chapter on traditional Chinese medicine covering such topics as diagnostic techniques for Qi, blood, and fluid disorders. This inclusion of traditional medicine into the ICD-11 is a major step forward in this process of medical integration and may help resolve the historical confrontation between modern and traditional medicine. However, the WHO decision limits recognition of traditional medicine to Chinese medicine, excluding all other kinds of traditional medicine. Thus, the historical question of whether or not traditional medicine is a true medicine remains ultimately unanswered.

Acknowledgements

Throughout the process of researching and developing this study, I have received a great deal of support.

I would like to thank my advisor, Saul Halfon, for both his intellectual guidance and his emotional encouragement during my research process. I also would like to thank my dissertation committee members, Matthew Goodrum, Bernice Hausman, and Rebecca Hester, for their expertise in helping me sharpen my analyses.

I am grateful to faculty who, though not on my committee, provided huge support in connecting me with diverse opportunities to develop my expertise: Ashely Shew, Jim Colliers, Gary Downey, Monique Dufour, Carol Olson, Phil Olson, and Helen Schneider.

I would like to acknowledge the Ministry of Education (Taiwan) for its Study Abroad Scholarship, which helped me start my journey as a researcher.

This study would not have been possible without the support of my partner, Shane Hu, who travelled with me across thousands of miles and attended to all the details of our everyday life when I buried myself in the archives. My parents also provided me with unconditional support, as I pursued my career far from where I was born.

Finally, I would like to thank all my friends and colleagues who helped me develop my thoughts and writing, often over coffee, snacks, chats, and other much-needed distractions: Kristen Koopman, Josh Earle, Kari Zacharias, KuanHung Lo, Bono Shih, Tarryn Wyllie, Seungmi Chung, and Damien Williams.

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Contents

Introduction ...... 1 Research Methods and the Analytical Lens ...... 4 The Diaspora of “Chinese” Medicine in Colonial Taiwan ...... 5 Going One Step Past “Alternative Modernity” ...... 8 Medicine and Culture ...... 9 Medical Resistance and Alternative Medicine ...... 10 Literature Review ...... 11 Chapter Overview ...... 14 Additional Note: Translations of Translations ...... 16 Chapter 1. When Traditional Medicine Met Colonizers: Licensing, Supervision, and Escape ...... 17 The Birth of a Non-Western Colonial Empire ...... 17 The Shift of Medicine in the Japanese Empire ...... 19 The Game-changing Black Death Outbreak ...... 20 Diagnosis and Treatment ...... 23 The Policy Shift in Traditional Medicine ...... 27 Local Healers and Practices Excluded from the Colonial Eyes ...... 30 Licensing Policy and Management ...... 32 Public Physicians’ Supervision of Local Doctors ...... 35 Han-medicine Education after the Colonial Government’s Implementation of Its Licensing Policy ...... 39 Conclusion ...... 40 Chapter 2. Translation between Medical Epistemologies ...... 41 The Intertwined Fields of Politics and Medicine in the Japanese Empire ...... 41 The Revival of Traditional Medicine in Both Colonial Taiwan and the Japanese Homeland ...... 42 Translation and the Re-“Japanizing” of Traditional Medicine ...... 45 The Epistemological Challenge of “Translating” Diseases ...... 46 The “Translation” of Cholera ...... 47 The Hidden Epistemological Conflicts between Traditional and Modern Medicine ...... 49 The Ontological Challenge of Finding the “Real” Causes of Diseases ...... 52 Re-Constructing Traditional Medicine by Placing It in Opposition to Biomedicine ...... 54

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Approaches to Experimental Therapeutics: Integrating Traditional Medicine into Modern Medicine through Clinical Trials ...... 56 Chapter 3. Uncovering the Traditional Sian-sinn-má Female Healers ...... 58 Introduction ...... 58 Materials and Archives ...... 59 Fact Checking the Colonial Taiwanese Narratives about Modern Birthing and Midwifery ...... 60 Witchcraft Medicine ...... 62 The Work of Traditional Female Healers ...... 65 Hygienic Modernity for Women but “Not My Midwife” ...... 67 Gendered Medicine ...... 70 The Economic Transformation behind Midwifery ...... 72 Chapter 4. The Transformation of Drugs and Pharmacies: Global and Local Trade Networks amidst the Changing Definitions of Drugs ...... 76 What Is Inside a Traditional Pharmacy ...... 77 Traditional Pharmacies as a Space for the Preservation of Traditional Medicine ...... 78 Traditional Pharmacies as a Space for Families and Workshops ...... 82 Traditional Pharmacies as Businesses ...... 84 The Market of Traditional Medicine and Stratification in Medicine ...... 86 The Reasons behind the Colonial Authority’s Tolerance of Traditional Pharmacies ...... 87 Seeking Health Care in the Era of Colonization ...... 89 Conclusion ...... 90 Chapter 5. Locating Traditional Medicine in Modern Places ...... 91 The Institutional Place of Traditional Medicine ...... 92 The Geographical Place of Traditional Medicine ...... 98 The Post-colonial Place of Traditional Medicine ...... 101 Places of Traditional Medicine, Complementary Medicine, and Alternative Medicine ...... 101 Conclusion ...... 102 Conclusion ...... 103 The Advantages and the Limits of the “Hidden Transcript” Approach ...... 104 Recommendations for Future Research ...... 105 Policy Implications ...... 106 Bibliography ...... 108 Primary Sources ...... 108 Secondary Sources ...... 110 Books and articles in Taiwanese/Chinese/Japanese ...... 110

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Books and articles in English ...... 115

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List of Tables

TABLE 1: THE STATISTICS OF PATIENTS ON DECEMBER 15, 1896 ...... 24 TABLE 2: THE SURVEY DATA OF LOCAL HEALERS, 1918 ...... 27 TABLE 3: SEVEN KEY SOCIO-ECONOMIC FACTORS IN COLONIAL TAIWAN’S TRANSITION FROM SIAN-SINN-MÁ TO MODERN MIDWIVES ...... 73

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List of Figures

FIGURE 1: A PAGE FROM THE CRKM UNIT ABOUT A DISCOURSE ON EPIDEMICS ...... 46 FIGURE 2: ADVERTISEMENT OF QIANYAUN 1932 ...... 77

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Introduction Today we have many alternative medicines, not a few of which connect back to aboriginal cultures. Some of these alternative medicines were born under the influence of European imperialism, as they were not “alternative” until modern empires and modern medicine came to these distant regions. The present study begins with a broad question: how did conceptions of the relationship between modern Western medicine and traditional local non-Western medicine come to be? One might simply assume that Western imperialism and Western modernization are the two fundamental answers to this question: after all, Western empires unremittingly imposed their political, economic, and techno-scientific power throughout the East and Africa during the modern era and especially during the 19th century. Regarding the field of medicine, for example, the West developed an epochal understanding of anatomy and germ theory while disposing of the faulty and antiquated views associated with humorism; and biomedicine-based public health systems successfully controlled outbreaks of infectious diseases, which were one of the biggest threats to human existence at that time. These and other successes of modern medicine meant that traditional medicine fell into disuse or, at best, became supplemental. This “progressive narrative” of medicine dominates most history books. When discussing medicine, many studies on the history of non-Western societies address only the modern medicine that Western empires introduced to colonies: this moment in history was the birth of legitimate medicine in the colonial societies.1 The progressive narrative also shapes our current healthcare system, which rests on biomedicine and pharmaceuticals. Thus, international organizations commit to bringing more cutting-edge medicine to developing countries, a process that is closely in keeping with the idea of the West’s civilizing influence on the non-Western world. This progressive narrative of medicine does not fully reflect reality, as traditional medicine has remained—and in many cases has become—a popular medical option. One might conclude that traditional medicine persists in its native lands because it has been highly politicalized: animosity toward colonizers and former colonizers has bred nationalism in colonies and former colonies. In short, traditional medicine has often been part of nation building. Take, for example, the Ayurvedic revival movement in India and the national medicine movement in China, both of which have designated traditional medicine a cultural and national symbol.2 Some arguments contend that former colonies,

1 For example, I consulted colonial Taiwanese archives related to healthcare and public health, and I quickly observed that the themes of all the documents fell under the category of modern medicine, even though practitioners of traditional medicine had participated in the healthcare and public-health system, as well. See Xiurong Zhang, Ri zhi tai wan yi liao gong wei wu shi nian xiu ding ban (日治臺灣醫療公衛五 十年) (2015). This exclusion of traditional medicine from official archives is by no means unique to colonial Taiwan: similar gaps have surfaced in colonial archives worldwide, including archives regarding African medicine, which many colonizers regarded as nonsensible, aside perhaps from a few herbs that were integrated into modern prescriptions. See, for example, HJ Burke-Gaffney, “The History of Medicine in the African Countries,” Medical History 12 no. 1 (1968): 31–41. The African example points to the fascinating sub-theme in which colonizers “abandoned diagnosis and only preserved drugs.” In Chapter 5, I explore this matter in relation to bioprospecting. 2 See Uma Ganeshan, “Medicine and Modernity: The Ayurvedic Revival Movement in India, 1885–1947,” Studies on Asia 4 no. 1 (2010): 108–131, which illustrates that the Ayurvedic revival movement provided

1 many of which are economically disadvantaged, rely on traditional medicine because they lack sufficient contemporary medical knowledge and resources.3 However, a curious trend has developed in recent decades: traditional non-Western medicine has become more and more popular in Western countries, which ironically enjoy an abundance of biomedical resources. In the United States, for instance, the market value of herbal medicine in 2020 was US$6.3 billion and is expected to reach US$8.5 billion by 2025.4 It is thus clear that traditional medicine is a competitive force in the contemporary world of medicine, and the reasons for this persistence are not solely political or economic. A popular recent argument is that traditional medicine is a perfectly legitimate field of treatment oppressed by imperialist supporters of Western medicine. This argument is not true. Nor is the argument that medical modernization has failed to improve human well-being. It is unquestionably the case that modern medicine and medical modernization have vastly improved our lives, with average life expectancy in many places increasing from about 40 years of age in the 19th century to between 50 and 85 years of age today.5 During these centuries, the meaning of medicine has been changing. Some people attribute the aforementioned improvements in well-being to public health systems rather than to modern medicine; however, this differentiation between public health and modern medicine is a contemporary one, as what we now recognize as modern medicine was the combination of public health and clinical medicine based on germ theory in the 19th and 20th centuries. Ironically, colonial medicine strengthened the emphasis on public health and equated it with modern medicine and indeed with civilization. The COVID-19 pandemic has slightly shifted the focus of modern medicine back to public health.6 The main takeaway from all these competing views is that the meaning of medicine changes historically, and my central aim in this study is to present some of these meanings and changes as they pertain to medicine at a particular historical moment. In my effort to explain how the relationship between modern medicine and traditional medicine has evolved, I go back to one of the birthplaces of the relationship: a colony where modern medicine was accepted and popular, but where traditional medicine also flourished. In this place, we can see what happened to traditional medicine when modern medicine sought to supplant its rival. In a place where modern medicine has

spaces for traditional medicine while also developing a scientific and modern identity; and see Sean Hsiang-lin Lei, Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity (Chicago: University of Chicago Press, 2014), which analyzes the birth of Chinese medicine, and which notes that Chinese medicine was not “Chinese” until this political and nationalist medicinal movement. 3 For example, the World Health Organization’s “Establishment of Pharmaceutical Production in Developing Countries: Report by the Director-General,” published in 1970, encouraged members to develop and manage traditional medicine as part of the solution to healthcare scarcity in various parts of the world. This same advice was offered in the 2013 WHO publication, WHO Traditional Medicine Strategy 2014–2023. 4 Grand View Research, “Herbal Supplements Market Size, Share & Trends Analysis Report 2018–2025” (Nov. 2018), https://www.grandviewresearch.com/industry-analysis/herbal-supplements-market. 5 WHO, “Life Expectancy at Birth,” https://www.who.int/data/gho/data/indicators/indicator- details/GHO/life-expectancy-at-birth-(years). 6 The definitions of ‘medicine’ and ‘disease’ change over time and vary from place to place. For a general overview of this pattern, see Kenneth F. Kiple, The Cambridge World History of Human Disease (Cambridge: Cambridge University Press, 1993).

2 become dominant, why and how did traditional medicine stay resilient? Why and how did traditional and modern medicine become co-existing concepts and practices in this place? This “place” is Taiwan, which is the focus of the current study. Taiwan is an East Asian island, historically known as Formosa. Japan and the Korean Peninsula are to its northeast, the Philippines to its south, and China to its north and west. Taiwan was a Japanese colony from 1895 to 1945, during which time the Japanese colonial government privileged biomedicine over traditional local medicine. During its fifty-year history, the colonial government constantly licensed and educated practitioners of modern medicine, but only once did the government license practitioners of traditional local medicine. Practitioners of modern medicine became elites who enjoyed economic advantages and the cultural legitimacy of medical modernity and civilization. Public health came to symbolize civilization and was gradually accepted by, among others, the growing legion of locally trained Taiwanese practitioners of modern medicine. Modern conceptions of public health became more and more acceptable, as colonial Taiwan rid itself of the plague in 1918 and of cholera in 1920.7 This success in public health reflected well on Japan’s consummate management of both the healthcare system and the colonial medicine in Taiwan. An important point to bear in mind is that modern medicine on the island was not solely for its Japanese residents. The colonial government encouraged Taiwanese to use modern medicine, and Taiwanese elites received modern medical training at the Taiwan Colonial Government Medical School. These elites became fixtures in the local political, economic, and cultural scenes, and some eventually led the local resistance to Japanese rule. Many prominent historical studies on medicine thus regard Japanese medical policy in colonial Taiwan as a success and regard traditional medicine there as a dying inferior tradition.8 Did modern medicine replace traditional local medicine in colonial Taiwan? For an answer to this question, consider some basic facts: there were 125 licensed practitioners of modern medicine and 1,434 licensed practitioners of traditional medicine in 1902, yet in 1940, there were 2,302 practitioners of modern medicine and only 133 practitioners of traditional medicine. These numbers and other evidence suggest that the replacement process was working. Other numbers, however, tell a different story. For example, the number of traditional pharmacies in colonial Taiwan grew from 173 in 1906 to 3,511 in 1922. This number later went down slightly, but there were still 2,130 traditional pharmacies in 1942. It is obvious that even though modern medicine became the official medicine of Taiwan, the business of traditional medicine was still active on the island. In addition, while the Japanese colonial government successfully controlled pandemics during this period by identifying and segregating patients and by improving the hygiene of environments, modern medicine was not able to cure such infectious diseases as plague, cholera, and syphilis. Only with the widespread advent of antibiotics in about 1945 were such cures possible. Under this circumstance, practitioners of traditional medicine actively participated in public health by making diagnoses and treating patients, a topic that I discuss further in Chapter 1. Taken together, this mishmash of statistics and other facts show that, in colonial Taiwan, traditional medicine co-existed with modern medicine—

7 Department of Health, Taiwan di qu gong gong wei sheng fa zhan shi (臺灣地區公共衛生發展史) (Taipei City: Department of Health, 1995). 8 Ming-cheng Miriam Lo, Doctors within Borders: Profession, Ethnicity, and Modernity in Colonial Taiwan. (Berkeley, CA: University of California Press, 2002).

3 modern medicine did not simply replace traditional medicine and monopolize the healthcare system. The dichotomy that emerged on the island thus helped establish the categories that we know today: contemporary Western biomedicine versus traditional alternative medicine. However, this dichotomy is problematic primarily because conceptions of each kind of medicine were frequently changing and were not always mutually exclusive: healers and patients integrated various categories of modern medicine and traditional medicine into each other. People have long regarded Western modernity as the “governing center” or the “master narrative” of modernity and thus as the “authentic” actor in recent history; by contrast, the non-Western experience of modernization has been a “hybrid” or an “alternative modernity.”9 This general conception of the world fails to reveal what kinds of modernity actually exist. For example, a statement such as “the goal of Chinese socialist modernization relied upon the discourse of [Western] scientific rationality and civilization” sheds no light on what kinds of “scientific rationality and civilization” were on the minds of Chinese socialists at the time.10 Nor can we know from this statement how and where these Chinese socialists learned about “scientific rationality and civilization.” My main point here is that the useful but distorting dichotomy between Western and non-Western histories re-produces itself while tending to hide the diversities within each historically unique dichotomy.

Research Methods and the Analytical Lens In this research, I will collect and analyze both official and unofficial archives, including government documents, town records, local newspapers, personal diaries, and memoirs. However, to track underrepresented medicine and healers, there are two main practical and moral issues: insufficient sources and possible misinterpretation of them. As practitioners of traditional medicine were hidden underground or not considered worthy to be recorded, very few of their practices were written in official archives. James Scott calls “hidden transcripts” those resistances that were neither heard nor recorded. This concept highlights the difficulty in uncovering local resistance from hidden transcripts. He suggests that it is good to notice “what fell outside its field of vision.”11 Following this suggestion, we can understand why half of the existing healers in a colonial Japanese survey of Taiwanese residents were categorized as “others.”12 These “others” were then ignored by the authority, and today it is hard to re-capture who they were. A possible solution to uncover these officially simplified “others” is unofficial sources, such as folk literature and diaries which represent the society outside of government records. Local newspapers also describe ordinary life and medicine, as was the case, for example, with an article criticizing the Japanese police for charging innocent herbalists with illegal

9 See Andrew Wachtel, Alternative Modernities (Duke University Press, 2001); and Margaret M. Lock and Vinh-Kim Nguyen, An Anthropology of Biomedicine (West Sussex: Wiley-Blackwell, 2010). 10 Nancy N. Chen, “Mapping Science and Nation in China,” in Asian Medicine and Globalization, ed. Joseph S. Alter (University of Pennsylvania Press, 2005), p. 108. 11 James C. Scott, Domination and the Arts of Resistance: Hidden Transcripts (New Haven: Yale University Press, 1990). 12 Anonymous, “Other: The Numbers of Local Taiwanese Doctors” (雜報：台灣土人醫生員數), Taiwan Medical Affairs Magazine (臺灣醫事雜誌) 2 (1899): 88.

4 preparation of local medicines.13 Through these sources, we can piece together a story of local practitioners during the colonial period. The other solution is to “reverse” the dominant vision. In other words, we can interpret the official, male-centric records from the opposite direction while referencing other materials. For example, during the Tang dynasty (618–907 AD) in China, there was a male officer who collected records of a treatment provided by a male monk helping a woman giving birth. In an unusual move, the father-in-law of this woman had invited the monk for help in the matter because the father-in-law’s wife and sister—the women who would have normally assisted in the delivery—had previously died from complications in their own deliveries. The monk believed that the pregnant woman needed a peaceful environment, so he asked her to give birth alone, and she successfully delivered a baby. The monk recorded this case to build his reputation, and the officer recorded the case to demonstrate the power of male healers. However, while this case was intended to promote male healers, it shows that giving birth at that time was usually a collective activity of women.14 This case is an example of reversing a dominant vision, and this interpretative approach can help to uncover stories about both illegal traditional medicine and female healers. The issue of misinterpretation is a serious concern. Can I as a researcher describing healers who were “quacksalvers” or “witches” represent their voices? Or will I misinterpret their lives and overstep boundaries? Chakravorty Spivak discusses Karl Marx’s concepts of “darstellung,” which refers to descriptions of people, and “vertretung,” which refers to speaking for people. She indicates that while subalterns are not able to speak, intellectuals might be too empathic and ambitious to speak for them. As she points out this concern, she suggests that researchers should pay attention to describing the structural conditions that prevent subalterns from speaking.15 In addition to the issue of representation between researcher and subjects, this concern might occur among subjects. In this study, it is also possible that the archives, which were written by colonial-era intellectuals, inappropriately represented folk healers. With this concern in mind, I cross-referenced the archives for accuracy.

The Diaspora of “Chinese” Medicine in Colonial Taiwan This study examines traditional medicine in colonial Taiwan because the island was, at the time, a nexus of geopolitics and knowledge production. Its political, cultural, economic, and medical encounters were frequent and even momentous, but have often been underrepresented by historians, who tend to focus on bigger actors, be they sprawling backwards nations (e.g., China), powerful Westernizing colonizers (e.g., Japan), figurehead leaders (e.g., Emperor Meiji), or prominent members of a national intelligentsia (e.g., Li Hongzhang and Ito Hirobumi). I, therefore, view colonial Taiwan not as a savage land settled by a colonizer who civilized it but as a frontier, a contact zone where important encounters happened.

13 Anonymous, “Strict Enforcement of Unqualified Doctors” (密醫的取締嚴厲), The Taiwan Minpao (臺 灣民報) 281 (October 6, 1929). 14 Zhende Li (李貞德), Nü Ren De Zhongguo Yi Liao Shi: Han Tang Zhi Jian De Jian Kang Zhao Gu Yu Xing Bie (女人的中國醫療史 : 漢唐之間的健康照顧與性別) (Taipei City: San min Shu Ju, 2008). 15 Gayatri Chakravorty Spivak, “Can the Subaltern Speak?” in Can the Subaltern Speak? Reflections on the History of an Idea, ed. Rosalind Morris (New York: Columbia University Press, 1988, 21–78).

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The concept of frontiers has been influential in American historiography. The “frontier thesis” argues that American development and political structures emerged from Americans’ westward expansion. At “the meeting point between savagery and civilization,” economic and political activities flourished, but were largely ignored by researchers.16 The frontier thesis radically shifts the historical focus from the center to the periphery, suggesting that the latter point in space shapes a country. Capitals and heartlands cede importance to outposts and hinterlands. Later historians inherited and modified this concept, asserting that frontiers are cultural contact zones where there “is a region in which no culture, group, or government can claim effective control or hegemony over another.”17 In the 1990s, this attention paid to frontiers helped shape Asian historiography, including New Qing History, which overturned the hackneyed theme that the ruling non-Han minority in Qing China had rapidly assimilated to Chinese, or Han, civilization. New Qing History asserts that the frontiers of Qing China explain a great deal about the Qing empire.18 Following these insights, I have set out in my current research to explore colonial Taiwan neither as a dully civilizing periphery nor as a barbarous center, but as a vibrant frontier—a host to powerful, world-shaping cultural, medical, political, and economic encounters. Taiwan was a geopolitical frontier, a trading hub between East Asia and Southeast Asia, attracting many visitors. In the 17th century, the Dutch East India Company and Spanish rulers established coastal trading posts around the world. Taiwan was one of their trading bases. Later in the 17th century, the maritime Zheng regime, which was a former pirate and business group active in southeastern Asia, occupied Taiwan and used it as a base of operations against the Qing rulers of mainland China. This brief though momentous event further integrated Taiwan into a vast international maritime trade network. Rather quickly, the Zheng regime fell to the Qing Empire, which in turn ceded Taiwan to Japan in 1895. These many changes in Taiwan resulted in a dynamic political, economic, and cultural landscape that gave the island considerable potential to influence relationships between neighboring parts of Asia. Tani Barlow has weighed in on this matter, criticizing scholarship that has treated East Asia as a “homogeneous, social- cultural totality” in which there are only three somewhat distinct entities: China, Korea, and Japan.19 Taiwan is evidence that this simplistic view of East Asia has hidden many previously overlooked geopolitical dynamics within the conventional trio of East Asian states. In addition to being a geopolitical frontier, Taiwan was a frontier of knowledge production. Most studies examining the production of knowledge focus on well-known

16 Frederick Jackson Turner, The Frontier in American History (New York: H. Holt and Company, 1920), 3. 17 Gregory H. Nobles, American Frontiers: Cultural Encounters and Continental Conquest (New York: Hill & Wang, 1997), xii. 18 Mark Elliott, “Frontier Stories: Periphery as Center in Qing History,” Frontiers of History in China 9 no. 3 (2014): 336–360. A controversial assertion is whether or not the “New Qing History” constitutes a school of thought. New Qing History has also triggered a political debate, as some historians in China consider this Western approach to be biased against Chinese civilization. I take these arguments seriously but regard New Qing History as resting on a historiographical approach that is independent of these controversies and that owes its origins to the frontier thesis. 19 Tani E. Barlow, Formations of Colonial Modernity in East Asia (Duke University Press, 1997), 1.

6 scientists and their affiliated organizations, such as the Royal Society in London. 20 However, new fields of knowledge often open up on the frontiers of a state. The tropical medicine that emerged in 19th-century Great Britain was possible only because the empire had “discovered” new territories, colonized them, and, in trying to manage them, realized the need for a pharmaceutical way to treat tropical ailments.21 Like Great Britain, Japan felt the need to establish its own research institute devoted to tropical medicine, and this need arose primarily because Japan was struggling to manage its newly acquired tropical colony, Taiwan. However, not all medical knowledge production took place from the top down, as it did in the previous two examples of Great Britain and Japan. Some bottom-up knowledge production took place in colonial frontiers, and colonial Taiwan’s traditional medicine served in this role quite impressively. Starting in the 16th century, immigrants from mainland China exported their medical practices to Taiwan. We should note that the term ‘traditional Chinese medicine’ did not exist in Taiwan before or during Japanese colonization. In fact, not until the early 20th century did Chinese intellectuals and medical professionals, under the influence of modern medicine and imperialism, connect what later become known as ‘traditional Chinese medicine’ with nationalism and with the revivalist movement in China. Only then was the term born.22 Although these early Chinese immigrants comprised a majority of the population in colonial Taiwan, “traditional medicine” at this moment was more diverse than Han medicine, not only because there were at least 16 indigenous ethnic groups, each with its own medicines, but also because there were slightly different approaches within Han medicine. During Japan’s fifty-year colonization of Taiwan, the localized Chinese immigrants still mostly referred to the island’s traditional medicine as ‘Han medicine’ (with the term ‘Han’ referring to both the Han Dynasty and Han culture). This nomenclature illustrates the cultural affinity that many Taiwanese felt for ancient Chinese culture. The Han Dynasty was an ancient Chinese state from 202 BC to 220 AD. Even after its collapse, the dynasty remained a cultural symbol of China’s greatness. During the centuries that followed, Japan developed its own traditional medicine, Kampo, which was almost identical to Han medicine. This similarity makes sense insofar as Japan was part of the broader Sino-cultural sphere, which China dominated. From the perspective of Taiwan’s traditional medical practitioners, especially those trained in Japan, Han medicine and Kampo medicine were largely interchangeable with each other. The ambiguous demarcation lines between Han medicine, Kampo medicine, and Chinese medicine later helped shape Taiwan’s cultural and political identity, a topic that I will explore in greater detail later in this study. The usage of the term ‘Han medicine’ in this study involves two historiographical senses. One is the original sense that colonial Taiwanese people had of medicine at that time. In the present day, the Taiwanese people rarely use either the term ‘漢醫’ (Han medicine) or the similar term ‘漢方’ (Kampo), which now refers only to traditional

20 See Michael A. Peters and Tina Besley, “The Royal Society, the Making of ‘Science’, and the Social History of Truth” Educational Philosophy and Theory 51 no. 3 (2019): 227–232. 21 Douglas M. Haynes, Imperial Medicine: Patrick Manson and the Conquest of Tropical Disease (University of Pennsylvania Press, 2001). 22 Sean Hsiang-lin Lei, Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity (University of Chicago Press, 2014).

7 medicine in Japan. However, the term ‘Han medicine’ reflects Taiwan’s cultural affinity with mainland China and Taiwan’s political and cultural semi-cooperative, semi-resistant relationship with Japan during the colonial era. In this regard, colonial Taiwan was an active, productive frontier between China and Japan—neither of which fully controlled or assimilated Taiwan. This frontier status points to a specific characteristic of empires: frontiers are where cultural encounters happen.23 The second historiographical sense to the term ‘Han medicine’ concerns the fact that Han medicine was one of several kinds of local medicine in Taiwan. Han medicine was not the traditional medicine: it shared the island’s medical realm with other kinds of traditional medicine. It became, however, the only officially recognized traditional medicine on the island because of the politics of colonial medicine, which I analyze in Chapter 1. From this fact, we can see that the term ‘Han medicine’ is very useful in the present study, as it enables us to distinguish between the traditional local medicine that Japanese colonizers grudgingly accepted and the various other traditional local medicines that the Japanese colonizers excluded from their list of acceptable healing practices. The Japanese colonizers thus re-defined local medicine through their colonial eyes. In the following chapters, I will analyze how this colonial re-definition of medicine proceeded and what medical practices the colonizers excluded, even though the practices were no less local and no less traditional than Han medicine.

Going One Step Past “Alternative Modernity” In this study, I challenge an idea that we take for granted today: the dichotomy between Western colonizers and Eastern colonial subjects. One of my aims here is to show how imperial Japan, which can be thought of as a “non-Western” power, managed its colonies with Western biomedicine. In this sense, the aforementioned dichotomy breaks down somewhat. The Japanese colonizers believed that the only semi-legitimate local medicine in Taiwan was Han medicine, not the traditional medicine of the indigenous people in Taiwan. Han medicine had been imported to the island by southern Chinese immigrants starting in the 16th century. These circumstances constitute the unique historical backdrop against which we can conceptualize the respective roles of modern Western medicine and traditional local medicine in colonial Taiwan. Indigenous Taiwanese people have had their own unique medicines, apart from those associated with Han culture. As the early southern Chinese immigrants interacted with the island’s earlier indigenous populations, the healing practices of the two segments of the population mutually influenced each other. Indeed, we can use the plural ‘traditional medicines’ to refer to the several categories of local medicine in Taiwan. In addition to Han medicine, there was folk medicine that used locally grown herbs and family therapies, the origins of which remain lost to the passage of time. Witchcraft was yet another category of medicine in Taiwan. Some of these traditional medicines overlapped, others did not, and many patients sought medical care simultaneously from various schools of medicine. The main focus of this study is Taiwanese Han medicine. It was the most mainstream traditional medicine in Taiwan and had the greatest number of adherents in the native population. It overlapped with the folk and witchcraft medical practices

23 Sebastian Conrad, What Is Global History? (Princeton: Princeton University Press, 2016).

8 mentioned above, and this fact distinguishes Taiwanese Han medicine from a purist’s view of Han medicine, which associates it with both a reliance on Chinese classics and an exclusion of religious practices. In this study, I use the term ‘traditional medicine’ to identify Taiwanese Han medicine, which contained a smattering of all these elements, and I use the term ‘Han medicine’ to identify the scholarly, purist’s view of Han medicine. The concept of alternative modernity undercuts the dichotomy between the Western and the non-Western. This dichotomy assumes that the Western experience is a single internally coherent domain, radically distinct from non-Western experiences. On the surface, this dichotomy might appear to be true: for example, the 18th-century police systems in France and Great Britain were, both, responsible for sanitation. On closer inspection, however, we can see that the two systems differed from each other regarding sanitation-related policies and practices. Still, these differences are subtle and thus easily concealed or overlooked. When adhering to the dichotomy between West and non- Western topics, people often regard indigenous non-Western medicine as something exotic and as something other than European. Although traditional European healing practices constitute indigenous medicine, they rarely if ever surface in the dichotomy between Western medicine and non-Western medicine. A common assumption is that unique developments in non-Western science and medicine stem from unique historical and political factors such as a particular society’s colonization and modernization rather than from a general thirst for knowledge. These assumptions that the Western experience is relatively homogeneous and that non-Western experiences are heterogeneous parallel a common conception of medicine: modern medicine is standardized, whereas traditional or alternative medicines are individualized and diverse. The rationale for this argument is that modern medicine relies on scientific research, especially randomized clinical trials, whereas traditional medicine relies on unsystematic clinical intuition and experiences. In fact, until the 1990s, when evidence-based medicine became standardized, modern medicine had been quite localized, diverse, and reliant on intuition. It is interesting to consider the training and the practices adopted by physicians who worked at a time when unsystematic observation and adherence to medical authority were unencumbered by critical reviews of data and by reproducible studies. 24 When we ignore the historical reliance of Western modern medicine on unsystematic clinical experience and on diverse practices, we tend to assign these characteristics only to non-Western medicine, thereby distorting the true course of history.

Medicine and Culture Traditional medicine has come to symbolize the struggle of non-Western colonized peoples against their colonizers, whose modern medicine has come to symbolize violence against the victimized colonized peoples. Although we are quick to connect traditional Chinese medicine with China and Ayurveda with India, we tend to ignore the historical links between modern medicine and specific Western traditions. For example, early on,

24 Gordon Guyatt, John Cairns, David Churchill, Deborah Cook, Brian Haynes, Jack Hirsh, Jan Irvine, Mark Levine, Mitchell Levine, and Jim Nishikawa, “Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine,” The Journal of the American Medical Association 268 no. 17 (1992): 2420.

9 religious charities existed in the Christian West but not in China or India. In the 18th century, these Christian charities played significant roles in establishing medical institutions around the world and thus promoted the institutionalization of modern medicine. In this sense, European modern medicine owes a considerable debt to cultural support, even though today we think that missionary medicine existed only in Europe’s colonies or in developing countries. 25 Rarely, if at all, do people refer to modern medicine as European medicine or as Christian medicine. In reality, modern medicine is neither geographically nor culturally neutral.26 It is thus important to address the possible cultural dimensions of Western medicine and to avoid focusing only on its economic or colonial dimensions. A symmetrical analysis of Western medicine and non-Western medicine is informative in that it enables us to deconstruct the encounters between these two spheres of activity. On the other hand, when addressing the cultural dimensions of traditional medicine, we should note that the “embedded” cultural aspects of a specific kind of traditional medicine might stem not from the medicine’s natural historical status but from cultural dynamics, generally. Early in their development, nation states reclaimed and reinvented “traditional” medicines, while also emphasizing their traditional and local aspects. For example, in attributing the origins of acupuncture to Buddhism, some Indians have argued that acupuncture is therefore an authentic discipline born in India. Interestingly, Chinese medical practitioners later claimed that acupuncture was originally a Chinese medical practice. Hence, competing claims about authenticity can lead to bitterly contested debates. By understanding how claims of authenticity have taken shape, we can understand how conceptions of non-Western medicines have taken shape.27 Of course, this same analytical approach is applicable to Western science and medicine. Many studies illustrate the cultural and political elements hidden in Western science and medicine. These elements range from the religious and the nationalist to the colonial and the racist. In conducting these analyses, we should indicate in what sense a kind of knowledge became “Western,” just as we would indicate in what sense acupuncture became “Indian” or “Eastern.” At some historical moments, “Western” medical practices may have been identified as local—though not traditional—medical practices because the practitioners were non-Westerners; that is, “natives.” Japan, once it Westernized, regarded its Western science and medicine as Japanese. Thus, whether something is “local” or “Western” depends on much more than just a clear-cut outline of verifiable events or a clear-cut lexicon of objective terms.

Medical Resistance and Alternative Medicine Not only has traditional medicine come to represent anti-colonial practices, but also skeptics of biomedicine have come to embrace traditional medicine as a major component of their anti-science agenda. In the eyes of skeptics, traditional herbal

25 Lindsay Patricia Granshaw and Roy Porter, The Hospital in History (New York; London: Routledge, 1989). 26 Scholars have identified the hugely influential cultural foundations with which the modern West imbued modern science and medicine. See Michael Adas, Machines as the Measure of Men: Science, Technology, and Ideologies of Western Dominance (New York: Cornell University Press, 1990); and Adele E. Clarke, Disciplining Reproduction: Modernity, American Life Sciences, and the Problems of Sex (California: University of California Press, 1998). 27 Nancy N. Chen, “Mapping Science.”

10 medicines are superior to vaccines and other pharmaceuticals. The interactions between capitalist-driven contemporary pharmaceuticals and community-driven traditional remedies constitute a zero-sum game. Not a few of these skeptics hold the belief that traditional medicine harbors “ancient wisdom,” which has lasted thousands of years without suffering any change.28 In the present study, I argue that, though there were indeed political and economic motivations behind modern medicine, traditional medicine is no immortal elixir: for centuries prior to the age of colonial empire, traditional medicine had been changing, and it was still changing at the colonial moment. In the present study, I return to this colonial moment to uncover the turning point at which a medicine became “alternative” in its cultural encounter with modern medicine in Japanese colonial Taiwan. I do not examine whether traditional medicine was effective or not. Rather, I examine why and how people believed that certain medical knowledge and practices were effective, and why people refused or hesitated to accept other kinds of medicine. Of special importance in my analysis is the historical process by which the practitioners of modern and traditional medicine, as well as patients, came to regard traditional and modern medicine as independent and coherent categories of practices.

Literature Review In the previous sections, I have discussed some of the most influential analyses of medical modernization, alternative modernity, and medicine and culture, insofar as these subjects are relevant to my current study. My aim is to give context to my analytical perspectives. Thus, I further discuss certain tensions and challenges that characterize the dichotomy between the West and the non-West—tensions and challenges that I have faced in framing my research and my contribution to these challenges.

The Tension within Modernity Science and technology were institutionalized in Europe and shaped governance and capital accumulation, which influenced the development of science and technology in turn between the 17th and 19th centuries.29 In modern states, science and technology produce information for policy making while also claiming their independence from politics.30 Thus, even though science and technology have been intertwined with politics, it is commonly believed that there is a dichotomy in which science concerns nature, and politics and society concern humans. Modernity, which is rooted in the idea that science and technology promote all aspects of human lives, emerged from Europe in the 17th century and, since the 19th century, has been presumed to be universal.31 Under this belief, science and technology are taken as the moral and political agendas for development, especially manifest in developing countries today. Here, science serves political purposes; science and the states

28 The current “big pharma conspiracy” argues that pharmaceutical companies hide “natural” cures from the public in order to profit from expensive pharmaceutical treatments. See Joe Schwarcz, “The Cancer Conspiracy Unveiled” Office for Science and Society (May 20, 2017). 29 Patrick Carroll, Science, Culture, and Modern State Formation (Berkeley, CA: University of California press, 2006). 30 Thomas F. Gieryn, “Boundary-Work and the Demarcation of Science from Non-Science: Strains and Interests in Professional Ideologies of Scientists,” American Sociological Review 48 no. 6 (1983): 781–95. 31 Arturo Escobar, Encountering Development: The Making and Unmaking of the Third World (Princeton, NJ: Princeton University Press, 1995).

11 together advocate developmentalism and modernity, when modernity ironically argues for the separation between politics and science. Sheila Jasanoff thus proposes the frame of “co-production” to indicate the inseparability of science from society. She argues that “science and society…are co- produced, each underwriting the other’s existence.” This idea of “co-production” is linked to an avoidance of scientific or cultural determinism. 32 However, Jasanoff’s review of Bruno Latour’s discussion of modernity addresses only the idea of translation and does not mention the concepts of modern constitution or purification. The concept of constitution describes modernity as having two contradictory but symbiotic parts: translation, which creates hybrids of nature and culture, and purification, which distinguishes human beings from nonhuman beings, such as societies and states, science and technology.33 Latour uses the concept of constitution to suggest that modern Western people regard modernity as a superior law so that they can differentiate nature and science from culture and society, but science and society remain united under modernity, just as synergistic but separate powers remain united under the constitution of a state. The exclusion of modernity and purification from the co-production framework makes it useful for analyzing the dynamics within such entities as governments and states, but not well-applicable to some non-Western circumstances. Indeed, modernity may not be universal, as Jasanoff points out. Nevertheless, when studying a latecomer to modernity, we should notice purification in addition to co-produced hybrids because there might be other fields of translation or purification where these latecomers adapted or resisted scientific or political intervention. For example, in developing countries, science and technology drive the action plan to fight hunger. Here, science and policy explicitly co-produce each other, so people in Latin America do not have the kind of science that is only about nature. Purification, however, occurs in those “advanced” places, like research institutions in the United States, where “independent research” is conducted and then applied to Latin America. 34 A comprehensive picture of Latin America includes purification in developed countries, the hybridity of which is a translation from science to international aid, and the hybridity of which is the science against hunger. The idea of “co-production” focuses our attention on the latter two types of hybridity, but does not address the practices of purification. In fact, for latecomers, science and technology are not expected to be free from politics, and questions surrounding this issue are always similar: How might our country adapt and use modern science and technology from the West? How do we avoid the existing unwanted Western effects of science and technology? For colonial empires and colonies, the questions go further: How can we adapt or refuse Western development models to become a modern state quickly and effectively? Can doing so enable us to resist white imperialism? Among these questions, purification is more like a strategy for becoming Western than a conception of the world. For latecomers, modernity is not a constitution but an action plan for formulating the constitution. To explore a late-comer to modernity, it is important to identify an action plan. Thus, in my research, I demonstrate this action plan and see how actors identified, adapted, and re-constituted

32 Sheila Jasanoff, States of Knowledge: The Co-Production of Science and Social Order (London: Routled ge, 2004). 33 Bruno Latour, We Have Never Been Modern (Cambridge, MA: Harvard University Press, 1993). 34 Escobar Encountering Development.

12 medicine to create purification or hybridization (co-production) in the pursuit of modernity.

The Conceptual Shift of Colonial Medicine and Modernity Michael Worboys notes that the historical study of colonial medicine has occupied itself principally with imperial tropical medicine, which served as a tool of empire. He then argues that colonial medicine was more than a tool of purely wicked subjugation, as he explores missionary activity, modernization, and the welfare of indigenous people.35 Waltraud Ernst reviews the Fanonian approach to colonial medicine, which analyzes the “project of modernity and its inherent evils,” and criticizes this approach for omitting diversity within bipolar colonizers and colonized. She also argues that the Foucauldian approach has a similar problem in addressing the complexity of history, as the Foucauldian approach generalizes colonial power. This is evident in the extent to which the study of colonial medicine often focuses only on Western medicine. Although “indigenous medicine” arises as a conceptual solution to the aforementioned problems with these two approaches, marginalized healings took place outside privileged colonial medicine. Ernst further argues that we can go beyond the idea of indigenous medicine and move forward toward a more inclusive idea of the social history of medicine—one that permits historians to reconstruct the life experiences of people without assuming any category.36 Indeed, as Ernst argues, modernity has been a crucial concept, but there could be a more inclusive perspective free from the assumptions of modernity. One of my central topics takes this perspective and applies the question “What is people’s idea of medicine and health care?” to colonial-era people without assuming the presence of modernity. Nevertheless, I acknowledge that some classical stakeholders, such as colonizers and colonized, are still essential parts of the social history of indigenous medicine. Thus, I have chosen to be flexible while avoiding over- simplified views of modernity and medicine. To this extent, I have historicized both biomedicine and traditional medicine in ways that show the fluidity within and between them, especially on a global scale of knowledge transition.

The Challenges to and Solutions for “non-Western” Studies Historicizing traditional Han medicine is a way to break free from existing global hierarchies. Historical studies of non-Western medicine are usually put into the category of the non-West rather than just the category of medicine. As discussed previously, the non-West categorization reflects the political legacy of the colonial period, and often treats colonial medicine as a central topic of non-Western studies while ignoring the fact that imperial medicine was practiced in the motherlands of the colonizers.37 Indigenous medicine has thus established itself as something exotic, something that happened outside Europe and North America. Although traditional European healing practices fall under the category of indigenous medicine, scholars often ignored herbal medicines when

35 Michael Worboys, “The Colonial World as Mission and Mandate: Leprosy and Empire, 1900–1940,” Osiris 15 (2000): 207–218. 36 Waltraud Ernst, “Beyond East and West. From the History of Colonial Medicine to a Social History of Medicine(s) in South Asia,” Social History of Medicine 20 no. 3 (2007): 505–524. 37 David Arnold, Imperial Medicine and Indigenous Societies (Delhi: Oxford University Press, 1989).

13 considering the dichotomy between Western modern medicine and non-Western traditional medicine. Scholars from various backgrounds have criticized this dichotomy, proposed solutions to the colonial legacy, highlighted the fluidity of cultures, and critiqued common related myths.38 These solutions sometimes tilt toward opposite extremes, which over-emphasize the flexibility or diversity of cultures without providing details or frameworks for capturing both the homogeneity and the heterogeneity of West and non- West. Thus, these solutions often suffer from the same flaws that beset its own purpose. Also, these solutions pay little heed to science, technology, and medicine as cultural subjects. In the current study, I identify knowledge communication as specifically as possible, avoiding the general terms ‘Western medicine’ and ‘Eastern medicine’ when analyzing the origins of these conceptions. For example, Japan imported ideas about modern anatomy first from the Dutch in the 18th century, and imported further medical knowledge and public-health knowledge from Germany in the 19th century. “Western” medicine in the Japanese empire was mainly and specifically, in fact, German medicine. On the other hand, even though the dichotomy between the West and the non- West is problematic in both historical and contemporary analyses, we should revisit encounters that various people had with various types of medicine to see how stakeholders in the 19th and 20th centuries conceptualized and understood Western and Eastern medicine, a topic that I analyze in detail in Chapter 2.

Chapter Overview In addition to this introduction and the conclusion, the present study contains five chapters illustrating the encounters between biomedicine and traditional medicine in colonial Taiwan. The first chapter identifies—and explores the effects of—the colonial licensing and supervision system that Japan imposed on local Taiwanese healers. Japan was initially unwilling to legalize traditional medicine on the island. However, when a plague struck the island in 1896, just a year after Japan had colonized it, the colonial government agreed to work with local practitioners of traditional medicine to stop the current outbreak and future ones. The colonial government thus shifted away from a policy of ignoring traditional medicine to a policy of managing certain approved healers, with plans to let traditional medicine perish gradually. In 1901, the Japanese colonial government required that all practicing traditional healers obtain an official colonial license and submit to supervision from official colonial practitioners of modern medicine. However, the licensing exam was held only once, at the beginning of the colonial period. After the licensed practitioners passed away, traditional medicine essentially became illegal. Traditional medicine survived only when its practitioners concealed their activities in “herb” stores and in rural areas outside the purview of colonial authorities. Japan’s colonial licensing and monitoring policies nonetheless led to an institutional shift that subordinated traditional medicine to modern medicine in Taiwan.

38 See James Clifford, “The Others: Beyond the ‘Salvage’ Paradigm,” Third Text 3 no. 6 (1989): 73–78; Hubert J. M. Hermans and Harry J. G. Kempen, “Moving Cultures: The Perilous Problems of Cultural Dichotomies in a Globalizing Society,” American Psychologist 53 no. 10 (1998): 1111–20; and Stephen Shulman, “Challenging the Civic/Ethnic and West/East Dichotomies in the Study of Nationalism,” Comparative Political Studies 35 no. 5 (2002): 554–85.

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The second chapter analyzes the emerging re-constitutions of modern and traditional medicine, focusing on three central topics: the knowledge production undertaken by local Taiwanese and Japanese practitioners of traditional medicine, a political movement seeking to revive traditional medicine in colonial Taiwan, and efforts by both practitioners of traditional medicine and practitioners of modern medicine to integrate traditional medicine into modern medicine. Under the Japanese colonial medical policies that devalued traditional Han medicine, practitioners of traditional medicine in Japan as well as in Taiwan launched a series of efforts to produce new knowledge in accordance with modern medicine. The objective was to show that traditional medicine could successfully treat diseases. The practitioners, for example, tried to show a significant overlap between traditional medicine and modern medicine by comparing modern medicinal treatments of various diseases with the corresponding traditional treatments. Even though Taiwanese and Japanese practitioners of traditional medicine collaborated with each other in this effort, the plan was by no means free from politics: Japanese healers, who enjoyed hierarchical superiority over Taiwanese healers, pushed them to learn Japanese techniques yet rarely learned Taiwanese techniques. The third chapter focuses on a specific traditional female medical profession in Taiwan: sian-sinn-má. Previous studies have treated sian-sinn-má as traditional midwives tasked with childbirth and postpartum care, as well as with some general matters related to women’s health. However, my research shows that sian-sinn-má were not only midwives, but also obstetrician-gynecologists, pediatricians, and religious practitioners. In addition, although Japan blamed these sian-sinn-má for practicing “dirty and backward” midwifery, statistics concerning infant-mortality rates suggest a far more complicated story. The colonial Japanese government established institutions that trained physicians, nurses, and midwives who would replace these sian-sinn-má. Despite these suppressive efforts, the traditional female healers remained popular, especially in rural areas of the island. The fourth chapter explores traditional pharmacies and drug markets in Taiwan during the colonial period. Traditional pharmacies were not only business sites, but also production sites. As they became the main and often the only spaces for traditional medicine, some of the on-site pharmacists became the leaders and financial backers of a local revivalist movement supporting traditional medicine. My research shows that most materials for the traditional medicine were imported from China, but that some significant herbs came from Southeast Asia, North America and elsewhere. The businesses that dealt in this pharmaceutical trade were international operations. Their trade network is proof that, in contrast to a commonly held assumption, Taiwan’s traditional medicine was not purely local at the time. In addition, this chapter places a spotlight on the relationship between traditional medicine and Taiwanese markets, in which consumers protested prohibitively high drug prices and voiced various other concerns publicly. The fifth chapter connects the past with the present. More specifically, I analyze the contemporary global and local management of traditional medicine. When, in 2019, the World Health Organization (WHO) included traditional Chinese medicine in the International Classification of Diseases 11th Revision (ICD-11), some vocal critics of this decision described it as a surrender to quackery; other critics hailed the decision an act of medical liberation against the “medical hegemony” of modern medicine; and between

15 these two extremes were other critics who supported the integration but wanted to maintain boundaries between modern medicine and traditional medicine. These views reflect often incompatible ontologies of diseases, bodies, and treatments. Interestingly, the arguments about these strategies are not new, as they date back to the moment when traditional medicine encountered modern medicine in the 19th and 20th centuries.

Additional Note: Translations of Translations A common argument is that traditional and modern medicine are two mutually exclusive and incompatible epistemological systems. My research shows that much effort has been expended in translating between these two general categories of medicine. In the current project, I explore these translations: What challenges do these tasks face? What are the various non-literal, as well as literal, conceptions of bodies and diseases that translators use for medical terms? For example, while translators have translated the English word ‘lungs’ as the Chinese word ‘肺’ (fei or hì), in the context of modern medicine, ‘lungs’ refers only to a specific organ in the anatomical sense. In the context of traditional medicine in colonial Taiwan, the word ‘肺’ (fei or hì) sometimes also refers to the organ in a metaphysical sense, which conveys the idea of non-physical respiration-based energy. Translations also involve terms for diseases. For example, around the 19th century, Japanese physicians translated two synonyms—the English word ‘plague’ and the German word ‘pest’—as the Japanese term ‘ペスト’ (pe-su-to) in katakana characters and as the Japanese term ‘百斯篤’ in Kanji. Meanwhile, local newspapers in colonial Taiwan used the terms ‘黑疫’ (black plague), ‘黑死病’ (black death disease), and ‘鼠疫’ (mouse plague). For readability herein, and unless the context calls for something different, I use medical terms that are in current American usage. In addition to medical terms, I dealt with translations from the most popular spoken language in colonial Taiwan, Taiwanese Hokkien, which is distinct from current Mandarin Chinese. Some local Hokkien proverbs and proper nouns, including people’s names, were difficult for me to translate. For example, the Chinese characters for the name of an eminent Taiwanese man who practiced traditional medicine are ‘黃玉階’, but these characters stand for ‘N̂ g Gio̍ k-kai’ in Taiwanese Hokkien and for ‘Huang Yu-Jieh’ in Mandarin. When writing this study, I chose the formats that were most common in the literature and online. Some names thus are in Hokkien while others are in Mandarin. This approach to terminology will enable readers to easily cross-reference and find the original names in the literature and online for the purpose of further research.

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Chapter 1. When Traditional Medicine Met Colonizers: Licensing, Supervision, and Escape

In 1895, the very first year when the Japanese colonizers came to Taiwan, they planned to bestow upon the colony a high degree of civilization, including not only the world’s most advanced medical knowledge drawn from biology, anatomy, and germ theory, but also public-health policies and infrastructure based on this new medical knowledge. However, an outbreak of plague soon challenged this modernization agenda. During the outbreak, the colonial government launched a series of public-health policies, the most prominent of which concerned lockdowns, quarantines, segregation, and vaccinations. The policies triggered medical resistance for two main reasons: simmering political distrust between the Japanese authorities and the island’s native population, and the authorities’ inability to treat plague-infected patients successfully. To counter this growing distrust, the colonial government temporarily legalized traditional medicine and even went so far as to license some practitioners of traditional medicine. Although part of the colonizers’ battle against the pandemic, these practitioners of traditional medicine occupied an inferior status in the medical hierarchy. The colonial government clearly regarded traditional medicine as a local cultural artifact rather than as a legitimate branch of medicine. This policy constitutes a particularly salient colonial encounter between traditional medicine and modern medicine—one that marked, in the late 19th century, an early institutional shift from the former to the latter.

The Birth of a Non-Western Colonial Empire In the First Sino-Japanese War (1894–1895), the Japanese navy swiftly defeated the fleet of the Qing Empire (China), which had been regarded as the stronger of the two. The war precipitated a series of political revolutions within Qing China, and Japan became the first modern Asian colonial empire, as it secured its first colonial possession (Taiwan) and assumed substantial control over Korea.39 As a latecomer to modernization and colonization, Japan uniquely resisted “white imperialism” and, as an empire, had historical experiences that were notably different from those of Western empires. 40 Prominent Japanese politicians, intellectuals, and other social elites believed that the key to civilization was science, which included technology and medicine. Medical terms such as ‘measles’ and ‘infection’ became epistemological terms reflecting the power of natural

39 The West had not officially colonized Japan but had forced it to accept treaties with Western countries. For example, by the Convention of Kanagawa, signed in 1854, the United States required Tokugawa Japan to open the ports of Shimoda and Hakodate, and thus ended Japan’s 200 years of national seclusion. 40 See W. G. Beasley, Japanese Imperialism 1894–1945 (Oxford: Clarendon Press, 1994). An 1885 newspaper article asserted that Japan should “leave Asia behind,” which was then summarized in the expression ‘Datsu-A-Ron’ (脱亜論). This principle was a central agenda in Japan’s embrace of modernization and imperialism. The principle rests on a curious overlap of geographical, cultural, and modern imaginations. Thus, although Japan would always be Asian geographically, it could definitively distance itself from “backward Asia” and effectively embrace “modern Europe and America” by civilizing itself on the basis of Western models.

17 law and the inevitable process of civilization. A medical narrative common in the 1800s and early 1900s in Japan is exemplified by the following newspaper article, which dates from 1885: When China and Korea encountered measles [i.e., the inexorable spread of Western civilization], they violated the natural law of infection [i.e., they rejected the West’s civilizing influence]…. They currently offer no benefits to Japan…. Because we are geographically close to one another, Westerners often view our three countries as one and the same. The criticism that Westerners level at China and Korea is no different from the criticism leveled at Japan…. If Chinese and Koreans don’t know what science is, Westerners will conclude that Japan believes in [China’s] five elements, as well…. China and Korea have weakened our international relations…. It is a pity for our country…. Rather than wait for our neighboring countries to civilize themselves so that we can make Asia great together, we should join the West…. We should firmly reject the ways of our subversive neighbors in the East.41 For Japan, the legitimacy that the country acquired as an empire put it on an equal footing with Western powers. This equality derived mainly from the widely held view among many Japanese that their civilization, not their racial makeup, granted Japan an unmistakable superiority over other Asians: Japan was the one East Asian nation possessing a rigorous knowledge of natural law. Once Japan had acquired its first colony (Taiwan), the task of passing this knowledge on to other East Asians became an essential part of Japan’s civilizing agenda. A central aspect of this knowledge was medicine, as exemplified by an article published in a Japanese newspaper article in 1895: Dr. Hamano…accompanied the colonial governor to Taiwan because it remains a wild, significantly underdeveloped location, riddled with serious local diseases. Physicians can protect our civil officials and, indeed, the local people in our new territory…. After all, the mission of a physician is to protect others; moreover, the people of Taiwan are also our empire’s people now…. We export civilization to them by saving and caring for them…just as Europeans civilize barbarians by introducing them to religion and medicine…. So in addition to politics, an empire’s colonization of a new territory must institute a system of medicine there. There are no proper physicians in China or in Taiwan…we will give them access to our civilized medicine so that they can learn about treatments beyond herbs and roots…. In turn, these people will gravitate to our ways and will pledge allegiance to us…. Medicine is of universal importance for people, regardless of their class or sex…the power [of medicine] can extend widely…[and thus] we…are planning to establish at least three hospitals in Taiwan.42

41 The quote is from “Leave Asia Behind,” a newspaper article written by an anonymous author who is commonly believed to be Fukuzawa Yukichi (福澤 諭吉), one of the most influential advocates of modernization reform in 19th-century Japan. The central idea in the article is that Japan needed to sever its ties with the rest of East Asia, specifically with China, which had long been a cultural model for Japan. See Urs Matthias Zachmann, “Blowing Up a Double Portrait in Black and White: The Concept of Asia in the Writings of Fukuzawa Yukichi and Okakura Tenshin,” East Asia Cultures Critique 15 no. 2 (2007): 345– 68. 42 Anonymous, “Dr. Hamano Went to Taiwan,” Domestic and International Medical News 366 (June 20, 1895).

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The Shift of Medicine in the Japanese Empire Under Japan’s modernization agenda, traditional medicine was a symbol of uncivilization that had to be abandoned, and Japan did indeed abandon its traditional medicine in the 19th century. Developed from Chinese Han medicine and imported to Japan via Korea in the 5th century, Kampo was Japan’s officially recognized traditional medicine before 1883. But as part of the Meiji Restoration starting that year, the Japanese government turned from Kampo to modern biomedicine in order to promote medical Westernization and to terminate Japan’s cultural connections with China.43 Implemented in 1884, “The Regulation of Physician Licensing” (医師免許規則) in Japan required that practitioners of medicine pass a licensing exam or graduate from medical schools. As both the exams and the schools were based on biomedicine, only practitioners of biomedicine could be licensed and become legally operating doctors.44 This shift from Kampo to biomedicine explicitly connected the reform of the state with the modernization of medicine and, in so doing, formalized the co-production of politics and medicine in Japan.45 The narratives behind this shift, as the quotes above show, situated biomedicine in the realms of nature and universal civilization while relegating Kampo to the realm of ancestral culture. In May 1896, soon after Japan came to Taiwan, the Taiwan Colonial Government (臺灣總督府) promulgated “The Regulation of Medical Practice in Taiwan” (臺灣醫業 規則), which required all healers to be licensed. According to this regulation, “physicians cannot operate their business unless they have a license from the Department of Domestic Affairs (Japan) or from the Taiwan Colonial Government.”46 As an extension of “The Regulation of Physician Licensing in Japan,” “The Regulation of Medical Practice in Taiwan” acknowledged only biomedicine and thus constituted a very early colonial attempt to govern Taiwan according to biomedical principles, which themselves were seen to be rooted in the universality of Western civilization. However, in 1901, the colonial government announced “The Regulation of the Licensing of Taiwanese Doctors” (臺灣醫⽣免許規則), by which the government would officially recognize and license the island’s existing practitioners of Han medicine. Although Japan relegated Kampo medicine to the “ashes of pre-modern history” and implicitly expressed this assessment in the relevant licensing policy, government officials in 1901 suddenly performed an about-face in their prized colonial possession of

43 Even though today Kampo is identified as Japanese traditional medicine, it was not covered by the country’s national health insurance until 1967 and was not covered in formal medical education until 2001. See Yoshiharu Motoo, Takashi Seki, and Kiichiro Tsutani, “Traditional Japanese Medicine, Kampo: Its History and Current Status,” Chinese Journal of Integrative Medicine 17 no. 2 (Feb. 2011): 85, http://doi:10.1007/s11655-011-0653-y. Kampo shared with Han medicine several features, including medical classics, but had different emphases. 44 Yasuo Fujimoto (藤本保雄), ed., A comprehensive Collection of Great Japan’s Laws with Corrections and Supplements (大日本法律規則全書改正増補) (Kōbe: Ryūeido (柳影堂), 1884). 45 Sheila Jasanoff, States of Knowledge: The Co-Production of Science and Social Order (New York; London: Routledge, 2004). 46 The Taiwan Colonial Government, “The Regulation of Medical Practice in Taiwan” (臺灣醫業規則) (1896).

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Taiwan, where the colonial government began to actively license and manage the practitioners of Han medicine. Why did the colonial government change its stance toward traditional medicine so abruptly?

The Game-changing Black Death Outbreak The Japanese government’s failures in its handling of the Black Death plague constituted the main reason they formally recognized Taiwanese practitioners of Han medicine. The outbreak of the plague came shortly after the Japanese had colonized the island. In the late summer and fall of 1896, people of Taiwan were hit by the plague, especially in Twatutia (大稻埕), which was the economic hub in the capital, Taipei. Japan soon mobilized police and public physicians to counter the outbreak, which was part of a global pandemic, known in some circles as the “third plague pandemic.” It lasted from 1855 to 1960. The 105-year pandemic, though it started in Asia, reached most of the world’s populations within just a few years.47 In Taiwan, Japanese police checked every household every day and searched for residents who looked like they had the plague. Upon finding a suspected case, the police would force the person into a quarantine hospital outfitted specifically for the plague. Among Taiwanese, these searches and detentions caused intense distrust of the Japanese government, as the actions were seen as unjustified violations of local families’ private space. The police exacerbated this distrust by sending people who simply “did not look good” to hospitals. Moreover, if a suspected case of plague was medically confirmed, the individual’s entire family would be quarantined.48 A local newspaper article, dating from late 1896, described the outbreak and the official response to it: Recently the Black Death [plague] has spread, causing many people to fall ill…day and night, police officers fearlessly enter civilians’ houses to check for cases of infection. If they find a suspected case, they force the individual to the hospital, where physicians perform intense treatments. Police allow patients who are cured to return home; as for patients who die of the plague, the police cremate the bodies—a practice that costs very little money…. Two police officers watch the homes of infected individuals’ immediate family: one officer guards the front door and the other officer guards the back door, ensuring that no one enters or

47 This pandemic triggered social conflicts not only in East Asia but also in the West. For example, in San Francisco, the first case emerged in 1900 and triggered a rise in anti-Chinese sentiment among Americans who believed that the disease had come from East Asian immigrants to the city. See John S. Marr, “When Germs Travel: Six Major Epidemics That Have Invaded America since 1900 and the Fears They Have Unleashed,” Medscape General Medicine 6 no. 4 (2004). 48 The quarantine time was initially 10 days but was soon reduced to 5–7 days. While there are limited archives describing the reasons for this change, two historical contexts should be highlighted. First, the colonial government loosened several of its public-health policies that had, as their target, the pandemic. This reduction in the strictness of anti-pandemic rules might have been a compromise with the reality of public resentment. If so, the Japanese colonial government would not admit this challenge, as it would have undercut Japan’s colonial legitimacy in the eyes of many around the world. Second, while Japan emphasized its superiority over neighboring countries regarding medicine, Japanese physicians knew little about the plague. For research on how both practitioners of biomedicine and practitioners of traditional medicine understood—and behaved in response to—this plague, see Ling-Yi Tsai, “Plague Control and the Inception of Modern Han Medicine in Early Colonial Taiwan, 1896–1901” (日治初期鼠疫防治與現代臺 灣漢醫的萌生), thesis (2020).

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exits the home for five days. For households where no infections have been recorded, the police and their teams clean the premises with plague-grade lime solutions…. Of all the local islanders, only those who are educated understand why these steps are being taken. Ignorant islanders have slandered law enforcement by labeling its household checks “assaults on the local people.” Further slanderous accusations have been made, including the assertions that physicians treat patients with harmful cold water, that cremations of corpses are profane, and that officers’ physical inspection of local residents is a violation of their rights.49 The actions outlined in the newspaper article above had one central aim: constrain the outbreak of the plague. However, the actions soon triggered local resistance because they not only disrupted the daily life of people on the island but also violated their traditional health practices. Another local newspaper article, this one dating from early 1897, reported on the extent of the distrust: Epidemics are worse than fires and flooding and have to be stopped…yet the civilians fail to grasp why police come to their homes. Thus, whole families are always clamoring about these intrusions. Indeed, many people who get sick with the plague would rather die than be found by the police.50 Given this pushback by locals, and despite strict enforcement of public health policies targeting the pandemic, the government failed to contain the outbreak and blamed local people for their ignorance of science and their evasion of police, Japanese physicians, household quarantines, and forced hospitalizations. In response to this distrust, a local business association of Twatutia submitted a petition to the Japanese colonial government, requesting that it authorize the establishment of a clinic, staffed entirely by local practitioners of Han medicine. The petition was successful: the colonial authority granted the petitioners permission to establish the clinic.51 As long as locals distrusted the colonial government, it had no chance of controlling the plague. Consequently, and quite reluctantly, the government worked with local social elites and practitioners of Han medicine. Starting in November 1896, the government announced a new policy: “The Regulation of the Plague Treatment Institution for Taiwanese People” (臺灣人黑死病治療所規則). According to this regulation, the director of the Treatment Institution, who was a Japanese physician, would focus on prevention and hygiene but would not intervene in local Han medical practices. At the institution, two local practitioners of Han medicine would see patients and manage prescriptions. The caretakers would also be locals and would take their instructions from the practitioners of Han medicine. The colony’s official budget would

49 Huang Jou in Twatutia (在大稻埕黃舟), “What I See in Quarantine Affairs” (檢疫所見), Taiwan New Newspaper, November 6, 1896. The police also checked households for opposition forces and bandits, according to “The Great Effort of Police,” Taiwan New Newspaper, January 20, 1897. At this time, the terms ‘black death’, ‘black epidemic’, and ‘plague’ were interchangeable and all commonly used. 50 “Must-know Information about the Quarantine” (檢疫須知), Taiwan New Newspaper, February 11, 1897. 51 “The Quarantine Hospital for Local People” (土人の避病院), Taiwan New Newspaper (Nov. 15 and Nov. 21, 1896).

21 cover all costs associated with this institution.52 The colonial government assigned a local practitioner of Han medicine—N̂ g, Gio̍ k-kai ( 黃⽟階)—to the position of medical contractor (醫務囑託), whose main role would be to work with the colonial government in the handling of the Treatment Institution.53 This policy change, along with others (e.g., the government’s decision to overturn the cremation-only policy and to authorize an isolated burial ground for plague victims), had the goal of placating the local population.54 These concessions, however, failed to instill local faith in the colonial government. Local Taiwanese people still actively evaded officials unless they were forced to go, because they thought the Treatment Institution of plague would kill patients. A local newspaper article from mid-1899 reported on this mindset: A barber…got seriously sick. When the police found that he had the plague, they took urgent action to clean his residence and workplace and to move him to the Treatment Institution. There, the practitioner of Han medicine N̂ g, Gio̍ k-kai suspected that the barber did not have the plague. The patient’s condition, nevertheless, was critical and he needed several days of treatment. When the barber entered the Institution, he thought he would die...a common belief was that the Institution would poison and kill the patients to stop the outbreak.55 Many local people evaded authorities for economic reasons. As the government issued lengthy quarantines for infected individuals and their contacts, people to whom these rules were applied would have to stop working. The absence of income, if even for only a few days, was of great concern to many islanders. This problem was addressed in an 1899 newspaper article: Yesterday, the police identified two infected individuals in a tea shop in Twatutia…one of them was not seriously ill and then escaped from a hospital…the other was transferred by police to a hospital but died on the way there…the tea shop has been closed for seven days…during this time, the tea shop was forbidden from doing any business…the police are still searching for the escaped patient.56

52 Taipei County Order A Class, No. 29, “The Regulation of the Plague Treatment Institution for Taiwanese People” (臺北縣縣令甲第二十九號臺灣人黑死病治療所規則), Archives of the Taiwanese Colonial Government (臺灣總督府檔案), November 16, 1896. 53 The Treatment Institution’s other assigned practitioner of Han medicine was Huang, ShouQian (黃守乾). While multiple news reports, including the official newspapers, such as Taiwan New Newspaper, confirmed that N̂ g, Gio̍ k-kai was a medical contractor at this time, no official document from the Colonial Government indicates that either N̂ g or Huang was a contractor able to provide services, including consultation, regarding medicine and healthcare. In fact, the extant documents of the colonial government indicate that it appointed no Taiwanese practitioners of Han medicine during this wave of the plague. 54 “Be a Moral Member of the Elite and Enjoy a Long Life” (仁壽同登), Taiwan New Newspaper, February 21, 1897. 55 “Turning Death into Life” (生死肉骨), Taiwan New Newspaper, May 12, 1899. 56 “Disease Escape” (疫病脫離), Taiwan New Newspaper, May 17, 1899.

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Even though the police tried to recruit local civilians as informants about possible plague victims in the community, accurate information was difficult to obtain. One news reporter in 1899 described the situation: The plague in Tiamsui is very bad…the police work hard to prevent the local Taiwanese people from following their traditions and from hiding plague victims. Indeed, the police announced that they would offer rewards of fifty yuan to members of the public who would give the police information about possible plague victims…two people came forward to report an aboriginal household harboring a plague patient, and each informant received fifty yuan…. However, when the police arrived at the house, the family had already…fled…the police were very angry and…hauled the two would-be informants off to jail.57 Once the plague temporarily ebbed in 1900, the Plague Treatment Institution closed its doors. Because the plague never actually disappeared during these years, a quarantine hospital, BiauAn Hospital (保安醫院) in Báng-kah (艋舺), accepted patients in 1901 during a relapse of the plague. 58 During these years, the island’s native population organized its own hospital: in 1899, the Tea Merchant Association in Twatutia funded the newly established Rejuvenation Clinic (回春所), which provided healthcare services to the area’s residents and migrant laborers, the latter of whom worked primarily in the tea industry. In 1901, the clinic grew into a medical institution, JiAn Hospital (濟 安醫院). The impetus behind the establishment of this Han-medicine hospital was the pronounced distrust between the island’s Japanese physicians and local people. As already noted, the Japanese acknowledged this distrust and attributed the government’s failures in plague management to the distrust, as well as to the Taiwanese people’s ignorance of modern medicine. When Japan sent a specific medical team to Taiwan to study the plague there, they wound up successfully culturing the germ that caused the plague. The team also uncovered data showing that the Japanese seemed to be more vulnerable to the plague than were the local people: the evidence supporting this conclusion was the higher incidence of plague deaths in the island’s Japanese population than in the local population. However, the conclusion was tempered by the team, which claimed that the data, being skewed, had led to an underestimation of the number of local deaths because many local people often buried the bodies of the recently deceased at night to escape the prying eyes of authorities.59

Diagnosis and Treatment Although scientists identified the cause of the plague in 1894, physicians in Taiwan at this time could accurately diagnose the disease only through visible symptoms in patients, not through laboratory tests. Because it was often difficult to determine whether a person was infected or not, a diagnosis could easily devolve into an

57 “Two People Punished” (甲乙受罰), Taiwan New Newspaper, April 11, 1899. 58 “The Situation of the Plague in Taiwan,” Domestic and International Medical News, September 5, 1901. 59 “About the Germ of the PEST Disease” (「ペスト」病病毒ニ就テ), Domestic and International Medical News (中外醫事新報), April 20, 1897, 415–430.

23 argument—sometimes aired in public—between practitioners of Japanese biomedicine and practitioners of Han medicine. In late 1896, a practitioner of Han medicine sent the following letter to the island’s official newspaper to describe his argument with a Japanese practitioner of biomedicine on a specific diagnosis case: On the 17th of this month,…a dealer in medicine, Yao…, came to…the clinic. I saw him at 10 a.m. the same day and diagnosed him with the plague…his symptoms were so bad that [I thought] he might not survive the night…a public physician, Akiwara,…also saw him but Akiwara diagnosed the patient’s illness as carbuncles instead of Black Death. We two could not agree with each other. The patient died at 10 p.m. that night, and the body had turned entirely black, so there could be no doubt that the patient had been suffering from the plague. I sent a note to Akiwara, requesting that he check the body to determine whether or not the ailment had indeed been the plague, but he refused the request.60 In addition to problems arising over diagnoses, treatments were often ineffectual because antibiotics capable of ridding a patient of the plague were not developed until the end of 1944. Records of infections in 1896 show that, even when patients received medical treatment, half of them passed away: 61

Table 1: The Statistics of Patients on December 15, 1896 ~Dec. 14, 1896 Males Females Total Cured 20 1 21 Died 61 9 70 Under Treatment 25 4 29 Total 106 14 120 Mortality Rate 57.55% 64.29% 58.33%

The many challenges posed by the plague created great difficulties for both the Japanese practitioners of biomedicine and the practitioners of Han medicine, the latter of whom had never before encountered an outbreak of the plague. The Japanese colonial government assembled a team of Japanese physicians and assigned them to the task of tracing the origins of the plague. This team interviewed many healers in Taiwan, including Taiwanese practitioners of traditional medicine and Western missionary physicians. According to the team’s report published in a local newspaper in early 1897, the island had never encountered this disease:

60 “A letter” (寄書), Taiwan New Newspaper, December 25, 1896. 61 “The statistics of patients” (患者統計), Taiwan New Newspaper, December 15, 1896. The number of female plague patients was much lower than the number of male plague patients, probably because local segregation based on the sexes made females less visible to police and to official medical practitioners than it made males. As for highly “visible” women, such as sex workers who were monitored by Japanese physicians, very few records exist with regard to the plague. Extant data indicate that the death rate for women was 90%, a figure much higher than the one for men (57.5%), suggesting that medical staff were primarily seeing those women who died of the plague and not the ones who survived the affliction. If this same phenomenon played out for men as well (though to a lesser extent than for women), the actual death rate for men was probably lower than the recorded death rate. As a result, this pandemic might not have been as deadly as the government thought.

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A local healer, Huang,…was a Qing medical officer and, thus, was a little bit more knowledgeable about the plague than a run-of-the-mill local healer would have been. Huang insists that the cause of this disease is dirty water and that no instances of the plague on the island were recorded until May or June of this year, when he treated about a dozen infected people.… A [British] practitioner of Western medicine, MacKay [says]…“I have lived on this island for years, and this year marks the very first time I’ve ever seen the plague here…I wonder whether it came from Hong Kong and Xiamen.62 A later installment of the newspaper explored this topic further: A local healer, Zhu...[says] there hadn’t been a mouse-borne disease in Taiwan until this year. Last year in Taiwan, there was an epidemic, but not like the current one, which results in a severe skin rash…Zhu heard that the mouse disease had come from Guangdong and then Xiamen…. A missionary by the name of Kao…was one of the very few Taiwanese who were knowledgeable about such natural sciences as chemistry, anatomy, physiology, pathology, and pharmacology…he insists that this disease did not rear its head on the island until this year…. A local healer, Mei, [says],…“the local people would throw away or burn a dead mouse…they had no idea that a dead mouse could harbor the plague. What the people did know was that dead mice release a highly unpleasant odor, which could be eliminated through immolation of their bodies…. People found very few dead mice before this year; this year, people have found many.63 One of the few practitioners of Han medicine who mastered the best available treatments of this disease was N̂ g, Gio̍ k-kai. He considered the plague to be similar to “hives epidemics” (疙瘩瘟), an established category of ailments in Han medicine. On the basis of this insight, he took a rather unique approach to prescribing treatments for the plague. In March 1899, a local newspaper reported on his innovative and successful treatments: N̂ g, Gio̍ k-kai is a practitioner of Han medicine in Twatutia. He commenced his medical training as a teenager, and is now over forty years old. He is experienced in medicine and his practice is a hard act for less seasoned healers to follow. Take the recent plague, for example: most healers use a combination of cold and warm medicine, but only N̂ g uses very strong and cold medicine, with which he has cured many patients. Furthermore, he prefers that payments for his services come not from patients…but from the [Japanese] government, which ideally will hear about his fine reputation and hire him…to treat patients in the [government’s] epidemiological clinic.64 Some Taiwanese practitioners of modern medicine recognized the successes of Han medicine, even though Japan had introduced biomedicine and public health to Taiwan several years earlier. In the 1920s, Tu Tsung-Ming (杜聰明), who held the distinction of being the first Taiwanese MD PhD trained in Japan, commented on his respect for traditional Chinese medicine:

62 “A survey of the origins of the plague” (ペスト病原調查), Taiwan New Newspaper, February 5, 1897. 63 “A survey of the origins of the plague” (ペスト病原調查), Taiwan New Newspaper, February 30, 1897. 64 “Medical education” (啟教醫術), Taiwan New Newspaper, March 5, 1899.

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I must confess that Han medical treatments can cure every cholera and plague patient, but a dignified, skilled practitioner of Western biomedicine can do nothing in this area—almost all of his patients will die. 65 Some members of Taiwan’s educated upper class, including those individuals who had knowledge of the West, also argued against biomedicine when it came to the issue of epidemics. Lí Tshun-Sing (李春生), an educated gentleman, international tea trader, and Christian who worked with the colonial government regarding local business and safety-management issues proposed a folk remedy for the plague. In fact, it was a time-honored family treatment that, though reflective of Han medical principles, was not a formal prescription in the canon of Han medicine. Lí contended that the remedy was rooted in local wisdom and was hence just like Han medicine. In late 1896, he sent a letter to a local newspaper to promote his folk remedy on humanitarian grounds: I used to practice this [remedy] to save my mother from the scourge of epidemics, which would trigger such symptoms as vomiting and diarrhea…. Thirty years ago my mother got sick…. I insisted that our family not only give her a strong alcoholic drink but also surround her with sources of heat…to make her feel very warm…. My mother soon recovered consciousness…. In Taipei, it seems as though mouse-borne diseases are everywhere…. I believe that urban patients also contract the same rash-type diseases [as described above]…but that the healers lack knowledge of my suggested treatment. Consequently, most patients die…. China is the oldest civilization in the world and has the most crowded population. This people dwells in the dirtiest, wettest places…but even though epidemics are worst in China, people there die less from epidemics than in Italy. Maybe the reason for this difference can be found outside conventional modern medicine.66 The cited comments above show that, from Li’s perspective, the plague could be simply handled by means of folk remedies and home-based care. Unlike Taiwanese doctors, Li was a local intellectual with no formal training in medicine. He prioritized selfcare over the advice of professionals. His comments also reveal his thoughts on the dichotomy between traditional Han medicine and modern Western medicine: while Li knew that Japanese physicians regarded biomedicine as a set of universal truths guiding public- health policy in Taiwan, Li believed that the wisdom of local Han medicine was vastly superior to Western medicine regarding the treatment of pandemic-related diseases. His comment about medical knowledge “outside conventional modern medicine” is clearly a reference to folk remedies, with an emphasis on both the natural environments and the lifestyles specific to Taiwan. These opinions showcase a classical Han perspective on the relationship between pandemics and traditional medicine: pandemics came from an imbalance between humans and their environments, not from germs, as the Japanese physicians argued. Li’s comments also constitute a political argument against the colonial government: in essence, Japan should step aside and permit the Taiwanese people to handle their own affairs, including the response to this outbreak, according to local ancient wisdom.

65 Tsung-Ming Tu (杜聰明), Memoirs (回憶錄) (Dr. Tu, Tsung-Ming Fellowship Foundation/ 杜聰明博士 獎學基金會, 1982). 66 Tshun-Sing Lí, “The trick of epidemics,” Taiwan New Newspaper, November 3, 1896.

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The Policy Shift in Traditional Medicine Facing the plague outbreak, the colonial government in Taiwan could not wish away just how counterproductive the local people’s distrust of the government was in relation to the medical response to the epidemic. The government acknowledged its need for cooperation from local healers, yet felt an equally strong need to manage the healers. In striving to achieve a balance between these two competing aims, the government drafted a survey, which rested on the premise that practitioners of Han medicine fall into five categories. By developing and issuing this survey, the colonizers tried their hand at codifying and controlling local medicine. Key takeaways from the survey data, as reported in a law-enforcement journal in 1918, are presented below. 67

Table 2: The Survey Data of Local Healers, 1918 Definition Number Outstanding People who have studied traditional medical classics well and 29 Doctors deeply understand traditional prescriptions. Confucian- People who are educated and have learned the classics of Han 91 educated medicine. Doctors Family-trained People who have learned about prescriptions from family members. 97 Doctors Informal People who have read a few classics of Han medicine and know 152 Doctors some prescriptions from doctors. Others People who have some relationship to medicine but fall under none 677 of the above categories.

When the colonial government conducted this survey, local healers were hesitant to respond. Perhaps one reason for this hesitancy was the healers’ concern that the survey would portray them as inadequately trained. Indeed, the survey required that respondents write down a description of their medical training. The following excerpt from a June 1901 article in a Taiwanese newspaper describes certain aspects of the survey and some local reactions to it: Yesterday…the head of the police…required local healers to report their names and addresses. Respondents who have received medical educations or who are family doctors must provide a detailed description of these matters. False or misleading statements will not be tolerated. The healers are reluctant to fill out the survey, as they remain confused as to its purpose.68 At the time this survey was conducted, the colonial government exercised rigid control only of the cities in Taiwan, not the towns, villages, and rural areas, so the numbers might not be perfectly accurate, but they still revealed the scenarios in major areas. Regarding practitioners of Han medicine, the survey reveals that the number of

67 Nama Numata (沼田生), “About the healing units on this island” (本島に於ける醫治機關), The Official Journal of the Taiwanese Police Association (臺灣警察協會雜誌), 18 (November 25, 1918): 23–27. 68 “Report on practitioners of medicine” (醫士呈報), Taiwan New Newspaper, June 13, 1901.

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Outstanding Doctors and Confucian-educated Doctors was surprisingly low.69 The huge number of “other” healers was also strange, as it suggested that the survey’s categories had failed to reflect existing patterns in the backgrounds of medical practitioners. Thus, the survey’s numbers constituted a somewhat useless simplification of the real-world- data about Taiwan’s traditional medical practitioners, since the colonial government still had to grapple with an enormous blind spot: a significant number of healers “outside its field of vision.”70 However, the survey was satisfactory from the colonial authorities’ perspective, as they now knew how many of the island’s healers were sufficiently acceptable for partnership with the government. Even though there is no way to identify these “others” today, we can identify several colonial values embedded in this survey, two of the most important being the preference for systematic, written medicine and the exclusion of spiritual medicine. First, the colonial government decided that, to qualify as a practitioner of Han medicine, an individual needed to have studied the written classics of Han medicine. The distinctions drawn between Outstanding Doctors, Confucian-educated Doctors, Family-trained Doctors, and Informal Doctors were all rooted in one central trait: the person’s level of literacy. This emphasis on literacy reveals the Japanese colonial presupposition that textual knowledge was a necessary basis for medical training. By coding and categorizing practitioners of local medicine, the Japanese colonial authority redefined local medicine. Before this colonial encounter, practitioners of local medicine ranged from those who had only practical clinical knowledge and those who had textual knowledge to those who had both. As this survey shows, Japan’s colonial idea that literacy was a necessary skill for truly rigorous healers ended up excluding most local doctors from this category. The Japanese empire thus began chipping away at local medicine and health markets by institutionalizing its own conception of medicine and medical professions in colonial Taiwan. During this imperial encounter with local medicine, a mismatch arose between the scholarly traditional local medicine recognized by the colonial government and the non- scholarly traditional local medicine commonly practiced among the local Taiwanese populations. This mismatch reflected the belief among Japanese practitioners of modern medicine that Kampo medicine was the same as the Han medicine practiced in colonial Taiwan: they were both “scholarly” medicines. However, the truth is that the Han medicine in colonial Taiwan was a complex mix of scholarly and non-scholarly medicine. Most practitioners of Kampo medicine in the Japanese empire came from families belonging to the samurai class—a social group of hereditary nobility who had served feudal lords before the Meiji Restoration in 1884. And most of these practitioners of Kampo medicine were educated intellectuals, literate in the Chinese writing system (kanji) and inheritors of their family medical practice. These Japanese doctors valued and

69 Right before the start of Japanese colonization in 1895, two northern cities, Taipei and Ke-lâng, had over 50,000 Taiwanese residents each. See Jihetai Jingchu (井出季和太), Tai wan zhi ji zhi (臺灣治績志) (Tai bei: Cheng wen, 1937). 70 James C. Scott, Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed (New Haven: Yale University Press, 1998), 12.

28 studied the accepted canons of medical literature. 71 Even when Japan shifted from Kampo to biomedicine in 1884, Japanese physicians remained well-versed in the old literature.72 Indeed, a common Japanese conception of a qualified healer was that the individual be learned in both traditional and modern text-based medicine. In Taiwan, exactly the opposite situation had taken hold: neither mastery of canonical text-based knowledge nor literacy was common, as many, if not most, local healers were either illiterate or poorly versed in canonical Han medicine. Among the recent Chinese immigrants to Taiwan, a healer’s mastery of canonical Han medicine symbolized the healer’s desirable social standing more than a set of necessary medical qualifications. Chinese culture’s coupling of scholarly medicine with class consciousness emerged in the 14th century in southern China, and the shift from a disregard for literacy to an emphasis on literacy in Confucian society turned Han medicine into a far more textual medical field than it had ever been before.73 And because Japan, like China, had come to prioritize literacy in the fields of medicine, during its colonization of Taiwan, the Japanese empire imposed its definition of qualified healers onto Taiwan. This practice was jarring for most Taiwanese healers, as they had remained insulated from the elitist mainland Chinese conception of canonical literacy-based medicine. Ultimately, the resulting mismatches led to problems in the Japanese empire’s “scientific management” principle, which was the theoretical basis for Japanese colonial rule. 74 This principle came from Gotō Shinpei, who was an accomplished Japanese politician, government official, and businessman: he oversaw Taiwanese civilian affairs under Japanese rule, became the first director of the South Manchuria Railway, held the mayoral seat in Tokyo City, and served as the first Director-General of the NHK (a Japanese public broadcasting company). He argued that the management of colonial Taiwan should be based on “biological principles” (生物学の原則), which, if studied, could clarify the different natures of people and places. To apply these principles rigorously, colonial rulers would have to accumulate survey data scientifically. However, despite widespread claims that the principle promoted objectivity and scientificity, the main function of the principle was to help Japan rule its colonies with strategic

71 Especially after the second half of the 17th century, Kampo medicine in Japan increasingly emphasized the desirability of a specific medical class that subscribed to Shanghan Lun (The Treatise on Cold Damage Disorders), under the influence of Confucian revivalism from China. This “classical school” of practitioners formulated the mainstream version of Kampo that exists today. The founder of this school, Nagoya Geni (名古屋玄医, 1628–1696), and his followers, such as Kagawa Shūtoku (香川修庵, 1683– 1755), were Confucian scholars who emphasized intellectualism and education based on Chinese-language literacy. See Senjuro Machi (町泉寿郎), “香川修庵の儒医一本の儒について.” 日本医史学雑誌 (Journal of the Japan Society of Medical History), 44 (1988): 49–71. 72 Shiyong Liu, Wu shi dao yu liu ye dao: ri ben xi yang yi xue de xing cheng yu kuo san (武士刀與柳葉刀 : 日本西洋醫學的形成與擴散) (Tai bei shi: Guo li tai wan da xue chu ban zhong xin, 2012). 73 For example, Chu, Hui-Ming (朱惠明, ca. 1590) argued that it is unethical for a doctor to practice medicine without knowing the principal texts on which the medicine, as a body of knowledge, rests. See Ping-Yi Chu, “Narrations of Histories of Medicine from the Song to the Ming and the Rise of the Confucian Physician,” Bulletin of the Institute of History and Philology Academia Sinica, 77 (2006): 401– 449. 74 Jen-to Yao, “Governing the Colonised: Governmentality in the Japanese Colonisation of Taiwan, 1895– 1945” (University of Essex, 2002).

29 efficiency.75 The principle’s lack of objectivity is evident in the aforementioned gap between the colonial government’s survey of local Taiwanese healers and the reality of those healers: the retrieved set of data, rather than clarify the reality of Taiwan’s community of healers, simply helped the colonizers reshape the colony according to their self-serving preferences.

Local Healers and Practices Excluded from the Colonial Eyes In colonial Taiwan, the government prevented practitioners of local folk medicine from identifying themselves as legitimate healers. Their potential mastery of the medicinal functions of specific local herbs was irrelevant; what was relevant was their lack of familiarity with Han medicine.76 The Japanese colonizers also rejected religious or spiritual medicine. For Japanese physicians, Han medicine was “witchcraft medicine” because “what they talked about was the mysterious, unobservable Yin and Yang, and the five elements.”77 It is worth noting that this conception of Han medicine was held by the colonial authority and by Japanese physicians, who regarded Han medicine as unrealistic and akin to witchcraft. Nevertheless, certain differences between Han medicine and witchcraft remained clear, both for the Japanese colonizers (especially the physicians) and the colonized local people: witchcraft, as a set of medical practices, usually involved a diverse group of practitioners relying heavily on rituals and locally grown herbs, whereas Han medicine involved mainly male practitioners who placed little emphasis on rituals and significant emphasis on imported medical materials, which I analyze in greater depth in Chapter 4. Despite this hostility toward religious healing, its rituals and prescriptions contributed to the fight against the plague. When the plague came, Taiwanese organized parades during which attendees would invite a god or goddess to fight against “the evil god of plagues” and to patrol neighborhoods in search of this malevolent deity. 78 Taiwanese would also request that shamans and local temples do everything in their power to stop the outbreak and to save dying patients. 79 Once the plague abated, Taiwanese held rituals and parades in honor of the gods’ assistance. One news reporter complained that “the people in Twatutia are suffering from the plague, yet have no

75 Yanqiu Fan, Xin yi xue zai tai wan di shi jian: cong hou teng xin ping de guo jia wei sheng yuan li tan qi (新醫學在台灣的實踐 : 從後藤新平的<<國家衛生原理>>談起) (Tai bei shi: Zhong yang yan jiu yuan li shi yu yan yan jiu suo, 1997). 76 Japanese colonizers marginalized Taiwanese folk medicine even more than Han medicine. This pattern of conduct showed up in fiction, such as the novel Mr. Snake, by the eminent poet and novelist Loa Ho. In the story, the protagonist is an uneducated but honest rural Taiwanese man who is reputed to have considerable knowledge about snake poisons and herbal antidotes, but a physician who is jealous of him reports his “illegal practices.” See Loa Ho, Taiwan Minpao (The Taiwan People’s Newspaper), Nos. 293, 295, 296, January 1930. 77 “The Current Status of the Plague in Taiwan” (臺灣に於ける「ベスト」病況), Domestic and International Medical News, 515 (September 5, 1901). 78 “Having Gods and Goddesses to Drive Away Epidemics” (賽神驅疫), Taiwan New Newspaper, April 12, 1899. 79 “Going to the Qing to Seek Treatment” (赴清求醫), Taiwan New Newspaper, June 17, 1899.

30 passion for cleaning and hygiene: they spend their time eagerly inviting gods to get rid of epidemics.80 On the other hand, some native Taiwanese wondered whether or not the plague was a punishment from the gods. One journalist of a local newspaper remarked, Chenghuang in Twatutia is an influential god for the people of Taipei. Every May 13, they hold a parade, entreating him to patrol their neighborhoods…but when the [Japanese] empire seized Taiwan, locals who had held these events in the past…left Taiwan and went to China…. Thus, no parades—and presumably no patrols—have taken place here for three years…last month the leaders of each city district convened a meeting where they considered whether or not this might be the reason for the plague.81 The priests and shamans who were the earthly agents of these gods were also healers serving the local people.82 A Japanese observer recorded his impression of the folk-healing practices of these religious practitioners: If you consider the old habits of native Taiwanese, you will be surprised by the powerful influence of priests: [if a problem arises], go to the priests; if babies are uncomfortable, go to the priests to strengthen the babies’ spirits; whatever the disease, just go to the priests. Local people ask, “Doesn’t the response to the medical crisis need not only human effort but also help from the gods?…. Why, after all, do people get sick?” A common belief has been that patients fall ill because they have done something wrong, whether intentionally or unintentionally, so they suffer punishment invoked by the gods. A priest can act as an intermediary between patients and gods, putting out offerings to repent and apologize on behalf of the patients.83 These religious practitioners, while spiritually comforting the local population, offered it medical prescriptions, when needed. In a Japanese journal article published in 1941, a Japanese-trained Taiwanese physician described his encounter with this kind of folk healing: A teenage boy and I had a chance to carry a sedan chair in commemoration of a particular god…but despite this lengthy effort, the god did not come to us…. The local priest acting as an intermediary between the people and the god said, “You two aren’t doing this right. Let someone else do it.” An illiterate textile worker took my position. Then the god came…stating, “These herbs are a kind of prescription. Take it and you will be fine.”84

80 “Discussions about the Situation of Recent Epidemics” (時疫閒談), Taiwan New Newspaper, exact date missing, 1897. 81 “The Reclusion of Chenghuang” (城隍幽居), Taiwan New Newspaper, May 24, 1897. 82 Fu-shih Lin, “Healers or Patients: The Shamans’ Roles and Images in Taiwan” (醫者或病人──童乩在 臺灣社會中的角色與形象), Bulletin of the Institute of History and Philology Academia Sinica (中央研究 院歷史語言研究所集刊) 76 no. 3 (2005): 511–568. 83 Baku Wada (和田漠), “Red-Headed Priests” (紅頭師公), Taiwanese Folkways (June 1942): 5–9. 84 Hurikoe Nishibayashi (西林振聲), “Superstitions Surrounding Diseases in Xiluo” (西螺地方關於疾病 的迷信), Taiwanese Folkways (September 5, 1941): 2–6.

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Sometimes local healers issued prescriptions by engaging in “prescription divination.” Local people would come to a temple in their community, accept a healer’s prescription, and then ask a god to confirm the legitimacy of the prescription. Usually composed of herbs, some of the prescriptions might have been simplified versions of classical prescriptions of Han medicine.85 While reluctantly granting Han medicine an official status in Taiwan, the colonial authority stood firm in its non-recognition of Taiwan’s shamanic medicine. If culture and medicine were two ends of a spectrum, for the government, biomedicine would be close to the “medicine” end of the spectrum whereas shamanic medicine would be close to the “culture” end, with Han medicine occupying a point somewhere in between, even though Japanese colonizers regarded both of these healing systems as superstition. Thus, no official colonial survey of local healing practices included a category for shamanic medicine. The Japanese colonial government either was ignorant of or paid little attention to many local healing practices. Thus, the aforementioned Japanese survey was in no way a comprehensive representation of local medicine in Taiwan. From all appearances, the survey was a specific method, adopted in earnest, to identify local healers who were sufficiently literate to have acquired written knowledge of Han medicine. In the end, the survey represented the Japanese colonial mission’s misreading of local Taiwanese medicine.86 In its quantification of the data, the colonial government spun together a story that purported to tell the “facts” about medicine in the colony, but that created a “colonial moment,” in which the empire—not the local people—defined what medicine was and who the healers were.87

Licensing Policy and Management For the Japanese authority, the only Taiwanese who could practice medicine were those who had received an impressive education. The Japanese authority, despite its conclusion that most local healers were sub-par,88 needed their cooperation to stop the outbreak of the plague, because, by and large, Taiwanese people trusted Han medicine much more than biomedicine. In the summer of 1901, the colonial government finally decided to recognize the practitioners of Han medicine through “The Regulation of the Licensing of Taiwanese Doctors.” This policy made a clear official distinction between practitioners of biomedicine and Han medicine by using different terms to refer to each group. The policy created a new license: it was exclusively for I-Sheng (醫生), or

85 See MeiZhi Yan and YiZhang Su, “Preliminary Literature Review of Traditional Chinese Medicine: An Example of Prescription Divination in Taiwan Temples,” Journal of Chinese Medicine, Special Edition 2 (2014): 275–293. 86 Zora Kovacic, “Conceptualizing Numbers at the Science–Policy Interface.” Science, Technology, & Human Values (2018). 87 Catherine Hall, “Histories, Empires, and the Post-Colonial Moment,” in The Postcolonial Question eds. Iain Chambers and Lidia Curti (Routledge, 2002), 74–86. 88 Tsugio Horiuchi (堀內次雄), “The Beginning of Public Health: Memories from the Initial Period of Japan’s Colonization of Taiwan” (臺灣衛生事始 - 領臺當時の思い出), Taiwanese Folkways (民俗臺灣) (November 1942): 22–24.

32 practitioners of Han medicine, rather than for I-Shi ( 醫師), or practitioners of biomedicine.89 Below are several key clauses in the regulation: First: Doctors are those who obtain a license from the local administration by means of this regulation and who practice medicine under the supervision of the local administration. Second: One who has met the conditions below and would like to be licensed should submit a résumé to the local administration. a: All applicants must be local islanders who are at least twenty years old. b: All applicants must have practiced medicine before the implementation of this regulation. Third: The local administration can approve licenses if it determines that applicants have satisfied the requirements above. Eighth: A license can be withdrawn if a doctor commits a crime or engages in any other improper behavior. Ninth: Public physicians shall supervise the practices of doctors. According to the first rule, only licensed specialists could practice scholarly Han medicine in colonial Taiwan, because in order to receive the license, one must either pass the exam of scholarly Han medicine or be recognized by the Japanese physicians and the Japanese authorities as having mastered scholarly Han medicine. Interestingly, the legalization of Han medicine in Taiwan did not change the policy in the colonizers’ homeland of Japan, where, since 1883, the government had recognized only biomedicine. Only in Japan’s colony of Taiwan was Han medicine permitted. The first rule rests on the colonial government’s intention not to formally legitimize Han medicine but to comply with the local culture. Unlike “The Regulation of Physician Licensing in Japan,” which explicitly required physicians to receive training at medical schools or to pass exams, “The Regulation of Medical Practice in Taiwan” placed significant limits on people’s access to licenses, as the government was under no obligation to routinely hold licensing exams, which specialists in Han medicine had to pass in order to practice their trade. The licensing policy for Han medicine was, in effect, just a contingency plan, and the colonial government held the exam only once in 1901, letting biomedicine gradually replace Han medicine in Taiwan. Just two make-up exams took place, one in 1901 and the other in early 1902. Moreover, many practitioners did not know about or could not attend the exams. The Japanese physicians who were trained in biomedicine supervised the exams, most of which were written. In December 1901, a local newspaper documented the stages of several exams: Public physicians from the Japanese homeland announced the exam’s questions to the examinees…the examinees for general medicine and general surgery took specific sets of questions that the examinees would answer in writing. Four examinees took the general surgery exam and their questions concerned the fields

89 I made these translations myself, as there were no existing translations of the document. In fact, most studies on this general topic are written in Chinese or Japanese. For more details about the licensing and training of medical professionals in colonial Taiwan, see Tetsuzo Suzuki (鈴木哲造), “A Study of the Medical Regulations in Colonial Taiwan” (日治時期臺灣醫療法制之研究：以醫師之培育與結構為中 心), dissertation (Department of History, National Taiwan Normal University, 2014), 65.

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of dentistry and ophthalmology. However, some of the examinees were illiterate. They mentioned this issue to the supervisor, who then tested their knowledge of dentistry by proctoring an oral exam for them.90 Other problems arose for examinees. For instance, as the survey shows, most practitioners of Han medicine lacked knowledge of the medical classics, so many of the examinees were unable to finish the exams. The same local newspaper article described some examinees’ inability to answer exam questions: There were about thirty test-takers. The three questions were on dysentery, typhoid, and syphilis. But some test-takers could not answer the questions. Only a few were able to fully answer those questions.91 A few Taiwanese doctors practicing Han medicine received their license not by taking an exam but by submitting to investigations carried out by such Japanese officials as police and public physicians. This process of licensing through investigation has attracted little attention from historians.92 Nevertheless, local newspapers documented the process, as can be seen below in a passage from a 1901 article: About 1,000 healers applied for licenses but we [i.e., the colonial authority] cannot license them all unless the commissioners investigate the healers in order to determine whether or not they are indeed qualified.... Twatutia is the most developed area on the island. The government started [the investigation-based licensing policy] there and sent the police to investigate applicants for doctor licenses. After the initial investigations, thirty or forty people obtained licenses.93 Despite relying on some non-written assessments for licensing, the colonial government privileged the conception of Han medicine as a written canon and thus relied heavily on the licensing of doctors by means of exams. The government later applied this preference for literacy to doctors’ prescription of medicine. The colonial government printed official documents for medical prescriptions. The documents featured administrative numbers and were mandatory for all doctors prescribing medicine. Pharmacies refused to sell medicine to patients if they had no officially printed prescription. 94 In short, the mandating of official written prescriptions made the pharmaceutical process, licensed doctors, and their patients more visible to the colonial government. The colonial government issued no new licenses to Han doctors after 1902. Over time, the number of licensed doctors dwindled as they grew old and passed away. There were 125 physicians and 1,434 doctors in 1902; in 1940, there were 2,302 physicians and

90 “The Follow-up Report on the Exam” (考試續聞), Taiwan Daily New Newspaper, December 11, 1901. 91 Ibid. 92 See Kun-Chien Ting (丁崑健), “The Medical Qualification Examination for Chinese Physicians during Japanese Rule in Taiwan,” Journal of Living Science 13 (December 2009): 83–11. The licensing through investigation was very much like a political and social honor, as most of the individuals possessing investigation-based licenses were practitioners of Han medicine who hailed from the upper social classes and who were working with the Japanese officials. 93 “A Survey of Doctors” (醫生調查), Taiwan Daily New Newspaper, August 1, 1901. 94 “Must-know Facts about Prescriptions” (問藥須知), Taiwan New Newspaper, January 28, 1902.

34 only 133 doctors.95 Many practitioners of Han medicine who could not obtain a license after 1902 turned to traditional pharmacology. While marginalizing traditional medicine and prioritizing official prescriptions, the colonial government tolerated the production, as well as the buying and selling, of traditional medicines. Being a licensed pharmacist became a way to continue practicing Han medicine. Thus, although the colonial government intentionally discouraged traditional Han medicine, the number of licensed pharmacists in the field of Han medicine increased until the late 1940s, when biomedicine became popular in Taiwan. In 1899, there were 173 licensed pharmacists of Han medicine, but in 1906, there were 1,029. The number of licensed pharmacists of Han medicine continued to increase, reaching 3,511 in 1922. By 1928, this figure had decreased slightly to 3,215 before decreasing even further, reaching 2,130 by 1942.96 Taiwanese pharmacists specializing in Han medicine created a space in which practitioners of both scholarly and non-scholarly Han medicine could practice traditional medicine, especially spiritual medicine and traditional feminine healthcare, both of which were discouraged by the Japanese colonial government. The colonial government required that pharmacists refrain from selling medicine to patients bearing prescriptions from shamans and unlicensed midwives. 97 To work around these obstacles, many pharmacists practiced a particular brand of spiritual medicine. For example, one of the oldest pharmacies in Tainan kept a catalog of “god’s prescriptions” in the store, and patients would go to local temples asking for god’s pick on the choice of prescription and come to the pharmacy to buy that prescription. 98 Even by the 1940s, when biomedicine in Taiwan had grown in popularity during the previous decades of colonization, some Taiwanese people continued to seek prescriptions of spiritual medicine to “drive disease ghosts away.”99 Han-based medical businesses grew between the 1890s and 1930s also because sizable percentages of the Taiwanese public found Han medicine to be significantly more affordable than biomedicine. The cost of a visit to a biomedical clinic was as much as twice the cost of a visit to a Han medical clinic.100 Han medicine thus continued to survive and sometimes thrive as a set of practices and prescriptions for ordinary Taiwanese, especially the poor. I will analyze the market of healthcare drug prices in Chapter 4.

Public Physicians’ Supervision of Local Doctors In “The Regulation of the Licensing of Taiwanese Doctors,” the eighth rule states, as noted above, that “a license can be withdrawn if a doctor commits a crime or engages

95 The Taiwanese Colonial Government, Sōtokufu tōkeisho (總督府統計書) (Taipei: Taiwan Sōtokufu Minseibu Bunshoka, 1899–1942). 96 Ibid. 97 “Must-know Information about Prescriptions” (問藥須知), Taiwan New Newspaper, January 28, 1902. 98 Cultural Affairs Bureau, Tainan City Government, “An Introduction to the Old Industries in Tainan,” accessed November 6, 2021, https://style-culture.tainan.gov.tw/food/index-1.php?m2=23&id=187. 99 “A Study of Shamans” (童乩の研究), Taiwanese Folkways, August 1941, 2. 100 TuanFei Hung (洪團飛), “Better to Revile Han Medicine” (漢醫之宜振興), in KouKanIKai in the Han Language (漢文皇漢醫界) (Taipei: The Taiwan Subgroup of the Oriental Medicine Group/ 臺北: 東洋醫 道會臺灣支部, 1930).

35 in any other improper behavior.” In essence, the rule served as a way for the colonial government to compel every doctor to report patients suffering from, for example, a highly infectious illness. The ninth rule (i.e., “Public physicians shall supervise the practices of doctors”) created an alliance of sorts between the colonial government and public physicians, in which the two parties would surveil the island’s practitioners of Han medicine. Public physicians, in the context of this study, were practitioners of biomedicine who had been assigned by Japan’s Department of Civil Affairs to work for the colonial government of Taiwan. Thus, this regulation turned the licensed practitioners of Han medicine into subordinates of the colonial government. Also, it implied that Han medicine had to be practiced under the guidance or management of biomedicine. Interestingly, while this regulation declared that the practitioners of Han medicine should be supervised by public physicians, it was education, not supervision, in which the public physicians actually engaged. Practitioners of Han medicine would invite public physicians to lecture on and share knowledge of biomedicine. In 1901 and 1902, a local newspaper published several articles on these activities. Below are excerpts from two such articles: The 60 practitioners of Han medicine in Twatutia were interviewed by the Administration of Taipei. It announced a list of qualified practitioners yesterday…. The Administration of Taipei also announced that these practitioners should be organized into a group and supervised by Japanese physicians. Heading the group should be individuals who possess both an excellent personality and laudable experience. The group should meet a few times every month in order to advance the members’ knowledge.101 N̂ g, Gio̍ k-kai, who was a renowned practitioner of Han medicine in Twatutia, organized a meeting of doctors for research purposes…and a physician at Taipei Hospital, Watanabe, joined the meeting and explained the detailed content in three images of human bodies. 102 The colonial authority’s licensing policy, by licensing practitioners of Han medicine under the “educational” supervision of public physicians, legally mandated and normalized cooperation between the colonial government and these practitioners. This cooperation could be witnessed at such institutions as JiAn Hospital, where a Japanese public physician served as director but where all diagnoses and treatments were performed by practitioners of Han medicine. JiAn Hospital accepted walk-in patients and possible plague patients brought there, often forcibly, by the Japanese police.103 The staff of this hospital was comprised of twelve practitioners of Han medicine who worked with police and health officials and were supervised by N̂ g, Gio̍ k-kai.104 The only thing that the colonial government required was that the hospital segregate patients according to germ theory—an idea that had not

101 “Qualified Doctors” (漢醫及第), Taiwan Daily New Newspaper, January 24, 1902. 102 “The Regular Meeting of Doctors” (漢醫例會), Taiwan Daily New Newspaper, July 21, 1901. 103 “Random Recent Information about the Hospital” (醫院瑣談), Taiwan Daily New Newspaper (臺灣日 日新報), June 6, 1901. 104 “The Life Story of N̂ g, Gio̍ k-kai” (黃玉階君小傳), Taiwan Daily New Newspaper, March 4, 1908.

36 previously existed in Han medicine.105 This hospital not only treated patients, but also buried those who had passed away at the hospital.106 Public physicians inspected the hospital, but no practitioners of biomedicine were actually stationed there.107 Hence, even though the Japanese authority in the early 1900s refused to recognize the intellectual and cultural legitimacy of Han medicine, in the Plague Treatment Institution for Taiwanese People and later in JiAn Hospital, local practitioners of Han medicine practiced this approach to health. The healthcare system established by the licensing policy ensured that qualified doctors not only treated patients but also cooperated with the colonial government on all kinds of local work related to public health. When cooperating with the colonial government, these practitioners of Han medicine had to shoulder a host of responsibilities: report plague patients to the government, introduce local people to biomedical practices, handle available vaccinations, and so on. A newspaper article dating from 1902 described a meeting between government health officials and local doctors regarding the topic of vaccinations: On the 25th of this month, Dr. Horiuchi and Twatutia’s police chief, Kaneko,…convened a meeting with various notable figures and licensed doctors…. Horiuchi announced the spread of the plague…the government’s plans to vaccinate people, and the possible end to the plague…. Some of the non- medical attendees opposed mandatory vaccinations because they might provoke push-back amongst local people. Furthermore, it was pointed out that Taiwanese females must not have contact with male strangers, even though the medical practitioners performing the vaccinations would be male…. Horiuchi declared that we acquire knowledge in order to save people’s lives, but that, if people refuse to be vaccinated, the procedure need not be mandatory…. Nevertheless, the government will vaccinate every member of law enforcement, from the chief of the police to every officer on the beat…and then vaccinations will be distributed to notable figures in the community and licensed doctors.108 This meeting touched on two main issues regarding vaccinations: gendered obstacles to mass vaccinations and vaccination skepticism. As for the obstacles, traditional Taiwanese society prevented women from interacting with most male strangers. Because of the gender segregation, women usually received their health care not from male healers but from sian-sinn-má, who were female healers taking care of women and children. In the following chapter, I will analyze sian-sinn-má as a wide range of female healers and care providers in the following chapter, but it should be noted here that Japanese officials were cognizant of the disruptive effects that local gender norms might have on a mass-vaccination campaign. It not only affected women, but also demonized Japanese physicians because many locals would regard any physician’s attempt to vaccinate women as sexually unethical and a profound intrusion into the lives of local people.

105 “Random Recent Information about the Hospital,” Taiwan New Newspaper, June 6, 1901. 106 “Donations for a Resting-place” (捐資獻塚), Taiwan Daily New Newspaper, June 7, 1901. 107 “Go Check a Hospital” (出巡醫院), Taiwan Daily New Newspaper, June 8, 1901. 108 “The Conclusion of a Disease-prevention Meeting” (預防議定), Taiwan New Newspaper, March 28, 1902.

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On top of this problem was widespread vaccination skepticism, which stemmed in part from a case in which a local patient developed an adverse reaction to an injection. At a meeting about this case, local Taiwanese doctors questioned a Japanese physician who was in charge of public health. The physician blamed local doctors for having mishandled the case. A local newspaper report, dated March 30, 1902, discussed this incident in some detail: Dr. Horiuchi announced the development of a plague vaccine and explained the measure [to attendees]…at the meeting held on the 25th…an attendee who was a practitioner of Han medicine…suddenly dared to question the vaccine, stating that last year, owing to locals’ persistent evasion of vaccinations, only one person got vaccinated—a person who soon died of the plague. This practitioner of Han medicine added that he had treated the person and would like Horiuchi to explain why the death had occurred. Horiuchi suggested that the person had died because this practitioner of Han medicine had failed to administer the treatment properly.109 The meeting did not resolve the safety concerns that locals had regarding the plague vaccine. Indeed, the meeting had just the opposite effect. The Japanese physician attributed the patient’s death to a mistake made by a local doctor. Interestingly, it was asserted at the meeting that local doctors had the obligation to get vaccination shots in order to prove to ordinary fellow Taiwanese just how safe the vaccinations were. Nevertheless, no record exists showing that these local doctors had, in fact, received the shots. Whatever the case, distrust existed between medical professionals and the public, between biomedicine and traditional medicine, and between colonizers and colonized. The meeting illustrates how some Japanese physicians felt no need to respond at all to local concerns, and how local doctors remained distrustful of vaccinations because a Japanese medical expert offhandedly responded to attendees’ reasonable questions. The colonial authority’s inclusion of Han medicine in the island’s public health system placed local doctors alongside police and public physicians in the fight against epidemics. This inclusivity occasionally caused problems: some arose between doctors and the colonial government, as the above debate over vaccination shows, and others arose between doctors and local people. For instance, families of patients would aggressively protest doctors if the doctors reported cases of epidemic infections to the government.110 Nonetheless, the colonial authority worked with local doctors to improve control of the plague in the colony. Local doctors used this cooperative relationship as both a space and a tool for subtle resistance against the colonial authority. The Japanese government, for its part, treated the cooperative relationship as a temporary solution to the epidemic. The hope was that soon the Colonial Medicinal School, based in Taipei, trained enough Taiwanese physicians to meet the needs of the Taiwanese population. The Japanese colonial authority never gave up their agenda of civilizing the island through medicine, as both Japanese and Taiwanese medical practitioners knew that medicine was inseparable from politics. In the first graduation ceremony held in 1902 by the Medical School of the Colonial Government, which was

109 “Demon Confession” (妖言惑眾), Taiwan New Newspaper, March 30, 1902. 110 “Hard to Be Thoughtful” (難以為情), Taiwan New Newspaper, March 29, 1902.

38 the first medical educational institution in Taiwan, the principal, Takagi Tomoe, emphasized the connection between medicine and civilization: It is not only the honor of these students but also my honor to be in attendance at this graduation ceremony…. You are the first generation of local islanders to receive an education in the field of modern medicine…. You have left the folds of China and entered into the glory of our empire…you…have to learn advanced knowledge…you must lead your islander people to civilization and never forget the glory of today or fall short of the Governor’s…expectations.111

Han-medicine Education after the Colonial Government’s Implementation of Its Licensing Policy Compared with the promotion of biomedical education by the colonial authority, “The Regulation of the Licensing of Taiwanese Doctors” almost terminated Han- medicine education. According to the second rule of this policy, the colonial government in 1901 would recognize only existing practitioners of Han medicine. Thus, insofar as the rule prevented future generations from being licensed doctors, it suppressed Taiwan’s education in the field of Han medicine. Some younger Taiwanese adherents to Han medicine, committed to getting an education in this field, chose to go to China for this purpose.112 In the late 1920s, Taiwan witnessed a revivalism of Han medicine, known as KouKan IDou (皇漢醫道), which served to promote these activities. Beginning at least in 1930, a journal devoted to the revival movement of Han medicine appeared in Taiwan. Entitled Huang Han Yi Jie (皇漢 醫界), the journal consistently featured admissions information about Chinese schools offering programs in Han medicine.113 In 1934, the editor of this journal, Su JinChiuan (蘇錦全), introduced a son of a colleague to a Shanghai-based school devoted to Han medicine. In the early 1930s, Su also counselled individuals hoping to take pharmacist- licensing exams that the Taiwanese colonial government offered in the field of Han medicine. During the colonial era, far fewer young Taiwanese received informal training or self-training in Han medicine than had been the case with their elders. Likewise, a far greater number of these young Taiwanese practitioners might have had a simultaneous background in biomedicine. An example of this new breed of Han medical practitioner was Doctor Cheng MuRong, who worked at a clinic of biomedicine in a sugar refinery in

111 “The ceremony to grant degrees to the first group of graduates from the Medical School of the Colonial Government” (臺灣總督府第一期卒業證書授與式), Domestic and International Medical News, 533 (May 6, 1902): 786–787. Interestingly, all three graduates were family members of a family committed to Han medicine: N̂ g YaoKun (黃瑤琨) was the younger brother of N̂ g Gio̍ k-kai; the other two were brothers (Cai, ZhangSheng and Cai, ZhangDe), whose father (Cai, Sheng) was also a practitioner of Han medicine. 112 Zhaohong Chen (陳昭宏), “KouKan IDou: The revivalism of Han Medicine in Colonial Taiwan” (日治 時期臺灣皇漢醫道復活運動), thesis (National ChengChi University, Graduate Institute of Taiwan History, 2015). 113 Huang Han Yi Jie (漢文皇漢醫界/臺灣皇漢醫界/東西醫藥報) (Taipei: Taiwan Subgroup of the Oriental Medicine Group, 1930).

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Xizhou, Changhua in 1943 but who decided to receive training in Han medicine after a few years working in that clinic.114 Despite this resurgence in the popularity of Han medicine in Taiwan, biomedicine became the dominant medical system on the island. Taiwanese medical schools by that time were devoted solely to biomedicine, and a biomedical degree conferred on its recipient considerable prestige. For example, the Department of Medicine at Taipei Imperial University, which was Taiwan’s top medical school beginning in 1901, churned out physicians who, trained in biomedicine, became members of the new social elite in Taiwanese society.115

Conclusion Despite its firm commitment to the agenda of modernization and Westernization, the colonial Taiwanese government in 1901 officially recognized practitioners of Han medicine during a severe outbreak of the plague. However, this policy of licensing practitioners of Han medicine had a rather subtle underlying function: transform local healers into allies of the government in the battle against the plague. The main goal was never to recognize Han medicine as a legitimate alternative to biomedicine. These co- opted practitioners of Han medicine, most of whom had to prove their literacy and their familiarity with canonical Han medicine, served the public health system by reporting suspected plague patients to the government and by working with—and often under— public physicians trained in biomedicine. The practitioners of Han medicine understandably walked a thin line, as they grappled with challenges from both the government and local people. To overcome one challenge thus often meant that another challenge would simply grow more daunting: compliance with government policy might very well offend locals; defense of native Taiwanese culture might very well offend the government. Japan’s colonial policy erected a hierarchy in which the colonial government and biomedicine were superior to the colonized people and their traditional medical principles, practices, and practitioners. Biomedicine became the politically mainstream form of medicine, though decades would pass before the island’s native population warmed to it. Meanwhile, civil society turned to Han medicine as a popular and trusted alternative. In addition to canonical Han medicine, both folk remedies and shamanic practices appealed to locals, as well. However, the colonial authority usually rejected these alternatives, refusing to license their practitioners and generally discouraging recourse to them.

114 LiangNong Cheng (鄭亮農), “In Memory of Doctor Cheng MuRong” (追憶鄭木榮老醫師), March 26, 2017. 115 See Chun-Kai Chen (陳君愷), A Study of the Social Status of Taiwanese Physicians During the Colonial Period (日治時期臺灣醫生社會地位之硏究), thesis (Department of History, National Taiwan Normal University, 1992); and YenChiou Fan (范燕秋), Diseases, Medicine, and Colonial Modernity (疫 病, 醫學與殖民現代性) (New Taipei City: Taoheung, 2010).

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Chapter 2. Translation between Medical Epistemologies

In this chapter, I explore how both practitioners of traditional medicine and practitioners of modern medicine produced knowledge that integrated traditional medicine into modern medicine in colonial Taiwan. The production of knowledge involved various strategies and various “translations” of medical epistemologies. In this effort, the practitioners of traditional medicine tried to show that traditional medicine, even though it had not adopted germ theory or the precepts of modern anatomy, could improve public health by curing patients’ diseases defined by biomedicine. In other words, the practitioners of traditional medicine were trying to establish their usefulness in colonial Taiwan’s biomedicine-dominant healthcare system while preserving most of their practices and precepts. These practitioners of traditional medicine were defending their field by differentiating its epistemological and practical applications from those of biomedicine: traditional medicine, these practitioners argued, deserved a space of its own alongside—and partially overlapping—the space in which biomedicine existed. In this chapter, I answer the following three questions: How did germ theory affect Japan’s policy toward traditional medicine in Japan and its colonies? How did Japan-imported biomedicine shape traditional medicine in Taiwan? How did Taiwanese practitioners of traditional medicine argue that their form of healthcare deserved to be recognized by—and integrated into—biomedicine? In answering these questions, I show how both Taiwanese practitioners of traditional medicine and Taiwanese practitioners of modern medicine strived to transform traditional medicine into a legitimate independent alternative medicine, or a kind of complementary medicine, functioning alongside modern medicine.

The Intertwined Fields of Politics and Medicine in the Japanese Empire Japan adopted modern medicine in the middle of the 19th century and began following a new medical policy that encouraged healthcare practitioners to abandon traditional diagnostic principles and to preserve only traditional prescriptive principles. This government policy, which allowed certified pharmacists to write out and to fill certain traditional Han and Kampo prescriptions, simultaneously ended the government’s licensing of traditional medical practitioners. In other words, the diagnostic side of traditional medicine was no longer certifiable medical knowledge, but the pharmaceutical side of traditional medicine (e.g., herbs, concoctions) was a legitimate area for government licensing. The Japanese empire applied this agenda of medical modernization to colonial Taiwan, where Japanese practitioners of biomedicine, many of whom also served as medical government officials, considered the island’s traditional medicine to be medically worthless “tree bark and roots.”116 This agenda, which intertwined biomedicine, public health, and the Japanese empire, was an intentionally selective import from Germany. After the Meiji Restoration,

116 Tsugio Horiuchi (堀內次雄), “The Beginning of Public Health: Memories of the Time When Japan Had Only Taiwan” (臺灣衛生事始 - 領臺當時の思い出), Taiwanese Folkways (民俗臺灣), November 1942, 22–24.

41 the Japanese government decided to adopt the biomedicine and the medical system of recently unified Germany. The system was based on centralized “state-medicine” overseen by the government, which used “medical policies” to manage medical personnel, public sanitation, and environmental conditions. The powerholders of the Japanese empire believed that Germany’s increasingly centralized political structure had struck a more sensible balance between government and monarchy than had Great Britain’s relatively decentralized political structure, which relied heavily on private healthcare. In Japan, even the medical services available to the Japanese royal family came to reflect the principles of biomedicine.117 The reasons for this shift to a centralized government-run modern healthcare system were political, as well as scientific. Social hygiene combined Japan’s traditional sense of community with Germany’s newfound commitment to state medicine, and was a dominant feature of Meiji Japan. Japanese officials believed that strong social hygiene would transform Japan into one of the world’s “fittest” nations. This social Darwinist view rested on the idea that Japan must catch up to the advanced Western states and must cultivate a nationwide respect for social responsibility.118 In this agenda of modernization, Japan saw Western medicine as an essential part of Western power, as science is never neutral.119 This nationalizing process in Japan required that medical and public-health stakeholders shift from traditional medicine to modern medicine. Interestingly, many of these new medical officials and practitioners came from samurai families with strong backgrounds in traditional medicine. Indeed, even during the modernizing period, these families would sometimes send one son to a traditional Kampo training institution and another son to a modern medical school. In this way, the families hedged their bets, balancing the risks of a potentially outdated practice (traditional medicine) with the risks of an unfamiliar practice (modern medicine).120

The Revival of Traditional Medicine in Both Colonial Taiwan and the Japanese Homeland As I pointed out in Chapter One, Japan initially sought to shift from traditional medicine to biomedicine in Taiwan,121 but with the outbreak of plague on the island just one year into its colonization, the colonial government backtracked somewhat, enlisting certain literate local practitioners of traditional medicine in the colony’s pandemic response. These practitioners were required to report suspected cases of plague to work with Japanese public physicians. To “educate” these local traditional practitioners, the colonial government held meetings at which the practitioners would learn about germ theory and modern anatomy. The policy was a temporary one-time concession to traditional medicine: as the licensed traditional practitioners retired and died over the coming years, the colonial government made a point of granting no new licenses.

117 Shiro Kira, “What Happened in Our Medical Care System during the Meiji Restoration” (明治維新の際, 日本の医療体制に何がおこったか), Kampo Medicine 6 no. 57 (2006): 757–767. 118 Michael Shiyung Liu, Prescribing Colonization: The Role of Medical Practice and Policy in Japan- Ruled Taiwan, 1895–1945 (Ann Arbor: Association for Asian Studies, 2009), 38. 119 Ibid, p. 29 120 Shiyong Liu, Wu shi dao yu liu ye dao: ri ben xi yang yi xue de xing cheng yu kuo san (武士刀與柳葉 刀 : 日本西洋醫學的形成與擴散) (Tai bei shi: Guo li tai wan da xue chu ban zhong xin, 2012). 121 See Michael Shiyung Liu, Prescribing Colonization.

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Traditional medicine nevertheless survived in Taiwan. After several decades, biomedicine emerged as the dominant—but not the sole—type of medicine in both the Japanese homeland and colonial Taiwan. In 1928, a movement to revive traditional medicine—KouKan IDou Revivalism (the Revivalism of Royal Kampo Medicine) emerged in the Japanese homeland. This movement’s Kampo supporters in Tokyo established an organization, TouYou IDou Kai (the Association of Oriental Medicine), which, from 1928 to 1940, published a journal: KouKan I Kai (the Community of Royal Kampo Medicine, or CRKM). The journal served as the principle means of communication for the KouKan IDou revivalist movement. The target audience of this movement was not only practitioners but also the general public, from whom the activists hoped to gain support in their effort to expand the scope of traditional medicine beyond limited treatments to primary healthcare. The foreword of CRKM summarizes the movement’s central aim: “Because this journal is for the public at large, we use Japanese characters that everybody can understand, regardless of one’s age or sex. Also, our articles, because they cover all types of research on health and food, include topics related to Western medicine.”122 The foreword emphasizes the journal’s use of Japanese characters rather than kanji, which, though familiar to most Japanese intellectuals, could be difficult for the general Japanese public to read. Kanji are the adopted traditional Chinese characters used in Japanese writing. 123 These kanji characters were the main written language for most Japanese intellectuals before the 19th century. In the early 20th century, more and more Japanese people started to use a new writing system, which combined kanji with kana. Unlike kanji, the symbols of which refer to ideas or words, kana involves symbols that refer to syllabic units of sound. The modern Japanese language we know today is a mix of kanji and kana. Because texts about Kampo medicine continued to use kanji symbols, Kampo medicine became increasingly inaccessible to Japanese laypersons, who were increasingly familiar mostly with the new kanji-kana-mix system, not kanji-only symbols. In essence, the journal sought to teach average Japanese what members of the privileged samurai class had learned before Japan had “separated from Asia and entered Europe” in the late 19th century, when Kampo medicine dominated almost all Japanese medicine, with the exception of a smattering of Western medicine that Dutch visitors had taught to some Japanese in Nagasaki, the only Japanese port that permitted foreigners during the era of Japanese isolationism. 124 Almost all pre-Meiji texts about Kampo medicine were written in kanji, so pre-Meiji practitioners of Kampo medicine had to master classical Chinese writing. The resulting exclusivity of Kampo medicine was at odds with the Kampo revivalist movement, and its organizers knew this.125 The journal

122 Minami, KouKan IKai, 1 (January 1928): 1. 123 Insup Taylor and M. Martin Taylor, Writing and Literacy in Chinese, Korean, and Japanese (John Benjamins Publishing Company, 2014). 124 Ronald Dore, Education in Tokugawa Japan (Routledge, 2010), ch. iv). 125 As for colonial Taiwan, educated people there used the Chinese writing system for a variety of spoken variants of Chinese, which made the texts of traditional medicine more accessible to Taiwanese people than to Japanese, but which became difficult for practitioners of Taiwanese Han medicine to “Japanize.” For more details about the development and challenges of the Chinese written language in colonial Taiwan, see Peifeng Chen (陳培豊), Nihon Tōchi to Shokuminchi Kanbun: Taiwan Ni Okeru Kanbun No Kyōkai to Sōzō (日本統治と植民地漢文: 台湾における漢文の境界と想像) (Sangensha, 2012).

43 thus rejected exclusivity and embraced inclusivity by trying to spread the teachings of Kampo medicine. The practitioners of traditional medicine in Taiwan soon connected themselves with the Kampo revivalist movement. A Taiwanese branch of the Association of Oriental Medicine published its own version of CRKM, entitled The Han-Language Version of the Community of Royal Kampo Medicine (Han-CRKM). The Taiwanese journal was a monthly publication, whose first issue appeared in November 1928. Most of its articles were written by local Taiwanese practitioners of traditional medicine, with only a few articles being direct translations from the original Japanese journal. In July 1930, the journal underwent a name change to The Taiwanese Community of Royal Kampo Medicine. In March 1933, the organization re-formed itself, now calling itself Taiwanese Research into Han Medicine. It continued to publish the journal, though with a new name: The Taiwanese Report of Royal Kampo Medicine. In 1935, the journal underwent a further name change—The Report of Oriental and Western Medicine—and remained in existence until at least November 1937.126 In this chapter, I use Han-CRKM to refer to all the incarnations of the Taiwanese journal. These two journals—CRKM and Han-CRKM—were the two main platforms from which practitioners of traditional medicine in Japan and colonial Taiwan organized their revivalist movement. Although this movement originally emerged in the Japanese homeland, and although the movement’s original participants argued that traditional medicine was a “real” medicine equivalent to modern medicine, the movement in colonial Taiwan soon turned its attention to a rather specific task: launching a petition for an official government system that would once again license the practitioners of traditional medicine in Taiwan. The petition’s central argument was that such a system would enable the island’s native population “to continue practicing their local culture” in a way that would solve the problem of limited healthcare resources for the colonized people. The petition was rejected by the Japanese parliament in 1933.127 These journals were also platforms on which practitioners of traditional medicine could produce and distribute knowledge about traditional medicine. Some of this knowledge concerned people’s perceptions of the current and future value of traditional medicine: contributors to the two journals thus tried to re-build their field’s intellectual legacy and legitimacy. Other knowledge espoused in the journals concerned the history of traditional medicine: for example, in order to establish the authenticity of Kampo medicine, Japanese contributors to CRKM devoted considerable effort to explaining that Kampo medicine had originally established itself in China but had become the traditional medicine of Japan. And of course, a third body of knowledge presented in the journals concerned the epistemological, ontological, and political challenges that Western medicine posed for traditional medicine: the journals’ contributors asserted that traditional medicine could compete with or at least support the diagnostic power and the increasingly effective treatments of modern medicine.

126 Zhaohong Chen (陳昭宏) “Appendix” in Ri zhi shi qi tai wan huang han yi dao fu huo yun dong (日治 時期臺灣皇漢醫道復活運動) (Tai bei shi: Zheng da chu ban she, guo shi guan chu ban, 2017). 127 For more information about the movement and its strategy in colonial Taiwan, see Chen, “Appendix.”

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Translation and the Re-“Japanizing” of Traditional Medicine During the first few decades of the 20th century, Kampo medicine in Japan and Han medicine in Taiwan were considered offspring of traditional medicine from China, with each just slightly differing from the others. 128 To justify the assertion that the traditional medicine of Japan was Kampo medicine, its practitioners went to great lengths to translate the classics of Kampo medicine from kanji-only to the modern kanji-kana- mix writing. In this way, Kampo knowledge could be passed on to future Japanese generations while also transforming Kampo into a “Japanese”—and thus a culturally legitimate—medicine. CRKM published a series of “distance learning” units to teach and promote the Kampo medical classics. The first unit presented A Discourse on Epidemics (溫疫論), which was a 17th-century Chinese medical classic. According to the author of this unit, the head of the Association of Oriental Medicine had asked him to launch the series of “distance learning” units. This particular unit presented the background of A Discourse on Epidemics and then went through the text, paragraph by paragraph, addressing the ideas, the Japanese pronunciation of kanji characters, and the definitions of significant words. The CRKM unit addressing A Discourse on Epidemics was not simply a case of medical education: it was a kana-based primer course about kanji medical texts. Using more kana characters in translations, the unit taught 20th-century Japanese who were unfamiliar with pure kanji how to read kanji Japanese medical texts. The unit reflected a wider effort to build a Japanese medical tradition that would be both accessible to the public in Japan and culturally distinct from Chinese medical traditions. However, the Chinese legacy of Kampo medicine was hard to erase. Thus, post-Meiji Japanese officials excluded it from the Japanese empire’s agenda for modernization. German medicine enjoyed political and medical legitimacy.129 The idea in Japan was that if the country had to borrow a set of medical principles and practices from abroad, they should come from a civilized and powerful Western country. However, Kampo medicine remained important, and its practitioners attempted to prove its worth by making it “Japanese.” Language was at the heart of this “Japanization” process of medicine. Japanization took the form not only of translations from the kanji-only written system to the modern kanji-kana-mix system, but also of “localization” of medical identities. For example, the Association of Oriental Medicine renamed itself the Association of Royal Kampo Medicine, thus shuffling off the broad reference to East Asia and situating the issue of medicine firmly in Japan, its royal family, and its

128 Today, Kampo medicine and Taiwanese traditional medicine are viewed as two similar but independent systems of medicine. However, during the colonial era, they were viewed as Chinese medicine, with the only noteworthy difference among them being their handling of the dichotomy between modern Western medicine and traditional Eastern medicine. See The Parliamentary Record, December 12, 1892, 219–227; The Parliamentary Record, January 18, 1895, 165–167; and The Parliamentary Record, February 20– March 1, 1929. 129 German medicine and the German medical system constituted the principal model of medicine for the Japanese empire. A major reason for Japan’s attraction to German ways of doing things was Germany’s highly centralized monarchy, which mirrored Japan’s. Thus, the Japanese empire’s decision to adopt German systems over British systems rested on more than just science. See Michael Shiyung Liu, Prescribing Colonization: The Role of Medical Practices and Policies in Japan-Ruled Taiwan, 1895–1945 (Ann Arbor, MI: Association for Asian Studies, 2009).

45 language. Figure 1 presents a page from the CRKM unit devoted to A Discourse on Epidemics. The page has three basic features: the original text, which was written in kanji; the text translated into the modern Japanese writing system (i.e., the mix of kanji and kana); and an explanation of the text, also written in the modern kanji-kana system

The original text in kanji

A Japanese translation of the text in the kanji- kana-mix writing system

An explanation, in Japanese, of the text

Figure 1: a page from the CRKM unit about A Discourse on Epidemics KouKan IKai, Vol. 1, p. 9

Although the Japanese practitioners of traditional medicine who undertook this translation project declared that they were simply trying to communicate important medical ideas to the many Japanese people who could not read kanji characters, the project was no less an intense effort to detach Kampo medicine from the overall field of classical Chinese learning. The activists in this re-vitalization movement thus avoided the pitfall of advocating a “backward” Chinese model, especially at a time when Japan was transforming itself in an intense atmosphere of rapid Westernization and modernization.

The Epistemological Challenge of “Translating” Diseases In addition to translating Kampo texts from kanji-only texts to the modern Japanese kanji-kana texts, practitioners of traditional Japanese medicine, with help from practitioners of traditional Taiwanese medicine, undertook the epistemological challenge of “translating” Western conceptions of diseases into Kampo and Han conceptions of diseases. At the time when humoral theory was the basis for the West’s understanding of pathology, physicians relied on their observations to make their diagnoses. 130 This reliance on observed symptoms for the diagnosis and definition of diseases in Western medicine later incorporated two additional fields of medicine: pathological anatomy,

130 Arturo Castiglioni, A History of Medicine (Oxon: Routledge, 2019), ch. xv.

46 which emerged during the Renaissance, and germ theory, which emerged in the early 19th century.131 As described in Chapter 1, public health was the initial and essential part of imperial medicine in colonial Taiwan. Furthermore, whereas traditional Han medicine focused almost only on symptoms to define and diagnose diseases, physicians in colonial Taiwan relied not only on observations of symptoms, but also and most importantly on germ theory, which became the center of modern medicine on the island. By bridging this conceptual and practical gap between Western medicine and Eastern medicine, practitioners of traditional Eastern medicine were essentially trying to pair the diseases identified in their medical canon with diseases identified in the modern Western canon. To accomplish this pairing of diseases, practitioners of traditional Eastern medicine would typically cite a modern Western medical text addressing a particular disease and would then point out similarities between it and a differently named disease addressed in a traditional Eastern medical text. The four examples below come from a 1928 edition of CRKM, in which the author uses Kampo terms to define modern medical terms: • “Metabolic arthritis is ‘wind-wet’ in Kampo.” • “Typhoid fever is the general description of ‘warm epidemics’. See A Discourse on Epidemics for details.” • “Influenza is called ‘sky-caught wind’ in Kampo, and is commonly known as ‘seven winds’.” • “Pneumonia is ‘swollen lungs’ in Kampo.”132

These “translations” served not only as diagnostic and treatment guides for Japanese practitioners of traditional medicine, but also as a forceful assertion that diseases handled by modern medicine were effectively treatable by traditional medicine. In other words, traditional medicine was legitimate. Because diseases associated with pandemics were one of the most serious health threats at the time, these diseases comprised most of the translations from the lexicon of modern medicine into the lexicon of traditional medicine. The translators created the translations mostly by identifying parallel symptoms, even though practitioners of modern medicine tended to define these diseases not so much by symptoms as by the presence of germs. In the next section, I closely examine a “translation” of the modern medical conception of cholera into the vocabulary of Kampo medicine.

The “Translation” of Cholera Although CRKM and Han-CRKM collaborated with each other on the production of medical knowledge, the two publications handled modern-to-traditional translations slightly differently. The Japanese publication annotated many traditional and modern descriptions of diseases, whereas the Taiwanese publication tended not to do so. Consider, for example, the translation of cholera. CRKM referred to cholera as ‘ko-re-ra’ in Japanese kana—a literal translation. According to CRKM, Japanese Kampo practitioners accepted the modern Western conception of cholera, and argued that cholera

131 Ibid, chs. xvi and xix. 132 KouKan IKai, 1, 8.

47 was, in fact, kakuran (huo-luan or hok-luān in Chinese), a disease with which Kampo practitioners had long been familiar: This disease was named on the basis of its symptoms…. ‘Kaku’ means very quickly, and ‘ran’ has several meanings: disturbing, initial abdominal pain, and a combination of diarrhea and vomiting. In general, ‘ran’ means disturbing, annoying, and messed up…. Likewise, in general, ‘kaku’ means very quick. Some people argue that ‘ran’…refers to food poisoning from meat soups. Some Taiwanese practitioners of traditional medicine acknowledged the modern Western concept of cholera, but rather than formally annotate the text for the modern-to- traditional translation, as the Japanese practitioners of traditional medicine did, the Taiwanese practitioners made only a passing reference to the topic, as the excerpt below, from a 1931 issue of Han-CRKM, shows: The symptoms of vomiting and diarrhea have specific causes and treatments when associated with huo-luan (ko-re-ra). The symptoms of huo-luan, vomiting and diarrhea, occur because the human body has separate yin and yang as well as strong and weak organs…. During the hot summertime, people drink too many cold beverages, relax too much in cool environments, or consume raw food. The body thus produces excessive amounts of yin, which cause disease.133 Furthermore, although some Taiwanese practitioners of traditional medicine accepted the assertion that the Western concept of cholera was equivalent to both ko-re- ra and huo-luan, other practitioners of traditional medicine rejected the concept of cholera from the outset. In fact, some Taiwanese practitioners of traditional medicine simply ignored the Western concept and term, and used only the Han term, huo-luan, when discussing the diagnosis, pathology, and treatment of this disease. The extended quote below, from a 1931 issue of Han-CRKM, illustrates this strictly non-Western approach: Emergency Prescriptions for Epidemics If, during the summer, people enjoy too much cool relaxation and fail to exercise dietary discipline, they will easily fall ill with vomiting and diarrhea. The name of this disease is huo-luan. It comes on very quickly and may overcome a person before proper treatments can be administered, so I list five kinds of treatments below and explain how to modify each of these [for different situations]…. If one can identify symptoms and administer treatments accordingly, the steps taken will be very effective. Patients suffering from huo-luan will vomit and experience either diarrhea or belly pain, or will feel cold or burning sensations, and a white film will coat the tongue…. For some people, huo-luan is fully associated with a temperature, a thick and deep yellow film coating the tongue…heartburn…brief releases of deep yellow or perhaps even red urine…watery diarrhea that is extremely smelly and a deep yellow…and an unusually rapid and powerful pulse… For huo-luan that is fully associated with low temperature, patients will vomit clear liquid; diarrhea will also be watery and clear. The limbs will feel cold and

133 Tzeng 曾三沂, “A Discussion about the Causes and Treatments of Cholera” (論霍亂（虎列拉）吐瀉 證之原因與治療), Han-CRKM 30 (1931).

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will sweat profusely. Patients will want to consume hot beverages or soup. The pulse will be faint, and the tongue will have a white coating. Some huo-luan patients who have low temperatures develop serious complications. The patients lose their vitality, cannot stop their vomiting, and experience diarrhea, profuse cold sweats in the limbs, a faint pulse, sunken eyes, a weak voice, an emaciated body, a tongue coated in a white film, and nails that fall out. These patients are minutes from death. Some huo-luan patients suffer from a high temperature. When their condition deteriorates, the patients lose their vitality, their eyes become sunken, their voice grows weak, their body is thinned to the bone and sweats profusely, nails fall out, and an unquenchable thirst overtakes the patients, who often experience a feeling of unease, an inability to sleep, a rapid and irregular pulse, a tongue coated with a thick greyish film, dry lips and dry mouth, chills throughout even the entire body, and extreme heat in the chest area. In these circumstances, the patients are minutes from death.134 It is worth noting that, during the years when these journals were being published, the Japanese government was operating a public healthcare system and was overseeing a formal system of biomedical education. These systems were firmly established in Japan for over fifty years, from the Meiji Restoration in 1867 until the revival movement during the 1920s and 1930s, and in Taiwan for over twenty or thirty years, from the beginning of Japanese colonization in 1895 until the 1920s and 1930s. However, neither in Japan nor in Taiwan did practitioners of traditional medicine integrate cholera-related germ theory into their theory or practices. Instead, the practitioners insisted that the Western concept of cholera was consistent with their traditional concept of huo-luan. There were at least two sub-types of cholera in traditional medicine, cold and hot huo-luan, but in biomedicine, only one basic type of cholera existed—a disease caused by the bacterium vibrio cholera. The Western typology of cholera was thus lost in traditional practitioners’ attempts to link it to huo-luan. Interestingly, in the 1930s, when biomedicine and the Japanese language dominated medical education in colonial Taiwan, many local Taiwanese encountered the concept of ko-re-ra and integrated the term into their local language. Today in both Taiwan and China, the term huo-luan has been stripped of its traditional meanings and retains only the modern medical meanings associated with the Western term ‘cholera’.

The Hidden Epistemological Conflicts between Traditional and Modern Medicine Many “translations” that used traditional medical terms to explain modern medical concepts failed to capture their essence. This failure involved many prominent “gaps” in knowledge. One gap that was seldom bridged concerned biomedicine’s emphasis on germs and anatomy. These two areas of inquiry played little role in Kampo and Han definitions of diseases, which tended to rest on symptoms. As the example above shows, biomedicine defines cholera in terms of its cause: bacteria. By contrast, traditional Kampo and Han medicine defined huo-luan in terms of its symptoms: chiefly, vomiting and diarrhea. Given this rather extraordinary conceptual gap between cholera

134 Chen (陳丙寅), “Prescriptions for the Emergency Treatment of Epidemics” (急救時疫要方), Han- CRKM 24 (1930).

49 and huo-luan, the translations simply cannot accurately match the two concepts with each other. Another example of a conceptual gap concerns the plague. In conceptualizing the plague, biomedicine focuses on its cause: the bacterium Yersinia pestis. The discovery of this cause is usually attributed to Alexandre Yersin from the Pasteur Institute. However, most Japanese physicians at this time believed the true discoverer was Kitasato Shibasaburō (北⾥柴三郎), a German-trained Japanese bacteriologist who identified the germ in 1894. As most elite Japanese physicians received their medical training in Germany during this period, they called the plague ‘pesuto’ (ペスト), which was a Japanese transliteration of the German term for the plague, ‘pest’. Plague, pesuto, and pest were three distinct languages’ term for one biomedical concept, but Han medicine in Taiwan had not only a different term for the concept but a different concept, as well. Traditional Han medicine dealt with a disease known as the “hives epidemic” or “spot (hot) rash” (斑痧): its chief symptoms included fever, cold intolerance, muscle soreness, bone pain, and red or black discoloration of the skin.135 These symptoms were very much like those of the plague, yet Japanese physicians wondered whether or not the hives epidemic was indeed the plague. When N̂ g, Gio̍ k-kai argued that he had cured five to six thousand patients suffering from the hives epidemic, Japanese physicians did not believe him: N̂ g, Gio̍ k-kai announced to Japanese physicians that Taiwanese patients had exhibited spot-rash symptoms beginning in April or May of this year…and that he had cured five to six thousand of them before the end of the year. He further asserted that the hives epidemic is the plague…. We [the Japanese physicians who had been assigned to study the origins of the plague] don’t know much about spot-rash symptoms, but they are like plague symptoms…. Although the two kinds of diseases sound similar, the number of allegedly cured patients is ridiculously high…so we have put his claims on record, but we doubt their veracity.136 The concept of hives epidemics comes from a Han medical book, Wen-Yi-Lun, which dates from the middle of the 17th century and discusses febrile epidemics, or “warm disease.” The book argues that epidemics are caused by abnormal odors, which themselves are caused by muggy, humid climates. According to Wen-Yi-Lun, humans get sick when exposed to either abnormal odors or other people exposed to such odors. This last point is important, as it explicitly states that epidemics can pass from humans to humans. The odor—or “miasma”—theory reflects a longstanding belief among many Chinese that China’s uncivilized southern frontier was much more conducive to disease than was the dry, cold, developed north. This cultural context of Han medicine was lost in translations between traditional medicine and modern medicine. For example, Marta Hanson—who tracked the emergence in the 17th century of wen-bing (warm diseases),

135 The Survey Committee of Local Diseases and Epidemics (臺灣地方病及傳染病調查委員會), The Chart of Terminologies Used by Local Doctors and Orthodox Terminologies of Diseases (本島醫生の慣用 スル疾病ノ稱呼ト普通病名トノ對照調查) (Publisher unknown, 1906). 136 “A Survey of the Origins of the Plague” (ペスト病原調查), Taiwan New Newspaper, February 30, 1897.

50 which traditional Han medicine regarded as a specific set of Yi diseases (highly transmissible and often fatal diseases)—found that Chinese intellectuals in the 19th and 20th centuries used the terms ‘wen-bing’ and ‘Yi’ to refer to epidemics.137 Not all practitioners of Han medicine equated the hives epidemic with the plague. In fact, many never mentioned the concept of the hives epidemic.138 However, although N̂ g, Gio̍ k-kai sowed distrust between himself and Japanese biomedical practitioners by drawing the connection between the hives epidemic and the plague, he was later described by both Japanese and Taiwanese sources as the top practitioner of Han medicine to treat infectious diseases, including the plague. In addition to the terms ‘hives epidemic’ and ‘spot rash’, the term ‘mouse disease’ emerged in the local Taiwanese lexicon when the island’s native population learned about the origins of the plague. Other names included ‘the black death’ and ‘the black epidemic’ because the bodies of patients would turn black. Local Taiwanese had not yet familiarized themselves with or accepted the idea of germ theory in the late 1890s, when they first encountered the plague pandemic and Japan’s system of public health based on germ theory. However, from the records of local healers, we know that many Taiwanese had already drawn the connection between mice and the disease. Japanese physicians, however, believed that local Taiwanese knew nothing about how to secure themselves against the spread of the plague. A practitioner of Han medicine reported in Taiwan that, before the outbreak of the plague, some locals had come across many dead mice, leading to speculation that the mice had gotten sick because of odors emanating from the ground. Local people would collect these dead mice and burn them in order to protect humans from coming into contact with any residual soil-based miasma in the dead mice. This thoughtful behavior was lost on the colonizers: one Japanese physician went so far as to claim that the Taiwanese outbreak of the plague happened not only because Taiwanese were unkempt, deceitful (hiding patients and bodies from the government), and ignorant of basic germ theory, but also because the locals would collect mice and eat them, which was allegedly a common dietary practice on the island.139 As we can see, linguistic equivalences in conceptual translations are not the same as conceptual equivalences. Ideas get lost in translation from one culture to another, regardless of whether the translation pertains to an everyday conversation or a highly technical medical theory.140 It is worth noting that these translations involved intense political dynamics between the West, Japan, China, and Taiwan, and not just the dynamics between biomedicine and traditional medicine. Moreover, the direction of this communication was one way: practitioners of traditional medicine trying to communicate (1) with practitioners of biomedicine, who were powerholders in both Taiwan and Japan, and (2) with the members of the general public, be they Taiwanese or Japanese. The translations under discussion were thus negotiations undertaken by marginalized medical practitioners and directed at privileged biomedical practitioners.

137 Marta Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China (Routledge, 2012). 138 “A survey on the Origins of the Plague” (ペスト病原調查), Taiwan New Newspaper, February 1897. 139 Ibid. 140 Peter Burke and R. Po-chia Hsia. Cultural Translation in Early Modern Europe (Cambridge University Press, 2007), 2–3.

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The Ontological Challenge of Finding the “Real” Causes of Diseases Many imperfections characterized the effort to match diseases identified by traditional Kampo and Han medicine with diseases identified by biomedicine. Nevertheless, the effort created an opening through which alternative medical systems could gain entrance into the monolithic world of biomedicine.141 The practitioners of traditional medicine were aware that this epistemological challenge came from two ontological sources in biomedicine: germs and organs—in other words, germ theory and anatomy. The practitioners of traditional medicine did not challenge the biomedical assertion that germs exist. However, the traditionalists argued against the biomedical assertion that germs cause disease. Take, for example, the passage below, from a 1929 issue of CRKM: it spells out a Kampo treatment for typhoid fever and, in the process, rejects germ theory as simplistic. Typhoid fever is a kind of epidemic…. Infectious diseases are caused by bacteria. When bacteria invade human bodies, humans will get sick. Because sickness comes from these bacteria, if we destroy them, we can cure diseases. But this last assertion is reckless, as diseases are not that simple.... Indeed, there are bacteria, but bacteria are only part of the reason, not all of the reason, for diseases.... If bacteria were the only reason, all people in contact with bacteria would become sick, yet there are countless examples to show that this assertion is not true. Also, there are carriers of bacteria who do not fall ill.... This evidence tells us that bacteria are not the only causes of diseases.142 Although vaccines for smallpox and the plague had been created in 1796 and 1897 respectively, physicians at this time knew little about the immune system, which can protect some people from sickness while failing to protect other people. Western healthcare systems, including imperial Japan’s, still operated on the premise, supported by germ theory, that all human bodies react uniformly to germs. The germ theory of diseases conceptualized the human body as a battlefield in which an internal defensive apparatus would fight off a multiplicity of invaders capable of causing diseases. Human biology, anthropology, and other sciences postulated that there is a “human species” made up of a hierarchy of races reflecting a “human universal.”143 This focus on the human species and on a human universal governing people’s bodies dovetailed nicely with the public health systems that colonizers established in their colonies: these systems, enforced by police and reflective of the colonizers’ superiority over the colonized, treated all bodies as one—the system treated the population, not the individual.144 In response to this biomedical approach to public health care, practitioners of traditional medicine in colonial Taiwan doubled down on

141 The “biomedical monolithic worldview” is still one of the biggest challenges besetting practitioners of traditional medicine whose goal is to integrate traditional medicine into biomedicine. See Daniel Hollenberg and Linda Muzzin, “Epistemological Challenges to Integrative Medicine: An Anti-Colonial Perspective on the Combination of Complementary/ Alternative Medicine with Biomedicine,” Health Sociology Review 19, no. 1 (April 2010): 34–56. 142 KouKan IKai, 1 (1929): 12 143 Bryan S. Turner, “Recent Developments in the Theory of the Body,” in The Body: Social Process and Cultural Theory ed. Mike Featherstone (SAGE Publications, 1991), 1–35 144 Jen-to Yao, “Governing the Colonised: Governmentality in the Japanese Colonisation of Taiwan, 1895– 1945,” thesis (University of Essex, 2002).

52 their insistence that heath care should emphasize not prevention but treatments tailored to individual bodies. Thus, these practitioners were targeting the foundation of colonial medicine and challenging colonialism itself by turning the focus from racial or social groups (the “civilized” Japanese versus the “dirty” Taiwanese) to individuals. 145 In colonial Taiwan, these arguments favoring traditional medicine over modern medicine intellectually justified the previously mentioned uncooperative behaviors exhibited by local residents during the outbreak of plague on the island: evading the police, fleeing medical centers, hiding the sick, and refusing to take vaccines. It is worth taking stock of the socio-economic dynamics at play in colonial Taiwan’s revivalism movement. The vast majority of the participants and supporters of the movement in colonial Taiwan were bourgeois. The first leader of the Taiwan revivalist branch was Chen MaoTong. He was a successful businessperson who owned a traditional-medicine pharmacy and who invested in and relied on traditional medicine throughout his career. Another high-profile participant of this movement, Lin Hsien- Tang, was a politician and activist from one of the wealthiest families in colonial Taiwan. It was not unusual for some of these supporters to consume traditional medicine while also taking modern medical treatments.146 For supporters like Chen MaoTong and Lin Hsien-Tang, the revival of traditional medicine was not about delegitimizing modern medicine, but about providing Taiwan’s upper classes with non-biomedical healthcare choices and about providing Taiwan’s lower classes, which could not afford expensive biomedical treatments, with affordable traditional healthcare. Because these traditional practitioners of medicine were able to make and fill prescriptions, the movement in Taiwan was geared mainly toward elevating the socio- political standing of traditional medicine and its practitioners. The patterns characterizing this movement were similar to those characterizing Malaysian peasants who, though not members of a bourgeoisie, sought to regain the “loss of a great part of both the social recognition and cultural dignity that define[s] full membership.” 147 This revival movement of traditional medicine in colonial Taiwan thus exposed a challenge faced by the colonized people: the Japanese colonizers were suppressing local culture and local practices, regardless of whether or not the suppression resulted in economic disadvantages. CRKM rarely published research articles written by Taiwanese practitioners of traditional medicine, but Han-CRKM published articles written by Japanese practitioners. In 1933, for example, Han-CRKM ran a series of training articles, authored by a Japanese practitioner, about abdominal diagnoses, which required physical exams of patients’ bellies—a practice popular more in Japan’s Kampo medicine than in other East Asian spheres of traditional medicine.148 The author, the Japanese chair of the Association of Oriental Medicine, stated that to be a Kampo practitioner, one must know how to practice

145 Interestingly, when physicians studied immunity in the latter half of the 20th century, the battlefield analogy extended from social groups to individuals, the latter of whom became worthy of blame if they failed to keep their bodies healthy and thus resistant to infection. See Ed Cohen, A Body Worth Defending: Immunity, Biopolitics, and the Apotheosis of the Modern Body (Durham: Duke University Press, 2009). 146 For example, Lin Hsien-Tang invited the practitioners of traditional medicine to treat one of his sons, who had also been treated by the practitioners of biomedicine. See Lin Hsien-Tang’s diary, June 30, 1930. 147 James C. Scott, Weapons of the Weak: Everyday Forms of Peasant Resistance (Yale University Press, 2008), 236–240. 148 Han-CRKM, 51 (January 1933).

53 abdominal examinations and that his goal was to educate the Taiwanese practitioners of traditional medicine. The uni-directional nature of this education reflected the colonial hierarchy. Japanese practitioners of traditional medicine were well aware that colonial Taiwan had many experienced practitioners of traditional medicine who were struggling to legalize traditional medicine there. Nevertheless, the Japanese practitioners were convinced that their Taiwanese peers could learn a great deal from Japanese Kampo.149 After the series of articles on abdominal examinations published in Han-CRKM, neither was there any follow-up article by Taiwanese practitioners, nor did abdominal diagnoses become a common diagnostic technique in the physical checkups performed by practitioners of traditional medicine in colonial Taiwan.

Re-Constructing Traditional Medicine by Placing It in Opposition to Biomedicine In response to the Japanese colonizers’ widely held belief that traditional medicine was a set of barbaric, mostly cultural practices, many practitioners of traditional medicine argued that traditional medicine was a reasonable alternative to modern medicine. In a 1929 issue of CRKM, a contributing writer compared the infectious- disease treatments of traditional medicine with those of modern medicine: The idea that pandemics occur because invisible micro-organisms invade human bodies has existed in both Western and Oriental medicine, but bacteriology was not a field of study until the end of the 19th century, when the invention of microscopes enabled scientists to see micro-organisms, to culture micro- organisms in dishes, to observe their growth and death in different situations and temperatures, to observe the reactions of bacteria to medicine, and to make possible the publication of studies on all these matters…. [However,] the composition of bacteria is the same as the composition of cells in our bodies, and in this sense, if something is harmful for bacteria, it is also harmful for our cells…. We need to be aware that, when we expose our patients to huge amounts of poison to kill bacteria, we are putting the patients’ lives in danger…. Bacteria are one of the causes of epidemics, but definitely not the only crucial one…. And if bacteria were the only reason for epidemics, all people would fall sick after exposure to infected patients. Also, there would be no such thing as a “healthy carrier”…. Western medical treatments rely on antisera…. This approach is like fighting fire with fire…. Kampo medicine chooses treatments depending on symptoms…. For example, the human body expels bad things from itself through urine and sweat…. Treatments reliant on these bodily functions can destroy bacteria without generating the bad effects of antisera.150 The above-cited passage argues that traditional medicine is, in fact, a legitimate sphere of medical practice and is, in many ways, better than modern medicine. The central aim of the passage is clearly to re-legitimize traditional medicine. In addition to attacking germ theory like above, the practitioners of traditional medicine in Taiwan and Japan questioned the research methods of biomedicine. For example, animal experiments,

149 See Chen, Ri zhi shi qi tai wan huang han yi dao fu huo yun dong (日治時期臺灣皇漢醫道復活運動). 150 Shan Bian Dao Ren (山邊道人), The Difference between Western and Kampo Medicine regarding Strategies against Infectious Diseases (傳染病に對する洋漢兩醫の戰法), KouKan IKai, 13 (2019): 11– 12.

54 it was argued, were poor methods for testing human treatments because animal bodies functioned so differently from human bodies, which reflected the distinction between animals and human bodies in traditional medicine, while this distinction faded because of modern biology.151 The editors of Han-CRKM further published an article in 1930 juxtaposing modern medicine with traditional medicine. The article emphasized their respective geographical origins and, in so doing, argued that modern medicine was distinctly Western and that Han and Kampo medicine was distinctly Eastern. The point of this seemingly obvious finding is that each of these medical fields has its unique advantages and disadvantages and that, therefore, neither medical field can lay claim to universality. The article was written by a Chinese practitioner of traditional medicine, reflecting the close ties between traditional medicine in Taiwan and traditional medicine in China. In fact, Han-CRKM often referenced medical ideas and sources from China, where the controversy between Western medicine and traditional medicine was also heated. Since Europe and Asia started to communicate with each other recently, practitioners of Western medicine have been everywhere in our country. Their equipment is refined and their practices require skill. And our people who study Western medicine mercilessly attack Han medicine for monetary and business reasons. Their criticism is ferocious. They accuse traditional healers of having slaughtered people for four thousand years. In response, the practitioners of traditional medicine defend themselves, acknowledging that Western medicine is good at anatomy, but that Han medicine is good at chi…. The things that Han medicine does better than Western medicine include the development of knowledge about pathology, diagnoses, and treatment…. Our nation is abandoning thousands of years of tradition because [traditional medicine] is not efficient in the realms of public health and military medicine.152 Narratives defending traditional medicine addressed a host of topics: traditional medicine’s superiority as a treatment-based practice (in contrast to biomedicine’s focus on public health); the fewer side effects associated with traditional medicine than with biomedicine; traditional medicine’s ability to address pathology related to invisible organs and chi, as well as to visible organs discussed in modern Western anatomy; and traditional medicine’s reliance on natural methods rather than on equipment common in biomedicine. All of these themes are still common in discussions about traditional medicine today. The point here is that we can track these narratives back to the colonial encounters between biomedicine and traditional medicine. Traditional medicine sought to carve out a space for itself in the increasingly dominant world of biomedicine by acknowledging the existence and even the worth of biomedicine while also distancing itself from biomedicine. In this regard, the re- constituted traditional medicine was—and remains—a product of medical modernity. Most existing studies of medical modernity view traditional medicine as a dying set of

151 Anonymous, “The Value of Animal Experiments” (動物試驗の價值), KouKan IKai, 3. For more analysis into the role of modern science in our changing worldviews and education systems, see John L. Rudolph and Jim Stewart. “Evolution and the Nature of Science: On the Historical Discord and Its Implications for Education,” Journal of Research in Science Teaching 35 no. 10 (1998): 1069–1089. 152 Tzu (祝味菊), “A Brief Introduction to Western and Han Medicine” (漢西醫學概論), Han-CRKM 18 (1930).

55 practices or as a pre-condition for the localization of modernity.153 Whatever the case may be, practitioners of traditional medicine in Japan and colonial Taiwan were actively responding to internal and especially external political and intellectual challenges. In addition, although traditional medicine has been considered a local practice and often limited to a single country,154 Japan’s traditional Kampo medicine was imported from China and was then further “localized” in Japan during the first half of the 20th century. Likewise, traditional medicine in Taiwan rested largely on insights drawn from China and later from Japan. Traditional medicine in all these places was communicating and competing with biomedicine. Through translations and comparisons between traditional and modern medicine, practitioners of traditional medicine preserved traditional medicine by forging a new “traditional” medicine—one born from global exchanges in medical knowledge. Not only did biomedicine travel from the West to the East, but traditional medicine travelled across various geographical boundaries, as well.

Approaches to Experimental Therapeutics: Integrating Traditional Medicine into Modern Medicine through Clinical Trials Arguments defending the integration of traditional medicine into modern medicine were made not only by practitioners of traditional medicine, but also by physicians trained in modern medicine. Between 1928 and 1929, the first Taiwanese person to receive a medical degree in Japan, Tu Tsung-Ming (杜聰明), suggested new directions for the scientific study of traditional Han medicine.155 Tu adopted experimental therapeutics, which he had learned from his visit to John Jacob Abel at Johns Hopkins University. According to Tu, the traditional Han medical treatments that were popular in Taiwanese society were perhaps effective. The best way to determine the effectiveness of the treatments was to run clinical trials. He planned to establish an official medical research institution that would test the safety, as well as the effectiveness, of traditional Han medicine on recruited clinical-trial patients. This undertaking would, as Tu envisioned it, involve a degree of collaboration between practitioners of traditional medicine, who would treat the clinical-trial patients, and Western-trained physicians, who would assess the outcomes of these traditional treatments. Tu argued that modern medicine’s extensive focus on research and diagnosis came at the expense of therapeutics. By conducting research on experimental therapeutics, including therapeutics associated with traditional medicine, modern medicine could identify the treatments that work and could integrate them into modern medicine while filtering out the quackery. This process would shift the focus of the medical community back to patients. Tu published his proposal in a local Taiwanese newspaper in 1928 and entered into a debate, published in a newspaper, with an anonymous Taiwanese physician who insisted that

153 See Chin-Chih An (安勤之), “From Chinese Herbs to Functional Food: A Study of the Revolutionary Category of Food and Drugs through an Analysis of Si Wu Soup” (論中藥作為保健食品：以四物湯的生 命史為 例探討藥品與食品範疇的革命), Taiwanese Journal for Studies of Science, Technology, and Medicine, 11 (2010): 89–148. 154 Yoshiharu Motoo, Takashi Seki, and Kiichiro Tsutani, “Traditional Japanese Medicine, Kampo: Its History and Current Status.” Chinese Journal of Integrative Medicine 17, no. 2 (2011): 85–87. 155 Anonymous, Taiwan Minpao (The Taiwan People Newspaper), July 1, 1928.

56 there was no need to study traditional medicine at all. In 1937, Tu submitted his proposal to the Taiwanese colonial government, but officials rejected it.156 Even though Tu’s proposal for clinical trials never took place, it illustrates another approach that East Asian medical practitioners adopted in their effort to integrate traditional medical practices into modern medical practices. Notably, experimental therapeutics avoided the ontological issues of organs and germs, focusing only on whether or not a proposed method could cure a patient. This proposal, with roots in Johns Hopkins University, ushered North America into the traditional-medicine debate going on in colonial Taiwan. Most importantly, the proposed clinical trials became one of the most common ways to test claims made in alternative medicine and to integrate effective alternative medicine into contemporary medicine. This trend was especially popular after the 1990s, when evidence-based medicine came to the forefront. However, in colonial Taiwan, the ontological differences between traditional and modern medicine continued to erect challenging obstacles to the integration of the former into the latter, a topic that I analyze further in Chapter 5. In the next chapter, I will explore the practices of traditional female healers who looked after women and children in colonial Taiwan. Unlike the leaders of the traditional- medicine revivalist movement, who made an intentionally public effort to garner attention and support, these traditional female healers and their clients tried to keep a low profile, and thus often hid from colonial officials and later historians.

156 Sean Hsiang Lei. “The Enigma Concerning Dr. Tsungming Tu’s Research in Traditional East Asian Medicine: On the Creation of Value in Integrative Medicine.” Taiwanese Journal for Studies of Science, Technology and Medicine 11 (2010): 201–86.

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Chapter 3. Uncovering the Traditional Sian-sinn-má Female Healers

Introduction In this chapter, I focus on traditional Taiwanese female medical professionals known as sian-sinn-má. Colonial officials and later historians considered sian-sinn-má to be traditional midwives. 157 Japanese authorities and physicians on the island often described the women as uneducated, dirty, uncivilized, superstitious, and generally benighted. At the direction of the colonial government, official schools were established and began training local Taiwanese young women to become “proper” midwives. Their job was not just to care for women and children but to replace sian-sinn-má, as well. These school-trained midwives formed a new profession for women. Because of its educational requirements, this officially sanctioned profession enjoyed both high social standing and good pay. Nevertheless, the modern midwives of colonial Taiwan were also subordinate to the island’s male-dominant pool of physicians, including obstetricians. Although modern midwives were popular during the colonial period, most Taiwanese women who needed help with childbirth and childcare preferred to retain the services of sian-sinn-má. Thus, although the colonial authority kept training, licensing, and marketing modern midwives, sian-sinn-má helped to deliver 80% of newborn babies in 1932 and 61.5% in 1940.158 The persistent popularity of sian-sinn-má constituted an instance of “counter- modernization” that has puzzled historians: why did local women prefer these sian-sinn- má over “fancy” modern midwives? Hong Youxi and Chen Lixin argue that the preference reflected the great extent to which sian-sinn-má were embedded in existing social customs and networks. However, Fu Dawei points out that this argument fails to explain the reasons for this particular instance of “counter-modernization,” as there were many “non-sian-sinn-má” who performed social customs for local women and who, thus, competed with sian-sinn-má.159 In this chapter, I explore the possible reasons why most Taiwanese women and their children, as late as 1940, were still receiving medical care from traditional “uneducated” female healers even though modern school-trained Taiwanese midwives were available and even though the colonial government strived to discredit traditional midwives. While the existing studies treat sian-sinn-má only as midwives, this perspective limits our understanding of what these traditional female healers actually did.

157 In addition to sian-sinn-má, there were shi-tsu-po, who were traditional caretakers tasked with helping pregnant women and infants. The work performed by shi-tsu-po was usually limited to the period when a woman was in labor. By contrast, the work performed by sian-sinn-má was of a much broader and deeper scope. See Youxi Hong (洪有錫) and Chen Lixin (陳麗新). Sian-sinn-má, Midwives, and Obstetricians (先 生媽、產婆與婦產科醫師) (2002). 158 Hong and Chen, Sian-sinn-má, Midwives, and Obstetricians, 122 159 Dawei Fu (傅大為), “Review of Sian-sinn-má, Midwives, and Obstetricians” (評《先生媽、產婆、與 婦產科醫師》), Taiwanese Sociology (臺灣社會學) (2002): 247–251.

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I have found that sian-sinn-má were far more than midwives: they were obstetricians, gynecologists, and pediatricians; some also engaged in religious and magical practices, which were occasionally mixed in with the healthcare work. In other words, the official colonial records got it wrong: sian-sinn-má did not fit the narrow definition of ‘traditional midwife’. Moreover, in contrast to modern midwives, whose work is restricted to helping with the delivery of babies and the care of newborns, sian-sinn-má provided comprehensive care that I explore in detail. The issue of medical costs is an important one in regard to sian-sinn-má. Their fees were much lower than those associated with licensed midwives and other practitioners of modern medicine. Thus, it is entirely possible that Taiwanese women continued to employ the services of sian-sinn-má not only because the services were comprehensive but also because they were more affordable than those of modern midwives. As modern midwifery was very much a monetary service, lower Taiwanese social groups who were not incorporated into the island’s fledgling monetary economy might have lacked the ability to pay, as well as the ability to afford, the licensed services. In Taiwan’s informal give-and-take economy, sian-sinn-má offered their clients competitive costs and convenient forms of payment, ranging from money to handmade gifts.160 Local Taiwanese women who used the services of sian-sinn-má enjoyed yet another unique benefit of this healthcare arrangement: the women intentionally or unintentionally evaded the persistent gaze of colonial medicine, colonial officials, and even traditional Taiwanese healers who, because they operated outside the women’s family or village, were not held in the highest regard. While the colonial authority tried to make women’s reproduction “healthier” by offering islanders the professional services of licensed midwives, both native women and their families considered midwifery a private practice that should be off limits to outsiders, be they officially sanctioned professionals or traditional healers from other local communities.

Materials and Archives Official colonial medicine marginalized traditional medicine, and sian-sinn-má were the target of a particularly concerted policy of stigmatization, which often took the form of neglect. For example, while the colonial government at least surveyed and licensed male practitioners of traditional Taiwanese medicine in the early years of colonization, the government kept no official data on sian-sinn-má themselves, with the sole exception of a brief note stating that local Taiwanese women would seek help from sian-sinn-má but that sian-sinn-má were uneducated.161 Officials also only rarely kept records of the practices of sian-sinn-má. The sparsity of records was due, in part, to the illiteracy of sian-sinn-má, which prevented these practitioners from filling out forms and responding to surveys. The sparsity was also due, in part, to the low regard in which Japanese officials and physicians held childbirth and childcare, which these men gendered as “care,” not as “medicine.” The colonial government lacked the necessary resources to effectively track sian- sinn-má, who were fairly well hidden from the prying eyes of authorities. Moreover, the

160 Hong and Chen, Sian-sinn-má, Midwives, and Obstetricians, 2002. 161 Seinosuke Fujisaki (藤崎 済之助), Taiwan Zenshi (台湾全誌) (Taihoku: Seibun Shuppansha, 1928), 874

59 colonial government tended to regard these local healers as unworthy of consideration, and their practices received scant attention in official archives. This absence of official primary sources is a challenge for researchers studying midwifery in many parts of the world. To overcome this hurdle, researchers have collected unofficial evidence, such as oral histories and folk stories. These unconventional sources have helped tell the history of midwives. For example, Leap and Hunter collected and organized oral histories of Western “handywomen,” who were working-class midwives dismissed as unprofessional by trained professional physicians.162 In this chapter, while I analyze official archives, I rely mostly on unofficial records, such as memoirs, to uncover truths about sian-sinn-má. Most of the unofficial archives in this chapter come from the records of colonial-era care- receivers, anthropologists, and Taiwanese practitioners of modern medicine.

Fact Checking the Colonial Taiwanese Narratives about Modern Birthing and Midwifery In documents filed by the colonial government, Japanese officials used the term ‘sian-sinn-má’ to refer to traditional Taiwanese midwives. As was the case with local Taiwanese practitioners of traditional medicine, sian-sinn-má were regarded by the Japanese colonizers as uncivilized, uneducated, and “dirty.” One Japanese obstetrician at the time wrote the following comment about traditional midwifery in Taiwan: It was difficult to have brightly lit delivery rooms before [colonization], so they were hard to clean and make hygienic…. We [the Japanese] have broken this bad cultural habit, but Chinese Taiwan still uses poorly lit rooms for the delivery of babies…. It is difficult to visually check for dirt in a darkened room….163 If a woman cannot smoothly deliver her baby, [sian-sinn-má] cut her perineum using either unsterilized scissors or even their own fingernails…putting the lying- in woman at serious risk of infection.164 Japanese physicians and officials also often declared that sian-sinn-má were witches instead of healers or caretakers. Below is a passage from a 1935 police record that illustrates this pattern of delegitimizing identification: The local islanders are extremely naive about childbirth. The women who help out during childbirth are called sian-sinn-má. They know nothing about hygiene and engage only in superstitious practices, with tragic results for both the mothers and their newborns. This reason helps explain why the rate of infant mortality among local islanders is high.165 Japanese physicians and officials blamed sian-sinn-má for many negative outcomes of childbirth, including puerperal fever. For these reasons, the colonial Taiwanese authority in 1907 began training “modern midwives” in order to “save women

162 Nicky Leap and Billie Hunter. The Midwife’s Tale: An Oral History from Handywoman to Professional Midwife (Pen and Sword, 1993, 2013). 163 Kenzo Kusuda (楠田謙藏). About Sterilization in Obstetrics (產科的消毒法に付て) (1900): 4–11. 164 Masakiyo Ogata (緒方正清), The History of Obstetrics in Japan (日本産科学史) (1980). 165 The Police Department of the Taiwan Colonial Government (台湾総督府警務局) Health in Taiwan (台 灣の衛生), 1935, 63.

60 and children from suffering.” 166 The colonial government established schools and programs for the training of local Taiwanese women in the field of midwifery and viewed these school-trained midwives as a major solution to the allegedly uncivilized, inhumane care that sian-sinn-má had been imposing on Taiwanese women and children. Japanese colonizers portrayed the modern midwives as young, educated women who symbolized modernization and civilization. A Japanese official in the early 1900s voiced this sentiment: Western obstetrics is advanced, and we have established [our] school to train students [in this field].… No woman lacking a graduation certificate from the school can work as a midwife [in colonial Taiwan], so there are now many young midwives…who perform their duties well and who reflect the fruits of civilization.167 According to colonial policy known as the Regulation of Midwives, established in 1902, licensed midwives had to be older than twenty years of age and had to have passed an exam exclusively for midwives. The colonial government treated these women as professionals comparable to lawyers and physicians. [Modern] midwives are well-paid…. Lawyers, businessmen, physicians, and midwives are all the same…among these [professions], female midwives can earn good, competitive salaries.168 Officially licensed midwives in colonial Taiwan were respectable and well-paid. Between 1933 and 1940, about 9% of permanently licensed midwives and 25% of temporarily licensed midwives either gave up their licenses, probably because of family responsibilities, or allowed their licenses to expire yet continued to perform midwifery work.169 The Regulation of Midwives limited the practices of licensed midwives to normal childbirths, as abnormal childbirths were the province of obstetricians. The licensing exam for midwives covered practices for normal pregnancies, labor, newborns, the diagnosis of abnormal conditions, diseases common to expecting women, lying-in women, and babies. While generally, only obstetricians could use advanced medical technology, some midwives used forceps to intervene during labor.170 No evidence has emerged regarding whether or not obstetricians in colonial Taiwan reduced the rate of puerperal fever, as no statistics about in-hospital puerperal fever seem to exist.171 Some scholars have stated that this fact undermined the colonial- era stigmatization of sian-sinn-má, and have further noted that even US hospitals had a dismal record of preventing puerperal fever until sulfonamide became available in the 1930s.172 Historians have pointed out several problems with Japan’s colonial narratives about Taiwanese sian-sinn-má. For example, the narratives alleged that these women’s

166 The Police Department of the Taiwan Colonial Government (台湾総督府警務局), Summary of Health in Taiwan (台湾衛生要覧), 1925, 148. 167 Magozō Sakura (佐倉孫三), A Taiwanese Miscellany (臺風雜記), 1903. 168 Tainan New Newspaper, no date. 169 Hong and Chen, Sian-sinn-má, Midwives, and Obstetricians, 60. 170 Hong and Chen, Sian-sinn-má, Midwives, and Obstetricians, 75. 171 Hong and Chen, Sian-sinn-má, Midwives, and Obstetricians, 88. 172 Fu, “Review of Sian-sinn-má, Midwives, and Obstetricians,” 97–98; Lois N. Magner and Oliver J. Kim, A History of Medicine (CRC Press, 2017), 558–561.

61 ignorance of germ theory and proper sanitation were responsible for the island’s high infant mortality rate (IMR). However, the IMR in colonial Taiwan was not always high or at least was not higher than the IMR in the Japanese homeland during the colonial period. In fact, between 1906 and 1912, the IMR in Taiwan was lower than in Japan. Moreover, in 1905, Taiwan’s IMR was comparable to Europe’s and America’s.173 Thus, imperial Japan’s “modernization narrative,” in which the colonial government fought to replace straggly sian-sinn-má with modern, school-trained midwives and obstetricians in order to improve the island’s atrocious IMR, has not held up well under the scrutiny of contemporary scholars.174 No extant primary or secondary sources have definitively proved that sian-sinn- má prevented puerperal fever or kept IMR levels low. Thus, the issue of whether or not sian-sinn-má were effective in these regards remains an un-resolved and intriguing puzzle awaiting further research reliant on yet-to-be-uncovered primary sources. While a decline in IMR was a major reason for imperial Japan’s establishment of a licensing and training system for midwives in colonial Taiwan, the effectiveness of the system, much like the effectiveness of sian-sinn-má, remains unclear. Despite these many unknowns, we can still gain a clear idea of the layout and the influence that the system had on Taiwan and, more specifically, on the practices of sian-sinn-má.

Witchcraft Medicine While researchers have focused on uncovering the medical practices and social networking of sian-sinn-má, I have sought to grasp the layered meanings of this term. Through these layers, we can uncover not only people’s perceptions of traditional Taiwanese female healers but also empirically verifiable facts about them. The starting point of this task is thus to avoid interpreting sian-sinn-má within the framework of contemporary medicine. In the local Taiwanese language of the colonial era, ‘sian-sinn-má’ referred not only to female “midwives” who provided healthcare for women and children, but also to witches who engaged in spiritual affairs and magical healing. 175 In some areas like southwest Taiwan, the term ‘sian-sinn-má’ specifically referred to witches who were members of Taiwan’s ethnic indigenous population, especially those of the plains indigenous peoples. 176 Islanders who were localized Chinese immigrants commonly

173 Yen-Chiou Fan (范燕秋), “Racial Hygiene in Colonial Taiwan under the Development of Japanese Imperialism (1895–1945) (日本帝國發展下殖民地台灣的人種衛生 1895–1945), thesis (National ChengChi University, 2001). 174 Fu, “Review of Sian-sinn-má, Midwives, and Obstetricians.” 175 Dictionary of Common Terms in the Taiwanese Language (臺灣閩南語常用詞辭典) (Ministry of Education, 2011). 176 When the Japanese colonial authority took over Taiwan in 1895, Japanese officials and anthropologists used the term ‘local islanders’ to refer to the large swath of the Taiwanese population that had an ethnic Han Chinese background. These individuals had ancestors who had immigrated from China to pre-colonial Taiwan around the 16th century. The island also had an indigenous population pre-dating the ‘local islanders’, perhaps as far back as 5000 BC. Japanese officials used the term ‘civilized barbarians’ to identify these earliest indigenous Taiwanese, who lived primarily in the lowlands. These categories reflected a racially unequal system of population management in the colony and constituted a re-framed picture of the local ethnic groups. This latter point is noteworthy: in essence, the categories turned the island’s Han people, whose ancestors had relatively recently immigrated from China to the island, into “local islanders” while labeling the historically indigenous people ‘barbarians’. Today in Taiwan, the

62 sought medical and religious help from indigenous sian-sinn-má. 177 The Taiwanese people believed that these witches could communicate with spirits, gods, or goddesses and could be possessed by these supernatural beings, which would then speak through the witches to ordinary people. These layers of meaning for the term ‘sian-sinn-má’—midwife, female doctor, witch, shaman—essentially point to women possessing wisdom, special knowledge, or special powers, not just simple medical knowledge. Imperial Japan’s effort to replace sian-sinn-má with licensed midwives was thus an effort not only to modernize Taiwan’s reproductive medicine but also to stamp out the island’s witchcraft practices. The importance of Japanese authorities’ hostility to native witchcraft should not be underestimated. First of all, the hostility exhibited a historical affinity with the stigmatization that modern Western intellectuals heaped upon Western witchcraft, including its medical components. Witchcraft in the West was stigmatized for hundreds of years, and led to a systematic persecution of women, as witches were generally female. Recent studies on Western witchcraft have shown that witches, relying on a combination of lay knowledge and personal experience, used folk medicine to provide health care to their communities. Ehrenreich and English discuss European evidence that, between the 14th and 17th centuries, “witch-healers were often the only general medical practitioners for people who had no doctors and no hospitals and who were bitterly afflicted with poverty and disease.”178 Europeans at the time associated midwives with witches because the Church accused the midwives, when they were practicing health care, of actually practicing heretical rituals. Both sexism and social inequality were foundations of these accusations, and Ehrenreich and English argue that, during this witch-craze in early- modern Europe, “male upper-class healing under the auspices of the Church was acceptable, female healing as part of a peasant subculture was not. The churches thus attacked these female peasant healers on practicing magic, not medicine.”179 Ehrenreich and English go on to describe the social stigma of female healers and the historical transition from informally trained female healers to formally trained male physicians. This transition, which occurred in both Europe and colonial Taiwan, was widely regarded as key to medical modernization. Ehrenreich and English note that epistemological differences existed between the concepts of “witchcraft” medicine and Catholic doctrine during the late Middle Ages and early-modern period: a witch “relied on her senses rather than on faith or doctrine, she believed in trial and error, cause and effect…. The Church, indigenous people are called ‘plains indigenous peoples’. This term became popular after Taiwan’s indigenous-peoples recognition movement in the mid-1980s rejected the label ‘barbarians’, which the Japanese colonizers had used in reference especially to Taiwan’s highlanders. The colonial government’s management of these highlands populations differed from the management strategies applied to Han and plains indigenous peoples. The islanders, themselves, used the term ‘sian-sinn-má’ to refer to witches and female healers, regardless of whether the witches were from an indigenous plains tribe or an indigenous mountain tribe. See Yayoi Mitsuda (満田弥生), “Sian-sinn-má, Narratives, and Ritual practices: The Survival Strategy of Thao Today” (先生媽、文本與儀式展演：當代邵族的生存策略) in Indigenous Witches and Ritual Practices eds. Taili Hu and Bizhen Liu (Taipei: Academia Sinica, 2010), 467–503. 177 Naoichi Kokubu (国分直一), Tsubo o matsuru mura: Nanpō Taiwan Minzokukō (壺を祀る村 : 南方 臺灣民俗考) (Tōkyō: Sanseidō, 1944). 178 Barbara Ehrenreich and Deirdre English. Witches, Midwives, & Nurses: A History of Women Healers (The Feminist Press at CUNY, 1973), 45. 179 Ibid., 45–46.

63 by contrast, was deeply anti-empirical. It discredited the value of the material world, and had a profound distrust of the senses.”180 Spiritual practices and medicine were intertwined with each other at this moment in Taiwan. For example, many local islanders believed that only an exorcism (siu-kiann) could rid a patient of a shock-induced malady.181 Childcare and reproductive health care also could involve spiritual practices. Exorcism was especially common for babies and toddlers if they constantly cried for no discernable reason or could not eat or sleep well. In northeastern colonial Taiwan, people believed that babies who regurgitated milk or had diarrhea would benefit from a red rope tied around their hands.182 If obstructed labor took place, sian-sinn-má would request that the family perform some sorcery, such as hanging tree leaves on the front door and praying for a smooth childbirth.183 It is believed that there is a God of babies who protected women once they become pregnant…. If anything were in the women’s room or if even a single nail were in the wall, the God of babies would be offended; thus, the God would make the pregnant women feel uncomfortable or make their fetal movements be abnormal. Sometimes the God would inflict abdominal pain or even a miscarriage or obstructed labor on the mother…. If an expectant mother cut her clothes or cleaned a ditch in a garden, her baby would have a cleft lip.184 Many pregnant Taiwanese women who felt compelled to avoid disturbing the God of babies would refrain from doing housework and might re-assign the work to other women in the family. Overwork was considered to be a serious threat to a healthy delivery. In particular, other women in the family cared for the lying-in women by cooking them special post-partum meals, by handling all gifts for the pregnancy, and by practicing magic specially concocted for the benefit of babies.185 These activities brought women together at the family level and even at the community level, all in support of lying-in mothers and their little offspring. Similar to witches in the Western contexts discussed above, sian-sinn-má in colonial Taiwan provided healthcare services. In contrast to Western witches, however, some sian-sinn-má openly and acceptably practiced magic, in addition to health care. Examples of this magic include rituals for women in labor and for infants. By providing health care and supernatural non-medical guidance, some sian-sinn-má came to be known as “wise women” who spent no less time caring for the spiritual well-being of women and children than for their physical well-being.

180 Ehrenreich and English, Witches, Midwives, & Nurses, 48. 181 Tsun Hsien Wu (吳尊賢), “The Practices and Magic Spells of Siu-kiann” (收驚，收⼟神的⽅法與咒⽂), Taiwanese Folkways (民俗台灣), 5 (1942): 60–61. 182 Chao Tzu Chen (陳⽒照⼦/池⽥敏雄), “Report on the Local Customs in Yilan” (蘭陽俗信), Taiwanese Folkways (民俗台灣) 3 (1942): 54. 183 A. Chang Lu (呂阿昌), “Taiwanese Folk Customs about Pregnancy and Laboring” (和姙娠及生產有關 的台灣民俗) Taiwanese Folkways (民俗台灣) (1941): 2–5. 184 Ibid. 185 Feng Tzu Huang (黃氏鳳姿), “The Practices of Postpartum Care” (做月內), Taiwanese Folkways (民俗 台灣) (1942): 38–39.

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The Work of Traditional Female Healers In traditional Taiwan, a woman undergoing pregnancy, labor, and post-partum care relied on multiple women from her family and her village, and sian-sinn-má were typically an important component of this group capable of giving technical instructions beyond everyday care. Aware of this reliance, Japanese police kept records of sian-sinn- má. These records were few in number and sparse, and are thus valuable primary sources regarding the matter. When a family has a pregnant woman, they will hire a senior wise woman. The very next day, the senior wise woman will pay a visit to the pregnant woman and will assess the patient’s situation. During labor, the senior wise woman will take care of the baby and mother…. If the family is too poor to hire a senior wise woman, they will rely on a junior wise woman, who usually hails from the local neighborhood…. In general, these two kinds of wise women are called sian-sinn- má. They tend to be over the age of thirty, as very few sian-sinn-má are young women…. In fact, if a midwife is younger than forty, no one trusts her.

Sian-sinn-má were also pediatricians. A Japanese-trained islander obstetrician recorded his thoughts on this medical role:

If babies present signs of an abnormality or sickness, [their families] have to take them to see a sian-sinn-má. Thanks to their experience, these old ladies are specialized in diagnostic practices for babies and toddlers. Most of these women’s methods involve needles for the treatment of oral mucosa and then prescriptions consisting of ground medical powders.186

Born in 1920 in Taiwan, Chuang Shu-Chi became the first female licensed practitioner of traditional medicine after Japan’s colonization of the island. Records of her oral history corroborated the assertion that sian-sinn-má were female healers familiar with many types of treatments. In this regard, she recalled the traditional pharmacy that her father had owned and operated: …in the afternoons [at the pharmacy], there were many sian-sinn (male local doctors, often lacking any formal education), sian-sinn-má, and bare-foot doctors. They had come to our store to get prescriptions. When they came, I often cooked delicious snacks for them and absorbed knowledge from them. Thus, thanks to my father, I acquired my medical skills and my knowledge of various kinds of secret prescriptions and natural treatments.187 Chuang Shu-Chi later saved the lives of children by using the treatments that she had gleaned from, among others, sian-sinn-má. She recalled one such situation involving one of her aunts who had lost four of her newborn boys: Because of disease, some of [the four boys] lived for just a few days and some for just a few months. [My aunt] had a fifth son whose name was Lao. When he was

186 A. Chang Lu (呂阿昌), “Taiwanese Folk Customs about Pregnancy and Laboring” (和姙娠及生產有關 的台灣民俗), Taiwanese Folkways (民俗台灣) 11 (1941): 2–5. 187 Shu-Chi Chuang (莊淑旂) and Hsueh-chi Hsu (許雪姬), The Memoirs of Shu-Chi Chuang (莊淑旂回憶 錄) (2001), 41.

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almost one year old, he developed a fever that turned into pneumonia. A…[Japanese-trained Taiwanese] pediatrician claimed there was no way to save him and declared, “Don’t take him here [to my clinic] anymore. Just come to get a death certificate”…. [The fifth son’s] hands and feet were cold, he suffered from abdominal distension, his breath was weak, and he kept twitching…. [At that time] I remembered a specific prescription that I’d learned about from the sian-sinn-má who’d bought medicine from [my father’s store]…. [With this medicine, I] then saved [the son]…. Lao is in his sixties now…he thanked me for saving his life… Chuang Shu-Chi also recounted how her own son’s life had been saved by a sian- sinn-má in a rather dramatic circumstance. After her son had fallen ill, Chuang took him to Mackey Memorial Hospital on the assumption that it was a good Christian hospital dedicated to caring for all patients. However, problems quickly arose: [The hospital] asked me to pay a deposit and have a guarantor. I was having trouble paying my bills at the time, so I couldn’t pay the deposit, either. I had no choice but to take my child back home with me…. Then I met a sian-sinn-má. She asked me, “What are you going to do with your baby?” I told her I couldn’t afford to send my child to the hospital, so she took my baby, used her mouth to suck out his phlegm, and for bloodletting, punctured his philtrum and nose followed by his fingers. At first, black blood oozed out. She didn’t stop the bloodletting until red blood started coming out. She then rubbed the child’s belly button, took off her outerwear to cover the child, and then gave me some advice: “Given your current circumstances, you can’t take care of your little one. It would be best if you give me the child. After three days, you can come back and get him.” Although I was comfortable giving her my child, I was worried about his health. I visited him every single day during these three days. My son recovered. It was almost like a miracle.188 Not all of Chuang Shu-Chi’s memories were of successful interventions by sian- sinn-má. She told one story about a sian-sinn-má who practiced witchcraft and whose medical advice was sometimes less than successful: My mother collected money from our honey-bee farm…but [one day she] fell over [at the farm]…. She developed a fever and started saying crazy things, yelling in uncontrollable fits, and feeling very uncomfortable…. A sian-sinn-má told my mother that her fall had caused her to lose her spirit but that her spirit could be recovered at the top of a mountain if somebody there would perform special rites involving her clothes, some rice, and seven black ropes. I’d heard there was a ghost with long hair on that mountain, so I didn’t want anything to do with it, but my mother would have been very disappointed with me if I hadn’t helped out…so I followed the instructions of that sian-sinn-má and collected the spirit. Despite all this, my mother’s condition didn’t improve.

Chuang Shu-Chi did not mention whether or not her mother eventually got better, but because Shu-Chi took over most of the work in the family pharmacy, her mother might never have recovered enough to re-assume the responsibilities associated with the business. Some sian-sinn-má practiced witchcraft medicine extensively and were respected for their power and care:

188 Chuang and Hsu, The Memoirs of Shu-Chi Chuang, 96.

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People called…Ms. Hsieh Chin-Lien, who lived from 1926 to 2000, a “sian-sinn- má”…she was highly respected in the Hualien Bay area [in the east of Taiwan]. She didn’t come from a high-class family and had no professional medical background, but she exhibited great sympathy and performed many miracles…. [One of the miracles involved] the first-born son of Ms. Chen…. [The baby] had returned home from the hospital after his birth but proceeded to cry every evening and night—the so-called darkness fits…. The neighbors referred her to…a sian- sinn-má, [Ms. Hsieh], who told her that because…an ancestor…was happy and was coming to play with the baby at night, the baby was crying every night…. [Ms. Hsieh] asked Ms. Chen to pray to her ancestors and to ask them not to play with the baby…. The sian-sinn-má then gave Ms. Chen seven pieces of colorful cloth and some Ohwia caudata and told her to bathe the baby in these materials. Afterward, the baby never cried [at night].189 The quotes above reveal just how varied the roles and practices of sian-sinn-má were. These women could be midwives, pediatricians, doctors, witches, or all of the above.

Hygienic Modernity for Women but “Not My Midwife” In colonial Taiwan, the story of school-trained midwives was quite different from the story above regarding sian-sinn-má. To get licensed, the midwives had to attend the School of Midwifery or other training programs established by the colonial government. These women often came from well-off families and had already received some formal schooling that made possible an independent professional career. Thus, the women, upon establishing themselves as midwives, enjoyed not only a much higher social status, but also a much higher income, than did the sian-sinn-má. Around the 1937–1938 period, the typical income of a middle-class family in Taiwan was between 40 and 150 Japanese yen per month, but a licensed midwife earned 120 Japanese yen per month in 1944, when the economy had worsened because of the wartime difficulties.190 Schooling in midwifery provided these female professionals with healthcare knowledge that was based on biomedicine. Their training covered human anatomy, sanitation, childbirth, fetal positions, and cord clamping.191 In addition to midwifery, the prevention of puerperal fever was one of the most important areas in which these modern midwives received training. Moreover, the prevention of puerperal fever was one of the most important indexes by which the colonial government could monitor the modernization of the island’s medical system and the health of the island’s population. Thus, the government required that licensed midwives record and report to the police all

189 “The Oral History of Sian-sinn-má in Hui-An-Tang (2): Darkness Fits and the Effectiveness of Seven Colors of Clothing (惠安堂先生媽濟世篇之二：哭暗黑、靈驗七色布) (2013), https://liu226688.pixnet.net/blog/post/297288956. This case took place in 1985, but considering that Ms. Hsieh Chin-Lien had started to practice medicine before the 1950s, at a time when Japanese colonization had just ended, I thought it useful to include the case in the current chapter, along with this qualification. 190 National Museum of Taiwan History (國立臺灣歷史博物館), Modern Women and the Career Paths of Midwives: The Working Notes of Mary Chen Huang (摩登女性，產婆軌跡──黃陳梅麗的助產工作簿) (2019). 191 He Chen and Shiyong Liu, Notes on Midwifery: Ms. He Chen (陳何女士助產學筆記) (2017).

67 data regarding births and cases of puerperal fever.192 This requirement reflects three important facts: the government’s inclusion of women healthcare providers in the official public health system, the government’s focus on hygiene, and the enormous official distinction between sian-sinn-má and licensed midwives. In their line of work, unlike sian-sinn-má, licensed midwives never engaged in religious or supernatural practices. The quality of a midwife’s work was often exemplified by the number of puerperal fevers and perineal tears she had treated in her career.193 Midwives were often described as modern, hard-working professional women by the media and in official records.194 The training and practices associated with modern midwifery reflected biomedicine’s emphasis on germ theory and hygiene in colonial Taiwan. School-trained modern midwives reflected, in particular, the application of germ theory to reproductive health care, which had not attracted much medical attention in Taiwan prior to 1907, when the colonial government started to recruit trainees for modern midwifery. The importance of hygiene to reproductive health care had even been lacking in missionary medicine, which had accounted for Taiwan’s only pre-colonial biomedical practitioners. In the realm of midwifery, colonial-era training and practices focused on the prevention of postpartum infections, which thus narrowed the scope of reproductive care. Excluded from this scope were children. Thus, colonial Taiwan’s program for modernized midwives partially medicalized reproductive care, mainly births and postpartum hygiene for the mother and newborns, leaving other elements of reproductive and pediatric care, such as breastfeeding and toddler health care, to traditional female healers. The pursuit of “hygienic modernity” was long at the center of colonization and semi-colonization in the modern era. Historian Ruth Rogaski, focusing on the late 19th and early 20th centuries, discusses “hygiene” in China generally and disease control in the treaty-ports of China specifically. The ports—including the notable port of Tianjin—were under the influence of multiple foreign countries, including Great Britain and Japan. The success of a colonial territory’s public health was a significant way to show off the power and civilizing influence of the colonizer. Aware of this dilemma, the Qing (Chinese) government sought to regain control of Tianjin by institutionalizing hygiene and other public-health practices in the port city. The process of institutionalization began with a major focus on personal behaviors and then extended to racial purity and nation building: Chinese physicians and intellectuals, who were often as worried about foreign intervention in China as the Qing government was, blamed Chinese people for being physically weak, dirty, and uncivilized, and argued that, if China was to improve as a nation, all Chinese had to live a “hygienic” life in unity. This argument continued into the 1930s and 1940s, when China was at war with Japan and in the 1950s, when China participated in the Korean war against the United Nations coalition. The argument was a powerful one: a successful personal war against germs would translate into a successful collective war against aggressor nations.195

192 He Chen and Shiyong Liu, Notes on Midwifery; and the National Museum of Taiwan History (國立臺灣 歷史博物館), Modern Women and the Career Paths of Midwives: The Working Notes of Mary Chen Huang (摩登女性，產婆軌跡──黃陳梅麗的助產工作簿) (2019). 193 He Chen and Shiyong Liu, Notes on Midwifery, 32. 194 Ibid. 195 Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (Berkeley: University of California Press, 2014).

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In this regard, an important question arises: were women to be part of Chinese nation-building? Historical studies focusing on colonial medicine have found that colonial powers subjugated colonized women to the “hard politics” of nationalism and imperialism, and that this subjugation operated mainly through the colonizers’ population policies aiming at mothers giving birth to—and raising—stronger children. 196 Under these policies, women were essentially incubators of future babies and were thus legitimate targets of reproduction controls. Policymakers were mostly male officials and professional contractors. However, the case of licensed midwives in colonial Taiwan shows that females were unwittingly but significantly involved in the politics of healthcare, not just the politics of motherhood. In the case of Taiwan, imperial Japan’s construction of colonial hygienic modernity on the island rested, in part, on midwifery, which itself rested almost exclusively on Taiwanese women: they were educated, licensed female professionals. However, this empowerment of Taiwanese females came at the expense of another group of Taiwanese females: Taiwan’s traditional female healers, sian-sinn-má. Moreover, the substitution of modern midwives for sian-sinn-má reflected a forced re-organization of healthcare for Taiwanese women. In colonial Taiwan, the Japanese authorities’ justification of modern midwifery rested mainly on hygiene, which itself rested mainly on a combination of germ theory and sanitation practices. It was this conceptual justification of modern midwifery that simultaneously justified the elimination of traditional midwifery. Medical modernization extended into women’s reproductive health care—an area that pre-colonial Taiwanese governments had left alone. It is worth noting that Japan did not introduce midwifery schooling for local Taiwanese women until 1907. Moreover, Japan did not extend the training program until 1923. In contrast, the Japanese colonial government regulated all-male practitioners of traditional Taiwanese medicine in the very first year of colonization. Yet another interesting point is that, in other Japanese colonies, such as Manchuria and Korea, modern midwifery was a significant eugenics effort undertaken by imperial Japan in order to breed stronger populations.197 These differences between Japan’s handling of Taiwanese midwifery and Japan’s handling of other imperial biomedical efforts reflect Japan’s prioritization of male over female healthcare providers in colonial Taiwan and Japan’s view that Manchuria and Korea were the frontlines in Japan’s imperial project to control mainland China: these two colonies offered Japan an expedient source of soldiers and workers. The healthcare policies in those two colonies were therefore firmly connected with Japan’s broader imperial agenda, in which colonial Taiwan simply did not play as prominent a frontline role as Manchuria and Korea, but functioned as a showroom of Japan’s male-dominated medical modernity. Imperial Japan’s re-organization of women’s health care in Taiwan focused on improving the hygienic practices of midwifery, not on childcare. This exclusion of

196 The Japanese empire launched a modern healthcare project in colonial Korea, but rather than train an army of hygienically minded modern midwives there, Japan focused largely on improving the “physical quality” of women and their offspring. To accomplish this goal, the colonial government promoted such steps as late marriages, while placing less emphasis on modern midwifery. Women in colonial Korea were thus absorbed into the biopolitics of the Japanese empire through a transformation of their marriages, childbirths, and motherhoods. See Theodore Jun Yoo, The Politics of Gender in Colonial Korea: Education, Labor, and Health, 1910–1945 (Berkeley: University of California Press, 2008). 197 Yoo, The Politics of Gender in Colonial Korea, 162.

69 childcare from midwifery is one possible reason why local women still preferred to work with traditional female healers. Archives, memoirs, and other sources of information about sian-sinn-má show that they devoted a great deal of their time to children’s health care, perhaps even more than to expecting women. The memoirs of Shu-Chi Chuang, for example, reveal that she saved a child by relying on a prescription taught to her by sian- sinn-má and that a sian-sinn-má extensively treated her own son. In other words, evidence suggests that Taiwanese women relied on sian-sinn-má not only for childbirth health care, but more importantly, for pediatric health care. Because previous research on sian-sinn-má has framed them as “traditional midwives” and thus as practitioners mainly of “midwifery,” it has been easy to overlook the child-oriented practices of sian-sinn-má. This insight likely sheds new light on why, throughout the colonial period, the Taiwanese population remained closely attached to traditional female healers even though formally trained midwives were available. The crucial misstep on the part of the colonial government was its assumption that trained modern midwives were replacing traditional midwives, when in reality, the traditional “midwives” were traditional female healers serving as pediatricians. Such practitioners would have been hard to replace, especially insofar as most middle and lower-class Taiwanese families could not afford formal health care, a topic I analyze in detail regarding drug prices (see Chapter 4).

Gendered Medicine Sian-sinn-má, because they practiced both magic and healthcare for women and children, were viewed by many Taiwanese as a necessary provider of family healthcare. Nevertheless, the social status of these traditional female healers was low because local Taiwanese society assigned great value to males and to formally educated intellectuals, and sian-sinn-má were neither. Male practitioners of traditional medicine, who themselves were also oppressed by the colonial government, often blamed ignorant traditional midwives and their preoccupation with magic for problems that might arise during the birthing process.198 Another factor that contributed to these female healers’ low social status was their mobility, which violated society’s gendered expectations of women: where Taiwanese culture expected women to stay at home and serve their own families, sian-sinn-má were constantly going in and out of others’ homes, giving advice, and prescribing treatments. Some Taiwanese considered sian-sinn-má to be “toxic” because the women’s extensive social network would enable them to spread poisonous gossip to “good” housewives.199 The social attitude toward sian-sinn-má was, thus, dual: Taiwanese admired them for their healthcare prowess but looked down on them for their violation of convention. By blaming sian-sinn-má for their “dirty” practices and witchcraft, colonial health officials (unsurprisingly, all males) were further helping establish in Taiwan a pair of

198 Teng Yun Huang (黃登雲), “A Few Warning Notes about Postpartum Issues, Part 1” (產後警醒數則 （一）), Daily New Newspaper in the Han Language (漢文日日新報), May 1, 1908. 199 The Taiwanese term ‘三姑六婆’ (san gu lioù pó) originally referred to nine kinds of religious and working women: Buddhist nuns, Taoist nuns, female fortune tellers, female human traffickers, marriage matchmakers, witches, female pimps, female doctors, and midwives. This term later extended to women who endlessly gossiped in public and to women whose intrusive toxic personalities could harm housewives on their own domestic turf. The usage reflected Taiwanese society’s stigmatization of women who worked or engaged in other frowned-upon activities outside the home.

70 categories that, according to historian Barbara Ehrenreich, had already emerged in medieval Europe: “female” superstition and “male” medicine, constructed by both the Church and university-trained physicians in order to exclude women from practicing medicine. 200 In the case of imperial Japan, the nation sought to suppress female superstition by institutionalizing school-trained midwifery: the resulting system placed several aspects of reproductive health care exclusively in the hands of females (the midwives), but these women were trained and managed by the male-dominant modern medical establishment of the colonial authority and, more broadly, Japan.201 The midwife licensing system in colonial Taiwan formally designated certain aspects of reproductive health care as a sphere of activity that was for women and only for women: the training programs and institutes for midwifery accepted only women as candidates.202 By the same token, in the colonial medical system, local women for the most part could be nurses and midwives, not physicians. 203 “Certain aspects” of reproductive health care were exclusively the terrain of female practitioners because the design of the licensing and training system for midwives also pointed to a clear line between health care and medical treatments; and this line existed because colonial medicine assigned normal births to (female) midwives and abnormal childbirths to (male) obstetricians. The assignation of normal births to midwives and abnormal births to physicians reflected a demarcation between health care and medical treatment. This differentiation meant that midwives were more like caregivers than healers, and were subordinate to—not independent of—physicians. In a parallel way, sian-sinn-má occupied a much lower rung in the social and professional hierarchies than did local male practitioners of Han traditional medicine. However, here the parallels end, because sian- sinn-má practiced medicine more broadly than a typical licensed midwife and did so mostly on their own rather than as support for male medical personnel. For medical supplies, some sian-sinn-má would likely rely on shops that, like Shu-Chi Chuang’s family-owned store mentioned above, sold traditional medicine. Nevertheless, most sian- sinn-má had no access to a formal medical network, and this fact is another reason why sian-sinn-má remained hidden from history. The colonial system’s assignation of births and only births to modern midwives also reflected a new system for categorizing care-receivers. Using these categories, the colonial healthcare system made specific healthcare providers responsible for specific aspects of women’s health care, including the reproduction process. For most local women in colonial Taiwan, having a baby was a continuous process in which they would

200 Ehrenreich and English, Witches, Midwives, & Nurses, 57. 201 It should be noted that a few Taiwanese female physicians, such as Dr. Tsai Ah-Hsin (蔡阿信), not only worked in the OB & GYN field but trained midwives, as well. The patients of these physicians were primarily local Taiwanese women. Because the Medical School of the Colonial Government accepted only male students, almost all physicians were male during the colonial period. 202 After Japanese colonization ended, male physicians became even more dominant in the OB & GYN field and further strengthened the gendered dynamics in this field. See Dawei Fu, Taiwan. A New Body in Asia: Gender, Medicine, and Modern Taiwan (Yaxiya de xin shen ti: xing bie, yi liao, yu jin dai/ 亞細亞的 新身體) (Qun xue chu ban you xian gong si, 2005). 203 The medical school in colonial Taiwan (known as the Medical School of the Colonial Government) accepted only male students. It was not until 1921 that the first Taiwanese female medical student, Tsai Ah- hsin, earned a medical degree, interestingly enough from Tokyo Women’s Medical College. Shortly thereafter, she started to practice medicine in Taiwan.

71 receive health care from one or multiple female caregivers—usually female senior family members or sian-sinn-má, who would individually or collaboratively take care of women across all the stages of the reproductive process (pregnancy, birth, and nursing) and would also take care of the newborn children. The establishment of modern midwifery was part of a new system for dealing with the “biological” stages in reproductive health care, with each stage corresponding to a particular category of practitioner: births and newborns were the province of school-trained midwives; toddlers and children were the province of physicians; healthy expectant or lying-in mothers were the province of midwives; unhealthy expectant or lying-in mothers were the province of physicians. This new system contributed to colonial legitimacy by mirroring the modern Western medical system at that time—a system that remains in place today. While historical studies have focused on the formation of modern midwives and have improved health care for women, it is worth noting that there were probably fundamental differences between women’s childbirth experiences with school-trained midwives and women’s childbirth experiences with sian-sinn-má. The two types of services reflected different conceptions of having babies, rather than a simple replacement of traditional female healers with school-trained midwives. Today, the American Pregnancy Association describes a midwife as “a health care professional who provides an array of health care services for women including gynecological examinations, contraceptive counseling, prescriptions, and labor and delivery care.”204 While many women are now physicians around the world, midwifery remains a heavily female-dominant healthcare field, and midwives are limited to reproductive care: they still do not provide comprehensive care for women.

The Economic Transformation behind Midwifery The school-trained licensed midwives in colonial Taiwan constituted a newly emerged profession, and many studies have noted how this profession improved the socio-economic status enjoyed by licensed midwives—one of the very few professions in which women, independently and outside the home, could earn a salary capable of supporting a family.205 While the establishment of the midwife profession in colonial Taiwan significantly advanced the lot of local women, this advancement was in fact an economic re-distribution from one group of women to another: from sian-sinn-má to licensed midwives. Studies on bio-medicalization have explored the economic transformation that accompanied America’s bio-medicalization in the late 19th and early 20th centuries.206 These studies are useful for understanding the historical processes that played out in colonies such as Japanese Taiwan. For the current study, I thus pay attention to seven key factors: organizational structure of the profession, forms of payment, sites of care, key economic phenomena or contexts, key socioeconomic processes of bio-medicalization, biomedical-research sponsorship, and government involvement in medical practices. Applying this analytical framework to Table 3, I demonstrate the socio-economic

204 The American Pregnancy Association, “Midwives,” April 25, 2017. https://americanpregnancy.org/labor-and-birth/midwives/ 205 Chen and Liu, Notes on Midwifery. 206 Adele E. Clarke, Biomedicalization: Technoscience, Health, and Illness in the US (Durham, NC: Duke University Press, 2010).

72 transformation that occurred as colonial Taiwan transitioned from traditional sian-sinn- má to modern midwives.207

Table 3: Seven key socio-economic factors in colonial Taiwan’s transition from sian- sinn-má to modern midwives key transformations sian-sinn-má school-trained licensed midwives organizational structure of the mostly mostly formal structures: (1) profession informal or semi-formal training involved official or structures: (1) training private institutions devoted to involved apprenticeships or midwifery; (2) no formal collaborations with other professional organization traditional healers; (2) represented the midwives, networking usually involved whose networking usually local recommendations from involved direct employment by clients the colonial government for service in designated areas

forms of payment currency-based payments, currency-based payments bartered goods and services sites of care clients’ homes clients’ homes key background economic before the 1920s, mostly after the 1920s, mostly phenomena at the time agriculture; overseas trade agriculture; colonial tropical focused on tea exports commercial plantations and light industry devoted to cane sugar and camphor208

key aspects of social structure in social elites consisted mainly landowners and bio-medicalization of landowners and traditional businesspersons occupied the intellectuals; businesspersons upper echelons; Taiwanese emerged as a new social elite physicians emerged as social elites medical research sponsorship none (all research was self- the colonial government funded) government involvement Rare establishment of training and licensing systems for midwives; enforcement of

207 A. E. Clarke, J. R. Fosket, L. Mamo, J. R. Fishman, and J. K. Shim, “Charting (Bio) Medicine and (Bio) Medicalization in the United States, 1890–Present,” in Biomedicalization: Technoscience, Health, and Illness in the US ed. Adele E. Clarke (Durham, NC: Duke University Press, 2010), 88–103. 208 For an interesting study on industrialization and the sugar industry in colonial Taiwan, see Chih-ming Ka (柯志明), Mi tang xiang ke: Riben zhi min zhu yi xia Taiwan de fa zhan yu cong shu (米糖相剋 : 日本 殖民主義下臺灣的發展與從屬) (Taibei Shi: Qun xue chu ban you xian gong si, 2006).

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licensing rules and of public health polices; use of modern medicine as a colonial- management tool in Taiwan

In the last half-decade of Japan’s colonization of Taiwan, most local women dealing with a reproductive healthcare matter sought the assistance of sian-sinn-má. Nevertheless, the colonial government’s attempt to shift supply—and in turn demand— away from sian-sinn-má and toward modern midwives had been increasingly successful over the decades. The shift helped modernize the Taiwanese economy, in particular by accelerating the shift from barter payments to currency payments. Thus, the colonial attempt to shift from sian-sinn-má to school-trained midwives eventually resulted in not only a medical transformation but an economic one, as well. Around the world, modernization practices under the pressure of Western imperialism often re-shaped whole economies, not just personal hygienic disciplines. Egypt from the 1860s to the First World War faced pressures from Europe and later became a British colony. Throughout this period, authorities in the North African state promoted public health, sometimes in combination with urban design that served to improve cleanliness, surveillance, and the Europeanization of Cairo. All of these changes had economic consequences. For example, in describing these changes, Timothy Mitchell states, “Open, well-lit streets were a benefit not only to health but to commerce, for they embodied the principles of visibility and inspection…”; also, “the need for cleanliness in the streets reflected the newly envisaged relationship between the city as a place of consumption and the countryside as a place of production.”209 Another example is the practice of “cleaning streets,” which brought about a new order in Egyptian public health, politics, and the economy. The street cleaning started with a simple, literal plan to clean the streets but ended up bolstering urban consumption and shifting production of goods to the Egyptian countryside. Mitchell’s research reminds us that colonial medicine had not only cultural and political consequences but economic ones, as well. Unsurprisingly, those who could afford modern midwifery in colonial Taiwan were often people who earned impressive incomes, which were associated with the island’s developing capitalist economy, not with self-sufficient farms or small businesses, in which monetary economic transactions had not yet fully taken hold. To improve the popularity of licensed midwifery in the wider Taiwanese population, the colonial government starting in 1923 assigned public-funded midwives to 319 towns, mostly in rural areas. However, in the 1930s and 1940s, more than half of new-born babies in colonial Taiwan were delivered without the aid of licensed midwives.210 This statistic shows that economic factors cannot fully explain why some people preferred traditional midwives over licensed midwives. It was difficult to detect to what extent economic factors shaped each Taiwanese family’s decision to work with sian-sinn-má or modern midwives, but forms of payment constitute another possible reason why people preferred sian-sinn-má to midwives. Sian- sinn-má accepted cash payments, bartered payments, or a combination of both, with bartered items ranging from handcrafted goods and agricultural produce to services

209 Timothy Mitchell, Colonising Egypt (University of California Press, Kindle Edition, 1991), 67. 210 Xiurong Zhang, Ri zhi tai wan yi liao gong wei wu shi nian xiu ding ban, 121.

74 rendered.211 This economic system maintained the pre-modern, pre-colonial economic system that had long existed on the island: not yet fully monetary and often limited to exchanges within a small community. The bills and payments in colonial Taiwan’s economic system were tantamount to social contracts among community members and reflected the social construction of childbirth. In a realistic novel describing the life and identity of colonial Taiwanese, “giving birth” was portrayed as a “natural” and “private” practice that required collaboration only with senior women in the expectant mother’s village.212 Historians have found that a majority of Taiwanese people during the colonial period preferred sian- sinn-má over licensed midwives not so much because of cost as because of privacy: Taiwanese traditionally assigned profound importance to keeping a low profile during the various stages of childbirth.213 This desire for privacy, coupled with the prohibitive cost of midwives and with the reluctance to receive modern medical attention from professional outsiders, goes far in explaining why so many people in colonial Taiwan still embraced sian-sinn-má and were decidedly unenthusiastic about modern midwives.

211 Iwao Kataoka (片岡巖), Taiwan feng su zhi (臺灣風俗誌) (Taibei Shi: Zhong wen tu shu gong si, 1921). 212 Zhuoliu Wu (吳濁流), Yaxiya de gu er (亞細亞的孤兒) (Taibei Shi: Yuan jing chu ban shi ye gong si, 1986). 213 Cai hui pin (蔡蕙頻), Hao mei li zhu shi hui she (好美麗株式會社：趣談日治時代粉領族) (Tai bei: Mao tou ying chu ban, 2013), 112.

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Chapter 4. The Transformation of Drugs and Pharmacies: Global and Local Trade Networks amidst the Changing Definitions of Drugs

This chapter explores the economic and social spaces of traditional medicine and traditional pharmacies in relation to the colonial authority, medical practitioners, customers, and their supply chains. Traditional pharmacies were not only spaces in which to sell traditional medicine, but also clinics, medical training sites, trading hubs, and drug factories. As traditional pharmacies became one of the few legitimate locations where traditional medical practitioners could continue practicing traditional medicine, these sites became the main channels through which everyday Taiwanese people received traditional medicine. Overall, as modern medicine was more expensive than traditional medicine, only members of Taiwan’s upper classes could afford modern medicine, so that traditional medicine became the default medicine for the poor. Because traditional pharmacies and biomedical clinics co-existed, patients and families in need of treatment would sometimes seek it from more than one provider. In other words, the diversity of the market gave patients the opportunity to choose from multiple kinds of medicine available at multiple outlets. Patients were bound to neither a single medical professional nor a single medical outlet. Thus, the preservation of traditional medicine along with the flourishing of modern medicine created an environment in which patients became customers with “freedom of choice.” This type of doctor–patient relationship was very similar to the one that emerged in the 1980s, when the United States commodified its healthcare system, gradually giving patients, as customers rather than as passive receivers, more and more control over their selection of healthcare products and services. The empowerment of healthcare recipients meant that healers became consultants and providers in a competitive market, rather than professional authorities. 214 However, while colonial Taiwan’s traditional healthcare market seems to have provided more options to patients, patients’ options were still limited owing to the regulations of pharmacies and, more importantly, to the low socio- economic status of many patients and their families. As mentioned in the previous chapters, the colonial authority took steps to curb the popularity of traditional medicines on the island and to preserve only the prescriptions of traditional Han medicine. Implemented by the colonial government in 1896, the Regulation of Pharmacists, Pharmaceutical Dealers, and the Pharmaceutical Industry required traders of medicine to take exams and obtain licenses. When the colonial government no longer held exams for practitioners of traditional medicine, exams for pharmacists and pharmacies continued and thus became the only legal way for Taiwanese traditional healers to provide traditional medicine, even though the government had technically barred them from performing diagnoses and from prescribing medicine. In fact, despite the concerted efforts of the colonial government to discourage traditional

214 Edmund D. Pellegrino, “The Commodification of Medical and Health Care: The Moral Consequences of a Paradigm Shift from a Professional to a Market Ethic,” The Journal of Medicine and Philosophy 24, no. 3 (1999): 243–66.

76 medicine, the number of licensed pharmacists of traditional medicine increased until the late 1940s, when, ironically with the collapse of the Japanese empire, biomedicine became popular in Taiwan. The following statistics make clear the immense popularity of traditional medical drugs in Taiwan during the colonial period: in 1899, there were 173 licensed pharmacists of traditional medicine, but in 1906, there were 1,029, and the number increased to 3,511 in 1922 and held relatively steady in 1928 at 3,215 before decreasing to the still impressive figure of 2,130 in 1942.215 These traditional pharmacies, together with unlicensed “house-call” healers, who most often bought medicine from the pharmacies and then resold it to patients, were the core of traditional colonial healthcare. Even though the colonial government and later historians emphasized the significant progress of medical modernization during the colonial era, the island’s biomedical resources were never sufficient: in 1940, there was only 1 physician for every 2,550 islanders (0.39 physicians per 1,000 people).216

What Is Inside a Traditional Pharmacy Traditional pharmacies sold ready-to-take and made-to-order prescriptions, nutritional supplements, and raw and processed medicinal materials for the mixing-and- matching needs of individuals. Most of these items were herbs, but there were also animal and mineral products. Below is an advertisement listing the flagship products of the QianYaun Pharmacy, one of the biggest traditional pharmacies in Taipei.

Business Items in Our Store Aged mountain ginseng, Jilin ginseng, American ginseng, Local/ Manchurian velvet antler, Thailand birds’ nest, Authentic North Vietnam cinnamon, South Vietnam/ Mountain cinnamon, Silver white tremella mushrooms, Authentic Tiger Balm, [all kinds of] Pills, ointment, and powders, Raw and processed medicinal materials, New-arrival prescriptions for oral or external use. Our shop has new equipment for the production of pills. * Special prescriptions made by the shop owner Ten perfect supplement pills: a good prescription for improving both qi and blood; Six ingredient pills: a good prescription for nourishing yin, promoting the circulation of fluids, tonifying the kidneys, and reducing pathogenic fire; Kids’ supplements: a good prescription for promoting kids’ growth; Safe-and-well powders: a good prescription for huo-luan/ cholera, vomiting, and diarrhea. Local island specialty: Finger citron (Oolong) tea *We offer a special rate for labor.

Figure 2: advertisement of QianYaun 1932 (translated on the right)

215 The Taiwanese Colonial Government, Sōtokufu tōkeisho (總督府統計書) (Taipei: Taiwan Sōtokufu Minseibu Bunshoka, 1899–1942). 216 The ratio is calculated on the basis of the population in 1940 according to the Taiwanese Colonial Government, The fifth Census of Taiwan (昭和 15 年第五回臺灣國勢調查). The population in Taiwan in 1940 was 5,872,084.

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The advertisement’s emphasis on the origins of certain ingredients reflects the importance that people assigned to this issue. The quality of medicinal materials was believed to depend on whether they were grown in a good environment. Certain areas had the best reputation for specific medicinal materials. These areas could be found not only in China, but also in Vietnam, Thailand, and even the United States. Most of these reputable areas were outside of Taiwan, so the QianYuan Pharmacy obviously dealt with many imported herbal and animal products.217 The descriptions of the functions of these items convey the medical theories behind these prescriptions: qi, blood, fluids, and fire were all highly theorized conceptions of pathology in traditional Han medicine. However, when prescribing medicine, pharmacists and their apprentices usually relied not on theories but on clinical experience. While some materials were imported from overseas, others were grown locally. For example, a traditional pharmacy in Taipei established an apiary to produce honey for sale and for prescription processing. 218 Aside from a handful of such examples, no evidence has emerged pointing to systematic local plantations that met the medical- material needs of colonial Taiwan. In colonial Taiwan, most processing of medical materials was done by owners, workers, and apprentices in traditional pharmacies, which I describe later in this chapter.

Traditional Pharmacies as a Space for the Preservation of Traditional Medicine Like doctors of traditional medicine, traditional pharmacies in Taiwan were not required by the government to obtain licenses until Japan’s colonization of the island. In June 1896, the colonial government announced the aforementioned Regulation of Pharmacists, Pharmaceutical Dealers, and the Pharmaceutical Industry (臺灣藥劑師、藥 種商、製藥業者取締規則), which covered both Western medicine and traditional medicine. The regulation categorized (1) pharmacies as entities that could “trade drugs,” (2) pharmacists as entities that could “produce and trade drugs,” and (3) the pharmaceutical industry as an entity that also could “produce and trade drugs.”219 This regulation stipulated that, pharmacists could sell medicine that they had produced either on their own or according to a physician’s prescription. All drugs on the market had to be registered with the Japanese Pharmacopoeia, an official list of records covering all known medical materials, crude drugs, and prescriptions.220

217 As traditional Han pharmacies handled many imported medical materials, fresh Taiwanese herbs could be found at green herbal stores. These stores would sell locally grown or collected herbs and distribute the resulting herbal prescriptions, which were based mainly on folk medicine rather than on traditional Han medicine. Some stores continue to operate today and include the Green Herbal Lane in Taipei. See TzuHua Chen (陳姿樺), “‘Saving Life Lane’ in History” (歷史中的「救命街」青草巷延續百年生機) (Bank of Culture), http://bankofculture.com/archives/4179. 218 Shu-Chi Chuang (莊淑旂) and Hsueh-chi Hsu (許雪姬), The Memoirs of Chuang Shu-Chi (莊淑旂回憶 錄) (2001). 219 National Research Institute of Chinese Medicine, Ministry of Health and Welfare (Taiwan), “The Policy of Han Medicine and Drugs in Colonial Taiwan (「廢醫存藥」－日治時期臺灣的漢醫藥政策), https://demo.cms.culture.tw/nricm/zh-tw/collections2. 220 National Research Institute of Chinese Medicine, Ministry of Health and Welfare, “The Network of the Pharmaceutical Industry in Colonial Taiwan” (日治時期臺灣的藥業網絡), https://demo.cms.culture.tw/nricm/zh-tw/collections5.

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Unlike the colonial government’s licensing policy for medical practitioners, Regulation of Pharmacists, Pharmaceutical Dealers, and the Pharmaceutical Industry did not make a clear distinction between practitioners of Han medicine and practitioners of Western medicine. When practitioners of traditional medicine were no longer being licensed, many kept their medical business by obtaining a license for pharmaceutical dealers. The licensing exam for pharmaceutical dealers offered two tracks: one for Western medicine and the other for Han medicine. Interestingly, even though there were two types of exams, there was only one type of license. Most store owners or practitioners of traditional medicine would obtain the license designated for pharmaceutical dealers and pharmacists, as it would permit them to make and distribute medicine. As mentioned in Chapter 1, this reliance on licensing became so systematic a way for Taiwanese practitioners of traditional medicine to preserve their heritage that, in 1933, organizers of the revivalism movement held lectures guiding prospective exam- takers through the licensing process. Receiving a license did not give traditional pharmacies carte blanche to do whatever they wanted: they were monitored by public physicians, whose surveillance was part of the colonial public-health structure. 221 Even more observant than public physicians were the police, who shouldered the brunt of the responsibility for investigating possible violations of medical regulations, including practicing medicine without a license and selling hazardous materials illegally. In 1912, the Japanese colonial government announced the Regulation of the Prescription Business in Taiwan (臺灣賣藥營業取締規則). This regulation required that marketed over-the-counter prescriptions obtain approval from the colonial authority. To get approval, the businesses attempting to sell the prescriptions had to disclose a significant amount of information pertaining, for example, to the identities and contact information of all responsible persons and to the proven effectiveness of the given drug. The regulation also required these businesses to comply with regular on-site inspections. Back in the Japanese homeland, some manufacturers of traditional medical drugs did significant business in Taiwan and were thus worried that the government would prevent them from importing herbs and other medicinal materials from China. This worry was based on these manufacturers’ assumptions that (1) it was difficult to work through the efficacy tests for each medical material and prescription, and (2) it was difficult to maintain sales in colonial Taiwan. The Japanese manufacturers, who went so far as to conceal their traditional pharmaceutical formulas from one another, argued against this regulation. This rule, although it applied to all manufacturers in colonial Taiwan, placed more pressure on Japanese manufacturers than Taiwanese manufacturers, because at this time, most marketed over-the-counter prescriptions were made by Japanese manufacturers, who were consequently the main target of government requirements. By contrast, the governing authority in Japan’s colony of Korea did not require transparency of formulas in prescriptions. Soon after the establishment of this policy, Japanese

221 Shiyong Liu (劉⼠永). Rong yao ji shi: xing zheng yuan tui fu hui rong min zhi yao chang. (榮藥濟世 : ⾏政院退輔會榮⺠製藥廠) (Tai bei shi: Dang an guan li ju, 2009), 27.

79 producers of traditional drugs convinced the government to loosen its requirements and not require the disclosure of detailed formulas.222 In colonial Taiwan, the government’s licensing of traditional pharmacies essentially created “shelters” for unlicensed practitioners of traditional medicine who offered their services to the public from these pharmacies, as I discuss in detail below. Because the colonial government in Taiwan focused on the registration of pharmaceutical products and pharmacists, which technically put the management of traditional and biomedical prescriptions and pharmacists under a single regulatory framework, traditional pharmacies were able to remain in business. Even though law enforcement would inspect them and search for unlicensed practitioners of traditional medicine, most of the time these pharmacies escaped crippling fines or closures.223 To some extent, thus, the pharmacies did not feel compelled to significantly re-design their establishments and practices. By regulating traditional local pharmacies, the colonial government was essentially trying to create modern pharmacies from establishments that had much in common with Western apothecaries of the past. Apothecaries in Europe were pre-modern pharmacies that, under little government supervision, formulated herb- and chemical- based prescriptions and distributed them to the public. The influence of European apothecaries grew from the 14th to the 17th centuries, and much of this growth is attributable to the alliance that apothecaries formed with groceries. The foray into food kept developing, as apothecaries increasingly engaged in the sale of imported spices, which was consistent with the paradigms of Humorism and of food–medicine homology, the latter of which was a strongly held belief in Europe, as well as in China at this time.224 It is well known that Europeans sought Eastern spices for the preparation and preservation of meat, but recent historical studies have found that, at least in 16th-century Europe, people considered spices to be akin to medications. The upper classes were willing to pay expensive prices for, among other spices, black pepper to improve men’s energy and cloves to maintain memory and alleviate tooth aches. The demand for these materials became a central motivation in European exploration of the world in the 15th century.225 It was not until the 19th century that the production of medicine shifted to the pharmaceutical industry, wherein licensed pharmacies and pharmacists replaced apothecaries, and the food–medicine homology faded from medicine. In the 20th century, the business of modern pharmacies relied more and more on distribution and on patient counseling than on the sale of groceries.226

222 Shuyuan Gao (高淑媛) “From the Improvement of Han Prescriptions to Professional Hermetical Industry (漢方改良到專業製藥─近代臺灣製藥史) in Tai wan jin dai hua xue gong ye shi (1860–1950): ji shu yu jing yan de she hui lei ji (臺灣近代化學工業史(1860–1950)：技術與經驗的社會累積) (Tai bei shi: Tai wan hua xue gong cheng xue hui, 2012). 223 “The Strict Search for Unlicensed Practitioners of Medicine” (密醫取締嚴厲), Taiwan MinPo Newspaper (台灣民報), October 16, 1929. 224 Gregory J. Higby and Elaine C. Stroud, The History of Pharmacy: A Selected Annotated Bibliography (New Yok: Routledge, 2020), viii–viii. 225 Masashi Haneda (羽田正), Higashiindo Gaisha to Ajia No Umi (東インド会社とアジアの海) (Tōkyō: Kōdansha, 2007), ch. 7. 226 Higby and Stroud, The History of Pharmacy, viii.

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The above foray into Western apothecaries is useful because they are similar to the Taiwanese shops that, before and after the licensing policies of the Japanese colonial government, sold both traditional medicine and groceries.227 A core tenet of traditional Han medicine is the aforementioned food–medicine homology: the idea that medicine and food are homologous, or inseparable. Thus, practitioners of traditional medicine in colonial Taiwan argued that the health benefits of certain foods are the same as the health benefits of certain medications. There is no fixed line between the two, as the line usually shifts depending on the amount, the timing, and the other characteristics of the ingested item. Thus, honey, black pepper, anise, and the like could serve as nutritional supplements and indeed as bona fide medication. This tradition of homology in traditional Han medicine explains why traditional pharmacies were also places where people bought everyday foods. 228 With the Japanese colonial government’s policies targeting pharmacies and pharmacists, traditional drug stores in colonial Taiwan technically became “pharmacies” because the Japanese policies granted the new legal status to the institutions. The government’s expectation was that the institutions would imitate modern pharmacies’ approach to distributing drugs and would stop making medicine and offering apothecary- like advice. However, in practice, these traditional pharmacies in colonial Taiwan continued not only to sell food as well as medicine, but to offer clinical healthcare services, as well. 229 In most of these pharmacies, one would find practitioners of traditional medicine who were known as “sit-in-store healers” because they would be seated on chairs while waiting for “patients” to enter the establishment. Sometimes senior apprentices would share this space with sit-in-store healers. Their aim would be to provide medical diagnoses to patients. In fact, apprenticeship was one of the major methods for obtaining an education in traditional medicine.230 However, most of these sit-in-store healers and apprentices were unlicensed. Their training consisted almost entirely of practicing medicine, not studying medical classics or preparing for government-mandated tests. Traditional pharmacies that were licensed could shield these healers from the colonial government’s prying eyes and could also promote the business of pharmacies. The resulting “under-the-table” practices of traditional medicine caused tension between traditional pharmacies and police, who tried to stamp out unlawful medical practices. Tension also surfaced between these pharmacies

227 William E. Court, “Pharmacy from the Ancient World to 1100 AD” in Making Medicines: A Brief History of Pharmacy and Pharmaceuticals, ed Stuart Anderson (Pharmaceutical Press, 2005), 21–36. 228 Y Hou and JG Jiang, “Origin and Concept of Medicine Food Homology and Its Application in Modern Functional Foods,” Food & Function 4 no. 12 (December 2013): 1727–41. 229 In some Western countries, governments encourage community pharmacies to provide accessible primary healthcare services to local neighborhoods. This approach is considered the new apothecary model and a revival of traditional practice. See Taylor, David. “The Apothecary’s Return? A Brief Look at Pharmacy’s Future.” In Making Medicines: A Brief History of Pharmacy and Pharmaceuticals (Pharmaceutical Press, London, 2005), 283–299. This model functions very much as traditional pharmacies did in colonial Taiwan, but because both traditional medicine and modern medicine were two mostly separate systems, pharmacies subscribing to one school of medicine would not refer patients to providers subscribing to the other school of medicine. Generally, patients themselves had to decide where and when to seek certain healthcare services. 230 BaiLing Chen (陳百齡), “Li Jhuo Jhang and the Association of Doctors in Hsinchu” (李倬章與新⽵醫⽣會), Hsinchu City Archives Quarterly (⽵塹⽂獻雜誌), 42 (2008): 98.

81 and licensed practitioners of traditional medicine: the licensed practitioners found themselves competing with the pharmacies’ unlicensed “sit-in-store” healers and apprentices, who had successfully skirted the financial costs and the official responsibilities associated with getting licensed.231 Because traditional pharmacies served as informal clinics, traditional medical practices in colonial Taiwan were never fully detached from traditional medical dispensaries. The colonial policy that sought to control these renegade native practitioners failed. The government’s decision to license very few practitioners of traditional medicine meant that, for most patients on the island, the licensed traditional pharmacies—and their unlicensed sit-in-store healers and apprentices—were the only viable source of diagnostic services and medical prescriptions.

Traditional Pharmacies as a Space for Families and Workshops The licensed traditional pharmacies produced medicine in-house for sale to practitioners and the general public. The social hierarchy in these pharmacies was that of a family-style shop. Some pharmacies would design unique prescriptions. Consider, in this regard, the aforementioned book The Memoirs of Shu-Chi Chuang, written by Taiwan’s first female licensed practitioner of traditional medicine. The Memoirs state that a typical traditional pharmacy consisted of both retail buildings and residential buildings. The pharmacy would occupy the primary building. There, customers and patients could enter the pharmacy through the front door but not directly access the pharmacy’s workshop and residential area. Other buildings contained the shop floor, where workers processed such ingredients as herbs. The living quarters were located at the back of these buildings. Thus, pharmaceutical practices and everyday living were inter-connected throughout the complex. These pharmacies became training sites in which younger generations of practitioners of traditional medicine would learn their trade. Shu-Chi Chuang described her father’s pharmacy, which hired apprentices, as well as workers, to process and prescribe medicine.232 When one of her father’s assistants unexpectedly passed away, her brother and she helped out in the business by performing menial tasks, including sorting and packing drug ingredients at night. Along the way, she started to learn the principles and practices of traditional medicine. Also helpful in this regard were her interactions with her father’s peers who would drop by the pharmacy to collect medical materials.233 It is worth noting that, in traditional pharmacies, most apprentices were male, so Shu-Chi Chuang’s experiences were somewhat unusual.234 Some trade centered on relatively unprocessed medical materials, such as dried or raw ginseng. However, most materials needed to be processed before they could be sold to customers. The processing involved one or multiple steps, including washing, cutting, pan-frying (sometimes with rice, charcoal, or other components), steaming, poaching, stewing, and soaking-and-drying (with alcohol, vinegar, or honey).235 The selection or

231 Ibid., 105–106 232 Chuang and Hsu, The Memoirs of Shu-Chi Chuang, 2001. 233 Ibid., 21. 234 BaiLing Chen, “Li Jhuo Jhang and the Association of Doctors in Hsinchu,” 2008. 235 YiJie Chen (陳以潔), “Improving the Safety of Prescriptions” 提升用藥安全--中藥材也能如法「炮 製」！(August 2011), http://www.kmuh.org.tw/www/kmcj/data/10008/18.htm.

82 combination of steps depended on the materials being processed and the purpose of the materials. The equipment necessary for the execution of the steps included pans, grinding bowls, knives, and pots. Most traditional pharmacies were family-owned establishments, sometimes generations old. Ku-Ching Pharmacy (古井藥房), a traditional pharmacy in southern Taiwan, was a multi-generational family establishment during the colonial period. The career paths of the family members exemplify the early trending shift from traditional medicine to Western medicine in colonial Taiwan: the first-born son of the pharmacy’s second-generation owners studied Western medicine in Japan and did not work in the shop, but one of his younger brothers took over the business and, in the post-colonial 1950s, expanded its operations. During these historical periods, sons—not daughters— usually inherited their parents’ businesses and property. Interestingly, the inheritance of Ku-Ching Pharmacy reflected a gap between the typically inviolable rules of primogeniture and actual practices: not all patriarchs required their first-born son to take over their business. This gap had been common in Taiwan even before Japanese colonization. We know this thanks, in large measure, to the Taiwan Traditional Manners and Customs Investigation, launched in 1901 by the Japanese government. As part of the investigation, Japanese colonial officials interviewed local leaders. The aim was to collect data that would help shape civil laws. Some interviews addressed the topic of inheritance, and the answers, summarized below, are revealing. Interviews about Traditional Manners and Customs Question: If the senior son is either adopted or the son of a concubine, and the (first) son of the formal wife is therefore a junior, can the senior son inherit [the leadership role, property, and wealth] in the family? Answer: According to Qing (China) Law, only the (first) son of the formal wife can inherit [the leadership role and family wealth], but in practice on the island of Taiwan, only Taiwanese government officials and gentlemen of high class have followed this rule. Ordinary families don’t always follow it. Question: If an adopted son, a son of a concubine, and a son of a formal wife split the inheritance of family property, is there any difference in the proportion that each one can get? Answer: There is no rule for this situation. All sons depend on their parents to decide these matters. These summarized answers show that the Ku-Ching Pharmacy might not have been a rare case in which a son other than the first born inherited the family business. The evidence indicates that Taiwanese families had not universally followed the island’s pre-colonial Qing civil codes for primogeniture and were still selectively ignoring them under Japanese colonization. Though the rules governing inheritance for sons were malleable, the gender hierarchy in Taiwan remained firmly in place. In the case of Ku-Ching Pharmacy, only sons were considered legitimate inheritors. As her memoirs reveal, Shu-Chi Chuang’s father refused to let her take over his shop until she promised never to marry and never to leave the home–pharmacy complex.236 In short, this traditional pharmacy reflected the

236 Chuang and Hsu, The Memoirs of Shu-Chi Chuang, 2001.

83 civil practices of Taiwan during the colonial period: they were far more flexible on the issue of male primogeniture than on the issue of strict adherence to a patriarchal system.

Traditional Pharmacies as Businesses A common subject for discussion in historical studies is the set of social conditions that underlay modern medicine. These studies tend to place a greater emphasis on economic factors than on cultural traditions because modern medicine is chiefly a Western topic—and the history of the modern West has long been chiefly a history of capitalism and colonialism.237 By contrast, when we connect traditional Chinese medicine with China, or Ayurveda with India, we tend to regard them not as scientific or economic activities but as cultural ones. 238 The truth is, however, that traditional pharmacies operating in these and other regions were also places where business happens. While traditional pharmacies in colonial Taiwan served as clinics as well, they were primarily drug retailers that bought and sold medicine. Some pharmacies would sell medicinal drugs to “bird of passage” doctors, who operated out of no specific clinic, and to female healers, the previously discussed sian-sinn-má. A few large-scale traditional pharmacies would buy medical materials from overseas and sell them to smaller pharmacies. All in all, the business of traditional Taiwanese pharmacies varied. They could be importers, wholesalers, or retailers. Shu-Chi Chuang, in describing her father’s traditional pharmacy, notes the financial side to transactions at the shop and reveals that, to maintain stable supplies and reduce costs, her father owned a beekeeping operation for the production of medicinal honey.239 Interestingly, traditional pharmacies were one of the few flourishing domestic businesses in colonial Taiwan. Economic initiative was thus one of the untold reasons why the colonial authority, despite its prioritization of Western medicine, did not ban these pharmacies. From 1886 to 1891, before Japan’s colonization of Taiwan, the Qing governor of the island tried to modernize its tax system on the basis of Western models but was unsuccessful. Taiwan’s patrimonial bureaucracy was one in which powerful families and officials acting as independent actors had the power to collect taxes. The state usually could not hold these agents accountable, and thus pre-colonial Taiwan lacked a modern government bureaucracy that would directly manage the tax system and collect taxes for the state.240 This changed in 1896, when Japan implemented its highly bureaucratized tax system on the island, fully superseding the existing tax system. The various taxes that pharmacies had to pay, including tariffs on herbs imported from China, the United States, and other countries, became huge sources of revenue for the colonial government.

237 Margaret Lock and Vinh-Kim Nguyen, An Anthropology of Biomedicine (Malden, MA; Chichester, West Sussex; Wiley-Blackwell, 2010). 238 Arthur Kleinman, Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry, Vol. 3 (Berkeley: University of California Press, 1980). 239 Chuang and Hsu, The Memoirs of Shu-Chi Chuang, 2001, 21. 240 Wen-kai Lin (林文凱), “Taiwan’s Financial System in the Late Qing Period: A Historical-Institutional Analysis of Liu Ming-chuan’s Financial Reform” (晚清臺灣的財政――劉銘傳財政改革的歷史制度分 析), Bulletin of the Department of History of National Taiwan University (臺大歷史學報) 61 (2018): 97– 157.

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The importance of these tariffs reflects how the colonial tax system in Taiwan shaped the global trading network that was so important to traditional pharmacies there. The pharmacies imported herbs from China through Xiamen, a treaty port in southern China. Later, when the tax system changed, traditional pharmacies imported herbs from China to Taiwan via Japan, where the herbs were taxed according to Japanese tariffs. This roundabout approach enabled the traditional pharmacies to evade the onerous tariffs that Taiwan’s colonial government imposed on directly imported products.241 As traditional pharmacies were business units, they were not immune from disputes, whether of a financial or social nature. For example, a traditional pharmacy that suffered damages from an accidental fire in 1899 was the site of a subsequent argument between the owner and an employee regarding the latter’s wages. A reporter for a local newspaper covered the story and, in an “opinion piece” moment, placed blame on the employee, describing him as “an unruly servant bullying his boss” and emphasizing that this bullying violated the social hierarchy.242 One can reasonably argue that traditional pharmacies in colonial Taiwan reflected an idealized view of Taiwanese social hierarchy as it ought to have been: the owner of a profitable business at the top and, below him, a group of apprentices and employees constituting various lower rungs of the hierarchy. In the early 20th century, traditional medicine remained the go-to pharmaceutical for most Taiwanese people, especially those who could not afford modern medicine. This lopsided demand had economic consequences, one of which was that the revenue of traditional pharmacies was often much greater than that of modern medical facilities. In 1909, Taiwan Daily New Newspaper described the substantial earnings of traditional pharmacies: In recent years, the pharmaceutical shops owned by local islanders have traded mainly in imported Japanese prescriptions or local Han prescriptions. The businesses in Báng-kah and Twatutia have grown considerably, with revenue averaging out to about 10,000 dollars per month.243 For some perspective on how this revenue stream compared with the earning power of professional workers in Taiwan around 1909, consider the fact that a newly hired teacher at a public school in the northern Taiwanese city of Hsinchu would earn 16 dollars per month.244 In comparison, consider licensed practitioners of biomedicine, who constituted an emerging segment of the island’s upper class: in healthcare clinics, which often served as pharmacies in colonial Taiwan, the practitioners earned between 200 and 500 dollars per month.245

241 Yi Han Ou (歐怡涵), Inside the Supply Chain of a Traditional Taiwanese Pharmacy a Hundred Years Ago: 101 Ways to Decipher Taxes and Customer Complaints (百年前臺灣藥行採購內幕──解密節稅與 客訴的 101 種方法), Story (故事) (December 26, 2019), https://storystudio.tw/article/gushi/nagasaki-tai- yi-hau/. 242 “An Arrogant Servant Abused His Master” (狂奴壓主), Taiwan New Newspaper, 1899. 243 “Healers and Drug Shops,” Taiwan Daily New Newspaper, November 12, 1909. 244 PeiSian Syu (許佩賢), “The Career of a Taiwanese Public School Teacher in Colonial Taiwan: The Footsteps of Chang Shih Ku” (日本時代一個公學校老師的發達之路：張式穀的軌跡), Kám-á-tiàm (歷 史學柑仔店) (September 28, 2018). 245 Wenxing Wu (吳文星), Ri ju shi qi tai wan she hui ling dao jie ceng zhi yan jiu (日據時期臺灣社會領 導階層之研究) (Tai bei shi: Zheng zhong, 1995), 104–106.

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Taiwanese cities had a few traditional pharmacies that, like QianYuan Pharmacy, did large-scale business, importing unprocessed pharmaceutical ingredients from overseas and doling out prescriptions for charity purposes. As we know, these pharmacies were the main site of the revivalist movement surrounding traditional medicine, and the owners of these pharmacies became leaders in the Taiwan branch of the Association of Royal Kampo Medicine. Most traditional pharmacies, especially in rural areas, were small businesses reminiscent of the community pharmacies that exist in contemporary Western countries. Overall, however, the owners of traditional pharmacies were quite affluent, and even though the Japanese authority despised traditional medicine, the government made no attempt to impose a sweeping ban on traditional medicine, chiefly because such a move would have severely degraded the tax revenue that these businesses could bring in. 246 The colonial government’s flexible attitude toward traditional pharmacies was understandable insofar as they financially benefited the government. These benefits explain the great difference between the government’s openness to pharmacies and the government’s strict suppression of practitioners of traditional medicine.

The Market of Traditional Medicine and Stratification in Medicine Between 1929 and 1931, calls for lower drug prices in colonial Taiwan evolved into an activist movement led by several Taiwanese political and social groups, including the New Taiwanese Cultural Association (新台灣文化協會), the Taiwanese People’s Party (Tâi-oân Bîn-chiòng Tóng, 台灣民眾黨), and the Taiwanese Farmers’ Group (Tâi- oân Lông-bîn Cho͘-ha̍ p, 台灣農⺠組合).247 In 1930, the highest drug prices in Taiwan were charged by hospitals belonging to the Japanese Physicians’ Association (內地⼈醫 師會). For example, physicians at these hospitals would charge 50 cents for a two-day prescription and 8 dollars for a single shot. We can get a feel for the high cost of these drugs when we compare it with the cost of staple products: one Japanese liter of long- grain rice, which could feed 2.5 adults for one day, cost about 20 cents.248

246 Scholars have noted that the management styles of these traditional pharmacies had more in common with private-sector money-making ventures than with public-sector healthcare facilities. See Michael Shi- Yung Liu, “Medicine, Business, and Social Imagination: Scientificalizing and Scientific Chinese Medicine in Colonial Taiwan” (醫學、商業與社會想像：日治臺灣的漢藥科學化與科學中藥), Taiwanese Journal for Studies of Science, Technology and Medicine (科技醫療與社會) 11 (2010): 149–197 247 These groups, which were organized mainly in the latter half of the 1920s, reflected the growing global pursuit of self-determination and democracy after World War I. The first two groups (i.e., the New Taiwanese Cultural Association and the Taiwanese People’s Party) were particularly active in organizing the Petition Movement for the Establishment of a Taiwanese Parliament. See Wanyao Zhou (周婉窈), Ri ju shi dai de Taiwan yi hui she zhi qing yuan yun dong (日據時代的臺灣議會設置請願運動) (Taibei Shi: Zi li bao xi wen hua chu ban bu, 1989). 248 Yi-Han Ou (歐怡涵), “The Medical Network in Taiwan during the Japanese Era: A Study of Consumers’ Reactions and Choices” (日治時期臺灣藥業網絡中消費者的反應與選擇) Historical Journal of Chi Nan 12 (2009), 115–116. For research on how the colonial government monitored staple products, standardized measurements, and modernized the economy, see Huixian Chen (陳慧先), Zhang liang tai wan: ri zhi shi dai du liang heng zhi du hua zhi li cheng (丈量臺灣 : 日治時代度量衡制度化之 歷程) (Xin bei shi: Dao xiang, 2014).

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This movement not only criticized what it considered to be overpriced drugs, but also revealed the stratification of medicine in the marketplace: modern medicine was expensive, so traditional medicine served the segments of Taiwan’s population that were economically disadvantaged. Thus, the business—and profits—of traditional medicine were impressive. In its discussion of the movement, a November 1930 issue of The New Taiwan People’s News described this stratification: It is common knowledge that traditional Han pharmacies attract a lot of revenue…. Except for some costly drugs, such as ginseng, antler, and guijiao, common prescriptions [of traditional medicine] are generally much cheaper than Western prescriptions. Also, unlicensed doctors are another common feature of traditional pharmacies. These doctors see patients and write prescriptions. There is no need to pay honorarium money to them, and their medicine works well. Although some medicine occasionally has baleful side effects, it is quite suitable for the working class and for anyone who cannot afford the expensive costs of modern healthcare. The issue of affordability also explains why the business of traditional pharmacies has grown well. With the exception of some customers who buy costly traditional drugs, most customers of traditional pharmacies are members of the working class.249 Not surprisingly, pharmacies that dealt in modern medicine identified traditional pharmacies as competitors and voiced this concern at meetings of medical associations, including a gathering of the Association of the Tainan Pharmaceutical Industry in 1936. This issue [of competition between traditional pharmacies and modern pharmacies] has attracted the attention of many Taiwanese citizens…. As soon as one modern pharmacy lowers its drug prices, customers would think that other modern pharmacies are charging [unreasonably and unnecessarily] high prices, so afterward, it is difficult for the price-lowering pharmacy to return to normal, sustainable prices. At the Association’s meeting that day [in 1936], arguments arose [about how to handle these pricing problems]. One member of the Association commented on Han-medicine associations: “…if we [representatives of modern medicine] sell drugs at newly negotiated [lower] prices and stop our door-to-door sales, we will [inadvertently] benefit these other associations.”250 The above quote reveals the extent to which pharmacies of modern medicine identified traditional pharmacies as significant competitors. The quote also conveys the tension between traditional and modern medicine in regard not just to scientific or political legitimacy, but also to economic viability. Even though I have unearthed no specific data on the relative sales of traditional and modern medicine during Taiwan’s colonial period, the sentiments expressed at the 1936 Association of the Tainan Pharmaceutical Industry show that economic competition between the two fields was fierce.

The Reasons behind the Colonial Authority’s Tolerance of Traditional Pharmacies The colonial government consistently devalued traditional medicine and local healing practices in Taiwan, yet never banned traditional pharmacies, nor attempted to

249 Anonymous, “Critics of the Movement to Lower Drug Prices” (對醫藥減價運動的批評), New Taiwan People’s News (臺灣新民報), November 22, 1930. 250 Anonymous, “The Association of the Tainan Pharmaceutical Industry considers re-negotiating drug prices” (臺南藥業臨時總會將重行約定價格), Taiwan Daily New Newspaper, June 5, 1936.

87 suspend the licensing policy that granted traditional pharmacies the official permission they needed to operate legally. I have already discussed one major reason why the colonial government tolerated traditional pharmacies: tax revenue. A second reason for the government’s tolerance was the socio-economic stratification of medicine on the island: because modern healthcare was available principally to the upper middle class and the wealthy, the middle and lower social classes, particularly in rural areas, would have had little or no access to affordable modern medicine. The colonial government wanted to avoid such disparity because it would have bred discontent and possible revolts among the islanders. As described in Chapters 1 and 2, the colonial government considered medical modernity to be a significant part of colonization for two reasons: the development of colonial Japan’s political legitimacy in the eyes of locals and the development of Japanese civilization’s legitimacy in the eyes of Western empires. Compared with its continuing policy to eliminate traditional medicine from colonial Taiwan, the colonial government’s tolerance of traditional pharmacies seems inconsistent with the agenda of medical modernity. The colonial government rarely publicly discussed the effects that this tolerant policy would have, but it was clearly driven with two goals in mind: an increase in tax revenue and a reduction in medical disparities. These two unstated goals explain the government’s tolerance of traditional pharmacies and reflect both the economic motivations behind colonial medicine and the dark side of medical modernity. Interestingly, these two reasons were cited by the revivalist movement in support of traditional medicine. The activists regarded each of the reasons as sufficient justification for the legitimacy of traditional medicine. In one of its 1931 issues, Han- CRKM published an announcement based on this argument, under the title “We Are Planning to Submit a Petition to Resume the Licensing Exams for Practitioners of Han Medicine”: Since July 1901, [the colonial government] has carried out…the Licensing Policy of Doctors, granting permission to these traditional doctors to practice their trade. During the last thirty years, however, [practitioners of traditional medicine] have had no opportunity to take licensing exams…. [Thus,] there were around 1,903 doctors in the fall of 1902 and the number has kept declining every year. By the end of 1928, there remained only 422 doctors [because the colonial government no longer licensed new ones]. However, as for traditional pharmacies, in 1899 there were 767 shops, a number that increased to 3,187 by the end of 1928. [We believe that] the connection between doctors and pharmacies is inseparable. If the colonial government can grant pharmacies permission to operate, [we] urge the colonial government to grant permission for doctors to practice medicine, as well. In the Japanese homeland, Han medicine pharmacies such as those in Osaka and Tokyo have enormous operations. If we included domestic small businesses in this calculation, the total monetary business of Han prescriptions and pharmacies could reach tens of millions of dollars in sales annually. In addition, our country [the entire Japanese empire]…produces great amounts of herbs. Needless to say, Han medicine is highly effective and is both internationally and domestically recognized. In addition, it is affordable and the most reliable

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[medicine] for the poor and lower classes. If Han medicine were no longer available, the welfare of the people would significantly diminish.251 This lengthy quote justifies traditional pharmacies by first identifying the economic value of the production and supply chain of Han medicine: farms, manufacturers, and retail shops specializing in Han prescriptions. The quote goes on to argue that this economic development mattered not only for colonial Taiwan but also for the Japanese homeland. The activists then identified all of these elements in the production and supply chain as a sound solution to the highly problematic stratification of medicine throughout the Japanese empire. The colonial government had no desire to recognize the effectiveness of Han medicine, but the critical roles played by traditional pharmacies in serving both the lower classes and the state coffers were two “untold reasons” for the colonial government’s rather lenient policies governing traditional pharmacies.

Seeking Health Care in the Era of Colonization Between the 1910s and 1940s, the wealthy Taiwanese activist Lin Hsien-tang kept a diary that recorded his experiences with local medicine. These diary entries reveal how well-heeled Taiwanese sought health care in the colonial era. He wrote down that he mainly received pills and shots associated with modern medicine, and that his extensive business network included at least one biomedical pharmaceutical company. 252 Nevertheless, he occasionally took Han medicine, such as ointments.253 By contrast, one of his brothers, Cheng-tang, demonstrated a much more flexible ability to move between traditional and modern medicine. When Cheng-tang was sick, he decided to first take Han medicine and then, “if Han medicine did not work,” he would seek modern medicine.254 Another diary, that of Chang Li-Chun, reveals how patients sought myriad treatments. When his son fell ill, Chang, who was a village mayor in Taichung from 1899 to 1918, sought treatment from a Taiwanese doctor specialized in Han medicine.255 Later, as the boy’s situation worsened, Chang asked two physicians of modern medicine to intercede in the case.256 The next day, his son was terminally ill. The family prayed to the gods and divined, and later requested that two other doctors treat his son with Han medicine; one of these two doctors was also an owner of a traditional pharmacy.257 Both of these personal records show that, members of the upper class sought traditional, as well as modern, healthcare treatment. These individuals had personal preferences for a particular field of medicine: Lin Hsien-tang’s first choice was modern medicine, and Chung Li-Chun’s was traditional medicine, but neither of them rejected a certain kind of medicine. In colonial Taiwan, as traditional pharmacies preserved Han medicine amidst the growing presence of modern medicine, the two schools of medical thought co-existed, and patients were able to choose between them. However, this

251 The Han Language Version of the Community of Royal Kampo Medicine (Han-CRKM), 15 (1931). 252 The Diary of Lin Hsien-tang, February 13, 1934. 253 The Diary of Lin Hsien-tang, January 19, 1940. 254 The Diary of Lin Hsien-tang, October 9, 1929. 255 The Diary of Chang Li-Chun (水竹居主人日記), August 28, 1913. 256 The Diary of Chang Li-Chun (水竹居主人日記), August 30, 1913. One these two physicians was Chang Li-Chun’s son-in-law, who had been trained in the Medical School of the Colonial Government. 257 The Diary of Chang Li-Chun (水竹居主人日記), August 31, 1913.

89 freedom of choice was a distinct privilege of the upper class. The cost of modern medicine was generally prohibitive for the lower classes.

Conclusion The colonial government, although it no longer recognized traditional medicine as a practice, allowed traditional pharmacies to remain in business. Traditional pharmacies thus became spaces for the preservation of traditional medicine. They served as clinics, as well as pharmacies. Although the colonial government never publicly justified its relatively lenient attitude toward traditional pharmacies, their economic contributions to the state were a significant reason for the leniency. Another likely reason was the paucity of affordable modern healthcare services available to the island’s lower classes. Not only were the costs of clinic visits and of modern medicine beyond the means of the general public, but the number of licensed physicians was limited, as well. Most people thus had no choice but to rely on traditional medicine for their healthcare. For the island’s upper classes, who could afford modern medicine, it stood alongside traditional medicine as a popular treatment option. In these cases, patients or their families, especially the heads of families, decided which kind of medicine they would seek, when they would seek it, and from whom. This patient-centered decision making was certainly a privilege of the economically advantaged, but it also reflected a remarkable degree of flexibility and diversity in Taiwanese healthcare.258 While a reliance on diverse medical healthcare options seems to reflect a pure freedom of choice, this freedom is shaped by marketplaces, which imposes prohibitively expensive goods and services on a largely non-affluent public. In the United States, neoliberal healthcare markets shape the care-seeking behaviors of patients not so much out of preference as out of financial necessity.259 Thus, freedom of choice in the medical world is severely limited in the lower social classes, as the freedom is, at its core, a compromise with the unaffordability of biomedical healthcare.

258 This hybrid practice of health care existed in other places and times, as well. For example, the Mixtec families in California in the 1990s rounded off clinical care of biomedicine with indigenous care for political and economic reasons: many of these families were undocumented and economically disadvantaged. Socio-cultural reasons also explain why the families used mixed health care, as indigenous care reenforced their cultural identity and traditional conceptions of illness and body. See Bonnie Lynn Bade, Sweatbaths, Sacrifice, and Surgery: The Practice of Transmedical Health Care by Mixtec Migrant Families in California, thesis (University of California, Riverside, 1994). 259 Vicente Navarro, Neoliberalism, Globalization, and Inequalities: Consequences for Health and Quality of Life (Routledge, 2020).

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Chapter 5. Locating Traditional Medicine in Modern Places

The previous chapters demonstrate the shift from traditional medicine to modern medicine in colonial Taiwan. The goal of the colonizers was twofold: transform modern medicine into the island’s only fully legitimate medicine and re-define traditional medicine by acknowledging only scholarly Han medicine and by thus excluding other traditional healing practices. The traditional healers in colonial Taiwan responded to this shift by organizing movements, by challenging the medical boundary-setting ideas of Japanese colonizers, and by staying out of the colonizers’ line of vision. In the present chapter, I explore this tendentious boundary-setting regarding the places where traditional medicine continues to operate. In the process, I shed further light on how colonial Taiwanese medicine underwent the abovementioned institutional shift and how the responses to this shift have shaped people’s conception of medicine since then. My analysis in this chapter focuses on the boundary work that differentiates medicine from non-medicine.260 Specifically, I analyze the institutional, geographical, and post-colonial places in which the boundary work of medicine has occurred.261 The analysis responds to two recent concerns about traditional medicine: its legitimization and its growing popularity in contemporary global culture. Regarding the legitimization of traditional medicine, in 2018, the World Health Organization (WHO) published the eleventh revision of the International Classification of Diseases (ICD-11), which, for the first time, featured a chapter on traditional Chinese medicine covering such topics as diagnostic techniques for Qi, blood, and fluid disorders. The presence of the chapter in the ICT-11 essentially granted traditional Chinese medicine a formal, officially recognized status as a legitimate diagnostic system in the global medical system. Does this acknowledgement change the boundaries between types of medicine? Does it signal the end of former colonial powers’ marginalization of traditional medicine and create more spaces in which traditional medicine can operate? Has imperial medicine faded into history? If so, are studies on colonial medicine purely historical and of little or no relevance to our contemporary world? Second, regarding the growing popularity of traditional medicines, though they are rooted in the cultural and geographical places of, for example, India and China, these medicines have grown quite popular around the world, especially in the West. As traditional medicine flows across cultural places, can we locate it through the lens of history? As noted above, people associate traditional medicine with certain places of origin. This conceptual association shapes and reflects the conceptions that people have of the traditional medicines, themselves: they become local and cultural. The emergence of

260 Thomas F. Gieryn, “Boundary-Work and the Demarcation of Science from Non-Science: Strains and Interests in Professional Ideologies of Scientists,” American Sociological Review 48, no. 6 (1983): 781–795. 261 I use the term ‘place’ for both geographical and conceptual locations. Medicine is a combination of general theory, pathology, treatments, and healthcare, all of which take place somewhere geographically and epistemologically. Traditional medicines have long been associated with their geographical origins. For its part, modern medicine, despite its claims to universality, is associated with the West. For more views on the geographical and social conceptions of places, see Yi-Fu Tuan, Space and Place: The Perspective of Experience (Minneapolis: University of Minnesota Press, 1977).

91 these associations can be traced back to pivotal colonial moments when traditional medicine lost its status as medicine. In colonial Taiwan, Han medicine became traditional, local, or cultural only through its encounter with Western medicine, as Han medicine had simply been medicine in pre-colonial Taiwan. The Japanize colonizers’ limiting definition of Han medicine in Taiwan reflected a much broader political process that (re)constituted traditional medicine in the context of imperialism and globalization.

The Institutional Place of Traditional Medicine Colonial encounters have fundamentally re-placed traditional medicine. In the case of colonial Taiwan, Japan’s policy of medical and pharmaceutical licensing turned modern medicine into the only fully acceptable medicine, with traditional Han medicine being briefly tolerated and “local” medicine being almost completely ignored. Traditional medicine lost its institutional ground and became a “local culture” rather than a medicine. Taiwanese practitioners and scholars of medicine challenged this boundary of medicine by proposing that traditional medicine was medicine. In 1928, Tu Tsung-Ming, a Taiwanese physician trained in modern medicine, proposed an approach to re-integrating traditional medicine into medicine: traditional prescriptions should be subjected to modern medical clinical experiments. Another approach, raised by the Revivalists of Royal Kampo Medicine between 1928 and 1940, translated the diagnostic and treatment practices of traditional medicine into the language of modern medicine to prove that traditional medicine was also a medicine—but one that used a language different from that of modern medicine. The two proposals failed to reshape the boundaries between modern medicine and traditional medicine in a way that would result in either the desired recognition of traditional medicine or at least opportunities for it to get recognized. Although the colonial authority in Taiwan continued to marginalize traditional medicine, such places as traditional pharmacies continued to give Taiwanese people access to legally practiced traditional medicine (see Chapter 4). The colonial institutional shift of medicine in Taiwan did not fundamentally change the definition of medicine for most of the island’s colonized people. Rather, the shift created a hybrid medical system of health care, which offered a mix of modern and traditional medicines depending on people’s symptoms, geographical location, and socio- economic status. The end of World War II marked the beginning of the end of most colonial empires, as dozens of colonies in Asia and Africa declared their autonomy between 1945 and the early 1960s. Most former colonies today treat Western medicine as their official medicine: some of these former colonies officially consider Western medicine the only gold standard, while some other former colonies have integrated traditional medicine into Western medicine, the latter of which tends to take precedence over the former.262 Rance P.L. Lee, in examining this “hierarchical pluralistic medical

262 For example, two former Asian colonies of imperial Japan—Taiwan and Korea—created dual medical systems in which traditional medicines have their own medical schools, professional organizations, and clinics. The systems emphasize the national traditions and identities of traditional medicines, but modern medicine accounts for the majority of medical expenses in national health-insurance systems: in 2017, the share of medical expenses attributable to traditional medicine accounted for only 3.7% in Taiwan and 3.6% in South Korea. For information about the institutional dual healthcare system in Taiwan, see Rance P.L. Lee, “Comparative Studies of Health Care Systems,” Social Science and Medicine 16, no. 6 (1982): 629– 642. For more information about South Korea and its medical expenses, see Dongsu Kim, Chun-Chuan

92 structure,” argues that former colonies’ continuing embrace of modern medicine has occurred in the context of modernization and progressivism: “Science has emerged as a dominant ideology. Anything concerned with science would be easily accepted by the government and the people, as it is generally believed that science is true and that the application of science will result in progress.”263 This “hierarchical pluralistic medical structure” preserved traditional medicines in many former East Asian colonies. Today, the resulting pluralistic systems consist of separate places in which medical practitioners can practice traditional and modern medicine without dissolving the boundaries between the two. The preservation of traditional medicine around the world looks especially successful today. As mentioned above, the WHO’s ICD-11 included, for the first time, a supplementary chapter on traditional medicine. The chapter addresses methods for “measuring, counting, comparing, formulating questions, and monitoring over time” and should “be used in conjunction with the Western Medicine concepts of ICD Chapters 1– 25.”264 Even though the diagnostic methods of traditional medicine are now included in the ICD-11, the WHO does not fully recognize traditional medicine as a legitimate medicine, as the Director-General of the WHO stated that the presence of the new ICD- 11 chapter neither mentions nor endorses any specific form of traditional medical treatment.265 In other words, the ICD-11 provides an opportunity—but not an explicit plan—for both traditional medicine and biomedicine to work together or at least to communicate with each other, since traditional medicine is an inevitable part of health care in many countries. Even though the ICD-11’s supplemental chapter mentions the traditional medicines of several Asian countries, it is Sino-centric, as it “refers to disorders and patterns which originated in ancient Chinese Medicine and are commonly used in China, Japan, Korea, and elsewhere around the world.”266 The supplemental chapter marks a political and cultural coup for China, the government of which has professed “a belief in evidence-based medicine and has invested millions of yuan in programmes devoted to the modernization and standardization of TCM [traditional Chinese medicine].”267 However, while the chapter states that its focus is traditional medicine, the content is traditional Chinese medicine, with few references to Japan and Korea, whose traditional medicines are, according to some researchers, unique and distinct from traditional Chinese medicine.268 Also, the supplemental chapter on traditional medicine makes no significant

Shih, Hung-Chiang Cheng, Soo-Hyun Kwon, Hyunmin Kim, and Byungmook Lim, “A Comparative Study of the Traditional Medicine Systems of South Korea and Taiwan: Focus on Administration, Education and License,” Integrative Medicine Research 10, no. 3 (2021): 100685–85. 263 Rance P.L. Lee, “Comparative Studies of Health Care Systems,” 637. 264 ICD 11 Reference Guild, Part 1.5, https://icd.who.int/icd11refguide/en/index.html#1.5Traditionalmedicine|traditional-medicine|c1-5. 265 ICD-11, The Lancet, June 08, 2019. 266 ICD-11 for Mortality and Morbidity Statistics, 26 Supplementary Chapter Traditional Medicine Conditions, Module I, https://icd.who.int/browse11/l- m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f718687701. 267 “The World Health Organization’s Decision about Traditional Chinese Medicine Could Backfire” Nature, June 5, 2019. 268 See Ichiko Fuyuno, “Japan: Will the Sun Set on Kampo?” Nature 480, S96 (2011); and Cha WS, Oh JH, Park HJ, Ahn SW, Hong SY, and Kim NI, “Historical Difference between Traditional Korean Medicine and Traditional Chinese Medicine, Neurological Research 29 Supplement 1 (2007): S5–S9.

93 mention of traditional medicines from India, Africa, and the Americas. Thus, ironically, the WHO’s “recognition” of traditional medicine repeats a historical pattern of colonialism: rather than recognize diverse practices of local medicines, the chapter selectively privileges a particular kind of medicine on the basis of politics.269 The post-colonial inclusion of traditional medicine in mainstream medicine has blurred the history of colonial medicine. Many trends and patterns in the context of colonization seem to have faded after colonies achieved independence. For example, Warwick Anderson describes, in the context of the colonial Philippines, the view that certain races are immune to certain diseases. Connecting this view with racism, he finds that colonists transformed colonial people into manageable bodies in laboratory experiments, with the aim of preventing racial degradation.270 Frantz Fanon describes a curious dichotomy: in colonial periods, the colonized sometimes so distrusted modern Western medicine that they refused to receive treatment from local physicians trained in the West, yet during and after independence movements, these same people strictly followed prescriptions made by the same physicians because now they were “local.”271 These studies point out how the structuring of power and race in colonies shaped the medical dimension of colonial and post-colonial societies. Hence, the question arises as to whether or not colonial medicine existed at a specific historical moment and ceased to exist afterward. If colonial medicine is no longer in place, why do we study it? Do colonial medical boundaries, which privilege certain treatments while excluding others, continue after the end of colonization? As Michel Foucault argues, to explore the boundaries of knowledge, we must analyze the conditions of knowledge, which are not from the point of view of the individuals who are speaking, nor from the point of view of the formal structures of what they are saying, but from the point of view of the rules that come into play in the very existence of such discourse: what conditions did [scholars]…have to fulfill, not to make [their] discourse coherent and true in general, but to give it, at the time when it was written and accepted, value and practical application as scientific discourse—or, more exactly, as naturalist, economic, or grammatical discourse?272 The historical and social processes of medical modernization have shaped the conditions that traditional medicine, in order to be medicine at all, has had to satisfy. These conditions, though somewhat varied and malleable, correspond to a relatively new set of political, social, and economic conditions that traditional medicine has typically failed to satisfy. A result of this incompatibility has been the categorization of traditional

269 Some observers have argued that the WHO authorized the chapter because of the organization’s growing reliance on Chinese investments. For an analysis of the WHO’s financial contributors, including China, see Srinivas Mazumdaru, “What Influence Does China Have over the WHO?” Deutsche Welle, April 17, 2020. The WHO, for its part, claims that the ICD-11 chapter is simply a reflection not of politics or of financing but of China’s vast scientific data showing the potential and the safety of Chinese medicine. This debate, in itself, is a case of boundary work, wherein various actors are struggling to determine whether or not medicine and politics actually overlap each other. 270 Warwick Anderson. “‘Where Every Prospect Pleases and Only Man Is Vile’: Laboratory Medicine as Colonial Discourse,” Critical Inquiry 18, no. 3 (1992): 506–29. 271 Frantz Fanon, A Dying Colonialism (New York Book: Grove Press, 1967). 272 Michel Foucault, The Order of Things: An Archaeology of Human Sciences (Knopf Doubleday Publishing Group. Kindle Edition, 2012), 184–340.

94 medicine as an aspect of culture rather than of medicine. In colonial Taiwan, these conditions were determined largely by politics because the colonizers, not the colonized, made the conditions. To qualify as medicine, which is nothing more or less than modern medicine, a set of ideas and practices had to refer—for example, during a pandemic—to germ theory, anatomy, quarantines, patient isolation, clinics, and hospitals. In other words, medicine needed to be about an ontology of germs and reactions to germs, as well as an ontology of the human body based on anatomy. Colonial politics, which helped shape the conditions that determined what counted as medicine and what did not count as medicine, was not about providing health care to people: it was about acknowledging that the human body is a visible, universal machine and that colonial powers could successfully manage injuries and illnesses, including pandemics. Places other than colonial Taiwan also experienced this institutional shift of medicine at an imperial moment. For example, as described in Chapter 3, Ruth Rogaski explores the history of “hygiene” in China and disease control in Tianjin from the late 19th century to the early 20th century. Chinese physicians and intellectuals who worried about foreign interventions considered Chinese human bodies to be weak, and this weakness was the reason for China’s status as a weak nation. With the introduction of “hygiene” from Japan and China’s failure to defend itself against colonial empires, “hygiene,” which combines biomedical research and education with the policing of bodies, became the solution to this national weakness. 273 In this view, traditional medicine was a historical remnant of, or even became a present threat to, modern medicine because traditional medicine lacked germ theory and thus lacked a viable approach to handling pandemics. In the specific political environment of colonial Taiwan, the place of medicine was reserved only for modern medicine, but traditional medicine found its own place by staying outside the limelight—that is, by evading authorities and their policies. Some practitioners of traditional medicine took a different tack: they actively communicated with representatives of modern medicine and the colonial government either by producing new discourses that essentially translated traditional medicine into the language of modern medicine or by applying the research methods of modern medicine to traditional medicine. Traditional medicine was thus not simply a remnant of history: its adherents sometimes actively and cleverly adapted it to colonial medical trends. Traditional medicine survives in the former colonies of Asia and Africa today, but is often considered a historical legacy that poses possible adverse health risks and that supports divisive cultural and political propaganda.274 However, rather than consistently opposing, medical modernization, traditional medicine evolved alongside it. And as the previous chapter demonstrated, practitioners of traditional medicine in colonial Taiwan constituted a significant part of the public health system’s response to pandemics. Today, the boundaries between included and excluded schools of medical thought go beyond the simple colonial-era distinctions between modern medicine and local medicine. The WHO justified its inclusion of traditional Chinese medicine in the ICD-11 because traditional medicine serves many people, and its inclusion “will, for the first time,

273 Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (University of California Press, Berkeley, 2004). 274 The Economist, “Why China’s Traditional Medicine Boom Is Dangerous,” Economist (United Kingdom) 413, no. 9053 (2017).

95 enable the counting of traditional medicine services and encounters; the measurement of their form, frequency, effectiveness, safety, quality, outcomes, cost; comparison with mainstream medicine; and research, due to standardized terms and definitions nationally and internationally.”275 However, the European Academies’ Science Advisory Council, the Federation of European Academies of Medicine, and other experts in modern medicine have argued that “concepts of body and disease used in TCM have not been substantiated by conventional scientific investigation. This lack of a scientific foundation often makes TCM mechanisms and claims neither verifiable nor falsifiable by scientific experimentation. In Europe, it is difficult to reconcile TCM with mainstream medicine and its frameworks for regulation.”276 This opposing argument questions the wisdom of medical integration by pointing out several challenges that modern medicine poses for traditional medicine: How does it measure, classify, and manage the human body? And how does it test its hypotheses? The WHO’s justification for inclusivity does not directly respond to the opposing argument, but emphasizes that inclusion in the ICD-11 is not equivalent to “membership” in the still exclusive club of modern medicine. In this regard, the contemporary arguments about inclusion are remarkably similar to colonial-era arguments about inclusion. The COVID-19 pandemic has created unique institutional challenges for both modern and traditional medicine. Throughout the 20th century, Western medicine has tended to focus more and more on individuals’ healthcare than on public health and disease prevention, yet the current pandemic has brought public health back into the spotlight. Traditional medicine has also attempted to atone for its historical failures in dealing with pandemics. In March 2020, the National Research Institute of Chinese Medicine in Taiwan announced a new prescription, NRICM101, for the treatment of COVID-19. Taiwanese President Tsai Ing-Wen praised the prescription, which makes use of herbs from traditional medicine, for “putting Taiwan in the global spotlight.” 277 Known as RespireAid, the prescription is labeled a dietary supplement in the United States and Europe, and, as such, does not require approval for safety or effectiveness.278 The product has enjoyed impressive sales among East Asian communities in Europe and North America. 279 However, RespireAid had a difficult time getting approved in its birthplace, as traditional herbs are generally considered medicine and require clinical trials for approval in Taiwan, a country with only 799 COVID-19 patients by the end of 2020. All of these patients stayed in the isolation wards of hospitals, where doctors of traditional medicine had little access. Thus, clinical trials for RespireAid were impossible. The irony of this situation is that traditional Han medicine—labeled a dietary supplement in the European and North American markets—had considerably more opportunities to

275 WHO, “Eleventh Revision of the International Classification of Diseases: Report by the Director- General,” Seventy-second World Health Assembly A72/29, Provisional Agenda Item 12.7 (April 4, 2019): 8. 276 Traditional Chinese Medicine: A Statement by EASAC and FEAM, November 2019, 2. 277 WeiTing Chen (陳偉婷), “The Chinese Medical Prescription ‘NRICM101’ Sells Well in Europe and North America: President Tsai Praised It for Putting Taiwan in a Global Spotlight” (中藥方「清冠一號」 熱銷歐美 蔡總統：中醫讓世界看見台灣), Central News Agency (中央社), March 14, 2021. 278 US Food and Drug Administration, “Questions and Answers on Dietary Supplements,” July 22, 2019. 279 Peng TzuShan (彭子珊), “This Chinese Prescription Can Defend Us from the Pandemic! The Taiwanese NRICM101 Is in Great Demand in the West. Why Can’t We Buy It?” (這款中藥能防疫！台灣「清冠一 號」在歐美熱銷，我們為何買不到), Common Wealth Magazine (天下雜誌), February 01, 2021.

96 achieve sales there than in the medicine’s point of origin, Taiwan, where the government regulates traditional medical herbs. With few clinical trials for RespireAid, its sales were restricted in Taiwan. In May 2021, the Taiwanese government granted RespireAid “emergency-use authorization” (EUA) shortly after the island-nation experienced a significant local outbreak.280 However, this institutional recognition triggered a debate about the safety and efficacy of RespireAid, which, prior to the EUA, had undergone both cell-level scientific testing and a non-random clinical trial with twelve patients. Clinical scientists, however, considered the data to be insufficient. The EUA also triggered a debate over whether or not RespireAid is, in fact, “true” traditional medicine: Is it a medicine concocted by practitioners of traditional medicine? And can a single prescription for all COVID-19 patients be a genuine traditional medicine, as this one-for-all approach violates traditional Taiwanese medicine’s insistence that treatments be tailored to the unique needs of each individual?281 For these reasons, RespireAid has occupied a medical limbo, for it has some of the traits of a traditional medicine but, as noted above, is labeled a dietary supplement in the United States and Europe; RespireAid claims to be an exemplar of modernized traditional medicine, but neither traditional nor modern medicine has fully accepted it. Some scholars today identify traditional Chinese medicine and Western medicine as two incommensurable Kuhnian paradigms, each with its own taxonomy and reality- building practices, and consider this incommensurability to be the reason for the controversy between modern and traditional medicine.282 As described in Chapter 3, this idea of incommensurability was, from the late 1920s to the 1940s, at the heart of colonial Taiwan’s revivalism movement of traditional medicine: its practitioners actively constructed traditional medicine as a field distinct from that of modern medicine. Traditional medicine was another kind of medicine and was more than just a cultural artifact or a religion. Thus, from a historical perspective, the argument that both biomedicine and traditional medicine are medicines fails to reflect the controversy of whether or not traditional medicine is legitimate medicine, because this belief (i.e., the belief that the paradigm of traditional medicine is different from the paradigm of modern medicine) is the historical result—rather than the origin—of all these medical revivalism and anti-colonialism movements. Revivalism movements in support of traditional medicine, whether they took place during the colonial moment or are unfolding in the present, symbolize the fight against the idea that traditional medicine is a purely cultural phenomenon, not a medical one. Today’s seemingly incommensurable medicines date back to all of the medical revivalism movements that colonial and post-colonial peoples around the world have undertaken in defense of traditional medicine. However, these movements have been unable to resolve the debate over “what counts as medicine.”

280 ChinChun Lin and Tzu-Hsuan Liao, “Chinese Medicine Fights the Pandemic! RespireAid Is Granted Emergency-use Authorization” (中藥抗疫! ｢清冠一號｣通過緊急授權) CTS News, May 18, 2021. 281 Po-Hsun Chen (陳柏勳), “The Ambiguous NRICM101 That Can’t Get Out of It” (舉棋不定又騎虎難 下的清冠一號, COVID-19 (記疫)) (May 29, 2021), https://covid19.nctu.edu.tw/article/8320. 282 Hong Hai, “Kuhn and the Two Cultures of Western and Chinese Medicine,” Journal of Cambridge Studies 4, no. 3 (2005): 1–35.

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The Geographical Place of Traditional Medicine These days, discussions about traditional and alternative medicine, medical modernity, and (post-)colonialization often focus on culture and nationalism. However, as we well know, traditional medicine today exists not only in Asia and Africa but also throughout the West. Today, while people often associate traditional medicine with those non-Western places, the West is the central place in which traditional medicine enjoys opportunities to expand. This fact in no way negates the historical legacy of imperialism’s and Eurocentrism’s denigration of non-Western knowledge, but as traditional medicine grows ever more prominent in the West, so too does the issue of how Western healthcare systems should handle traditional medicine. In this regard, two main challenges are the boundary work of medicine and bioprospecting. Traditional medicine in the West is often considered witchcraft or, at best, a non- medical supplemental treatment rather than medicine. In 1994, the US government passed the Dietary Supplement Health and Education Act (DSHEA), which formally defined most herbal products, mineral products, and botanicals as dietary supplements.283 The National Center for Complementary and Integrative Health (NCCIH), founded in 1992 by the US government, promotes the integration of medicines into one another by emphasizing the usefulness and safety of complementary medicine based on modern scientific investigation.284 Whether intentionally or not, these institutional settings submit various medical treatments to a hierarchy of medicines that stems from colonial times. According to this hierarchy, modern medicine is the “real” medicine and the gatekeeper responsible for managing the boundary between real medicine and fake medicine. On the opposite end of this continuum of views, some Westerners consider traditional medicine to be the panacea for all diseases and for the seemingly intractable problem of unaffordable health care. This view often connects modern medicine with a conspiracy in which Big Pharma (pharmaceutical companies) sell high-priced ineffective or harmful medicine to overly trusting patients. In other words, medical professionals and pharmaceutical industrialists make money at the expense of—rather than for the benefit of—the general public.285 It is also the case that some Westerners connect traditional

283 C. Lee Ventola, “Current Issues Regarding Complementary and Alternative Medicine (CAM) in the United States, Part 1: The Widespread Use of CAM and the Need for Better-Informed Health Care Professionals to Provide Patient Counseling,” Pharmacy and Therapeutics 35, no. 8 (2010): 461. 284 National Center for Complementary and Integrative Health (NCCIH), “Mission,” https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-center-complementary-integrative-health- nccih#mission. 285 “The Truth about Cancer” is a US-based organization that exemplifies the unrealistic view that traditional medicine is a panacea for all that ails the human body. In 2018, the organization published a series of documentaries about traditional Chinese medicine in seven countries including Japan, Taiwan, and Malaysia, arguing that these countries subject traditional medicine to governmental regulations that allow both patients to freely choose cancer treatments and medical practitioners to flexibly suggest cancer treatments. This freedom of choice, the documentaries argue, stands in stark contrast to the restrictive medical scene in the United States, where the Food and Drug Administration controls licenses for prescriptions and where patients and doctors are unreasonably limited in their treatment choices. However, these descriptions of traditional medicine in contemporary Asian countries are fundamentally inaccurate. For example, one of a series of documentaries claims that practitioners of traditional medicine in Taiwan use marijuana to treat patients, but marijuana has never been commonly used in colonial and post-colonial Taiwan, nor has it ever been a traditional herb in Han medicine.

98 medicine with an adoration of nature.286 In the United States, people’s conceptions of traditional medicine usually fall into two antithetical but overlapping categories: traditional medicine is either barbaric or a cure-all. This duality reflects the Orientalism at the heart of Western attitudes toward traditional medicine: they are unrealistic. The boundary work of medicine seems similar to the boundary work of science generally, but the historical boundary work of science and medicine in most non-Western places is different from the corresponding work in Euro-American empires. Thomas F. Gieryn points out that the boundary work of science rests on the assumption that science is the preferred style for describing nature and is free from ideology, emotion, and more importantly, religion.287 The boundary work that differentiates sciences from one another also differentiates “scientific, objective, effective” modern medicine from “superstitious, subjective, ineffective” traditional medicine. However, modern medicine, because it arrived in non-Western cultures via Western imperialism, was inescapably rooted in ideology, emotion, and religion from the very outset of these encounters. As the colonies became frontiers offering plentiful resources to colonizers, colonial medicine had an opportunity to develop. The resulting growth in physicians’ grasp of pathologies and treatments extended into tropical medicine, which stood out as a kind of imperial medicine.288 Modern medicine thus reflected colonial ideology, racially and ethnically charged emotions, and the Christian and Shinto religions of the colonizers. Emerging within this context, traditional medicine also intertwined with the narratives and the activities of anti-colonialism. In the case of imperial Japan, this amalgamation of influences created a specific conception of medicine that was highly politicized both for the Japanese colonizers, who, under pressure from Western empires, relied on modern medicine for political legitimacy, and for the colonized Taiwanese people, who acknowledged that recent shifts in medical doctrine were consequences of recent shifts in the island’s political authority. Another issue for traditional medicine around the world is bioprospecting, which is the systematic search for natural resources that scientists can transform into commercial products. The process often depends on global or local inequalities, as pharmaceutical industries use aboriginal knowledge to identify the medical potentials of herbs and then claim patents without sharing profits with local tribes.289 Bioprospecting is also a selective re-allocation of natural resources from former colonies to their former masters.290 This re-allocation of natural medical resources thus not only involves the

286 See Tamara Venit Shelton, Herbs and Roots: A History of Chinese Doctors in the American Medical Marketplace (Yale University Press, 2020). While some Americans believe traditional Chinese medicine represents a close tie between nature and humans in Asia, Chinese people who take traditional medicine in Asia are often alienated from their natural environment. This gap between perception and reality is yet another sign of Westerners’ imagination of the Oriental. See Barbara Potrata and Anzurat Akobirshoeva, “The Orientalist Lens and Traditional Medicine: Circumventing Western Biases in Studying Traditional Medicines” In Health and Environment: Social Science Perspectives eds. Helen Kopnina and Hans Keune (Nova Science Publishers, 2013), 165–181. 287 Gieryn, “Boundary-Work and the Demarcation of Science from Non-Science.” 288 Pratik Chakrabarti, Medicine and Empire: 1600–1960 (Basingstoke, Hampshire: Palgrave Macmillan, 2014). 289 Cori Hayden, When Nature Goes Public: The Making and Unmaking of Bioprospecting in Mexico (Princeton: Princeton University Press, 2003). 290 For example, in the 18th and 19th centuries, European botanists’ “motivated (mis)translation” of natural history from Dutch to English described breadfruit as a superfood perfect for slaves; consequently,

99 global political economy, but also re-produces the distinction between what counts as medicine and what does not. As Chikako Takeshita argues, bioprospecting is “a set of narrated knowledges and representations of constructed realities, which determines what modes of being and thinking are permissible or disqualified.”291 In other words, the ideas that underlie bioprospecting serve not only to transplant certain natural resources usually from poor regions to wealthy regions but also to exclude “unworthy” natural resources from “worthy” ones. Imperial Japan’s bioprospecting in colonial Taiwan excluded the herbs and other natural resources of Han medicine from “legitimate” medical resources.292 Through its medical licensing policy in 1895, the colonial government of Taiwan recognized Han medicine as traditional medicine but contended that Han medical prescriptions could not treat diseases scientifically and effectively. Even though many traditional local prescriptions were available in the local and immigrant communities of Taiwan, the Japanese colonial government had no interest in exploring or harvesting the traditional natural resources necessary for the prescriptions. Rather, Japan turned colonial Taiwan into an island-wide plantation for Western-bioprospected herbs related to the cinchona genus. With its rejection of Han and local medicine and its embrace of cinchona, Japanese colonial bioprospecting in Taiwan reproduced an imperial distinction between “legitimate” Western medicine introduced by the Japanese empire and “illegitimate” traditional medicine in Taiwan. Cinchona is a traditional pre-Columbian herb of indigenous people in South America and is the source of quinine, a medication used to treat malaria. Iberian colonizers considered the indigenous claims about cinchona to be “true but unscientific,” so that, in the eyes of the West, cinchona did not become a “real” medical plant until European botanists studied it and planted it globally in the 19th century.293 Cinchona, which was cultivable only in tropical regions, became a significant resource for colonial medicine. Thus, colonial Taiwan, which was imperial Japan’s only tropical colony, became an ideal location for the empire’s cinchona plantations. The colonial government and the Japanese pharmaceutical companies that owned the technology for extracting quinine from cinchona established cinchona plantations on the island in the 1920s and 1930s.294 Cinchona thus evolved from a traditional medicine found in South America to a modern medicine produced in colonial Taiwan and elsewhere. In transplanting cinchona breadfruit trees were transplanted from Pacific islands to North America. See Juliane Braun, “Bioprospecting Breadfruit,” Early American Literature 54, no. 3 (2019): 643–672. 291 Chikako Takeshita, “Bioprospecting and Its Discontents: Indigenous Resistances as Legitimate Politics,” Alternatives 26, no. 3 (2001): 259–260. 292 The Japanese colonial government tried to survey the local medical plants of folk medicine and the medical knowledge of indigenous people in Taiwan between 1899 and 1944, but did not invest sufficiently in the survey to create either a consistent and accurate index or the groundwork for a systematic bioprospecting project. See Xin-Qi Huang (黃信麒), Tsai Chung-Chih (蔡忠志), and Su Yi-Chang (蘇奕 彰), “Review of Pharmaceutical Plant Studies in Taiwan during Japanese Rule: A Case Study on Filicales” (日治時期的臺灣藥用植物研究回顧－以蕨類門為例), Journal of Chinese Medicine 30, no. 2 (2019): 1– 26. 293 Kavita Philip, “Imperial Science Rescues a Tree: Global Botanic Networks, Local Knowledge, and the Transcontinental Transplantation of Cinchona,” Environment and History 1, no. 2 (1995): 173–200. 294 Ya-Wen Ku (顧雅文), “Historical Research of Cinchona Cultivation and Quinine Production in Colonial Taiwan” (日治時期臺灣的金雞納樹栽培與奎寧製藥), Taiwan Historical Research 18 no. 3 (2011): 47–91.

100 to Taiwan, the Japanese empire committed itself to growing the plant and, thus, practiced bioprospecting there.

The Post-colonial Place of Traditional Medicine In recent decades, traditional medicines have become resources with which intellectuals have sought to overturn the current Western slant of intellectual communities. The conventional intellectual underpinnings of modern Western science assert that it is a singular, objective, and universal description capable of accurately reflecting the external world.295 This possessive epistemology shaped colonial medicine by denying local knowledge and, today, shapes post-colonial medicine in the same way. Traditional medicine challenges this conventional epistemology by resting on different kinds of knowledge and thus by becoming a resource for post-colonial activism. John Law and Lin Wen-Yuan take traditional medicine as alternative knowledge that can help defeat European- and US-centric knowledge production. Citing Western privilege and the publish-or-perish dictum, these scholars lament the tendency of non-Western researchers to rely exclusively on Western scholarly concepts for analyses of non-Western societies. Law and Lin’s solution is to actualize the principle of symmetry—a step that should enable, for example, Eastern scholars to analyze topics through Eastern epistemologies, such as the lens of traditional Chinese medicine.296 This approach treats modern and traditional medicine as two exclusive framings of diseases, bodies, and the environment, and facilitates the analysis of diseases from non-Western perspectives.

Places of Traditional Medicine, Complementary Medicine, and Alternative Medicine Our current conception of traditional medicine emerged largely during colonial encounters in an age of medical modernization. The term ‘traditional medicine’ is often interchangeable today with other terms, such as ‘complementary medicine’ and ‘alternative medicine’. According to definitions provided by the NCCIH, “if a non- mainstream practice is used together with conventional medicine, it’s considered ‘complementary’,” and “if a non-mainstream practice is used in place of conventional medicine, it’s considered ‘alternative’.”297 Thus, complementary medicine and alternative medicine are identifiable in relation to conventional medicine. The NCCIH does not provide a definition of ‘traditional medicine’. NCCIH categorizes these non-conventional approaches according to their corresponding types of treatments or practices: natural products, deep breathing, Yoga, Tai Chi or Qi Gong, chiropractic or osteopathic manipulation, meditation, massage, special diets, homeopathy, progressive relaxation, and guided imagery. This categorization avoids epistemological and ontological issues related, for example, to

295 For more discussions about the epistemology of modern Western science, see Harding, Sandra G. Is Science Multicultural? Postcolonialisms, Feminisms, and Epistemologies (Race, Gender, and Science) (Bloomington, IN: Indiana University Press, 1998). 296 John Law and Wen-yuan Lin. “Provincializing Sts: Postcoloniality, Symmetry, and Method,” East Asian Science, Technology, and Society 11 no. 2 (2017): 211–27; John Law and Wen-yuan Lin, “The Stickiness of Knowing: Translation, Postcoloniality, and Sts,” East Asian Science, Technology, and Society 11 no. 2 (2017): 257–69. 297 NCCIH, “Complementary, Alternative, or Integrative Health: What’s in a Name?” https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.

101 organs, and focuses on effective and safe treatment and experimentation. NCCIH also asserts that these non-conventional treatments are mostly dietary supplements, occupying a position somewhere between medicine and food.298 This conception of complementary health practices involves a strict boundary between them and true medicine. By contrast, the WHO’s definitions are more general and not based on treatments. The WHO defines ‘traditional medicine’ as “the total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.” The WHO goes on to define ‘complementary medicine’ and ‘alternative medicine’ as a country’s “broad set of health care practices that are not part of that country’s tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries.”299 The definitions of the WHO differentiate traditional medicine from complementary and alternative medicine by referring not only to the foundational knowledge of the medicine but also to the origins of the medicine. Curiously, the WHO provides no instructions about how to determine these origins. Formal conceptions of traditional, complementary, and alternative medicine remain ambiguous. Since the 19th century, conventional medicine has been the standard by which all other medicines are judged, yet how non-conventional medicines relate to conventional medicine is more debated today than ever before.

Conclusion Imperialism in the 19th and 20th centuries assigned traditional medicine to a position far inferior to that of modern medicine. In fact, traditional medicine was labeled non-medicine while modern medicine was labeled the true medicine. This institutionalized view of medicine often did not fit actual medical practices in colonies around the world. Traditional medicine occupied an important, though often low-profile, position in local colonial communities, while modern medicine, as privileged as it was in theory, remained available chiefly for members of each colony’s urban upper class. The waves of decolonization after the Second World War enabled traditional medicines to travel beyond their geographical and cultural origins, but disputes continue to swirl regarding the boundaries between modern medicine and non-conventional medicine. In recognizing traditional medicine as legitimate medicine, some former colonies have created an institutional place for traditional medicine and another institutional place for modern medicine. The WHO’s ICD-11 extends some legitimacy to traditional medicine by integrating it, to a certain extent, into modern medicine. However, this integration has left unresolved the fundamental question concerning the boundary between the two systems: what counts as medicine?

298 Ibid. 299 WHO, “Traditional, Complementary, and Integrative Medicine,” https://www.who.int/health- topics/traditional-complementary-and-integrative-medicine#tab=tab_1.

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Conclusion In this study, by exploring the history of traditional medicine in colonial Taiwan, I have demonstrated that “traditional medicine” was not simply something that existed before the arrival of the Japanese colonizers: it was also something reconstituted in the political and ideological contexts of colonization. These contexts reflected two trends in colonial Taiwan: the government’s institutional recognition that a shift from traditional medicine to biomedicine was taking place; and the government’s institutional recognition that a certain kind of traditional medicine was the traditional medicine. Local medicine in colonial Taiwan originally contained multiple styles of medicine, such as folk medicine, aboriginal medicine, and witchcraft medicine. However, scholarly Han medicine became the traditional medicine on the island because the Japanese colonizers, in their assessment of traditional healers, institutionally recognized as capable only those practitioners who subscribed to scholarly Han medicine. The government adopted this position for reasons of expediency, and later retracted its initial support for practitioners of Han medicine by refusing to license them. Nevertheless, unlicensed traditional medicine, in all its varied forms, remained popular in colonial Taiwan by operating outside the line of sight of the colonial government. In this study, I also tackle the myth that modern medicine, because of its efficacy, came to dominate the field of medicine, relegating traditional medicine to the ash heap of history. When Japan made modern medicine the official medicine of colonial Taiwan, this recently imported set of medical ideas and practices faced several formidable challenges, the most acute one being its inability to treat patients during a pandemic that gripped the island shortly after Japan’s colonization of it. Another challenge was the widespread distrust that local people felt toward the colonizers’ public-health interventions, such as quarantines and segregation orders. This distrust, coupled with the even broader distrust of Japan’s imperial agenda, convinced many locals during the pandemic to rely exclusively on traditional medicine and to hide from the quarantine- enforcing police. In other words, governmental recognition of modern medicine, not its efficacy, transformed it into the legitimate medicine of colonial Taiwan. The myth about modern medicine was a progressive narrative that extended to women’s healthcare. In particular, colonial officials’ agenda of medical modernization included the introduction of modern midwives to colonial Taiwan. These female professionals were intended to replace traditional female healers, sian-sinn-má. However, throughout the colonial period, most Taiwanese women still chose traditional female healers for healthcare services. One likely reason for this preference, I argue, is that sian- sinn-má provided more comprehensive care than modern midwives. While modern midwives focused on midwifery, sian-sinn-má took care of women regardless of whether their health problems were related to reproduction or not. Also, because they cared for infants and toddlers, sian-sinn-má functioned as pediatricians. In this regard, they became significant healthcare providers for young mothers who, for instance, had trouble nursing their babies. Medical modernization brought a new type of midwifery to Taiwanese women, but it was not always a “better” healthcare practice for many of them. A central argument in my study is that traditional medicine was never simply a tool with which the colonized resisted the colonizers. Matters were far more complicated.

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In the revivalist movement of traditional medicine in the 1920s, Japanese practitioners of traditional medicine worked with Taiwanese practitioners of traditional medicine to convince the colonial government that it should offer them licensing opportunities in Taiwan. In particular, Japanese practitioners of traditional Kampo medicine tried to connect it with Japan’s cultural heritage and detach it from Chinese culture, but as the Japanese empire was eager to continue its Westernization and as Japanese saw this path as the best way to slough off Japan’s Chinese legacy, the Kampo movement failed. In the process, it revealed that Kampo, rather than an intrinsically Japanese traditional medicine, was in fact a largely Chinese construction that had undergone a problematic process of becoming Japanese. Another avenue that I have explored in this study is the integration—or at least the attempted integration—of traditional medicine into modern medicine. Practitioners of traditional medicine in Japan and colonial Taiwan organized the KouKan IDou Revivalism movement to promote the status of traditional medicine in Taiwan. The activists tried to match traditional categories of diseases with modern ones. If successful, the project would demonstrate that traditional medicine had identified—and thus had probably been successful in treating—many diseases defined by modern medicine and often based on germ theory. In the early 20th century, a Taiwanese scholar of modern medicine, Tu Tsung-Ming, proposed another approach to verifying the efficacy of traditional medical treatments: clinical trials. However, neither the disease-matching project nor the clinical-trial project addressed the stark differences between modern and traditional medicine, such as their vastly different conceptions of body and pathology. This goal of integration continues in the contemporary debate about whether the ICD-11 was right to have devoted a chapter to traditional Han medicine. Apparently, even this partial step at medical integration has triggered more disagreements than it has resolved.

The Advantages and the Limits of the “Hidden Transcript” Approach The various historical incidents and trends that I have discussed in this study demonstrate how medicine and health care were viewed by people outside the colonial apparatus, which itself persistently characterized local medicine as a vile and quackery- riddled aspect of local culture that had to be eliminated. As James Scott argues, to examine these power dynamics, we must identify—and analyze the relationships among—three kinds of transcripts: the public transcript of power relations, the hidden transcript of subordinate groups, and the hidden transcript of powerholders.300 For the current study, I have analyzed the public transcripts of Japanese government and medicine, the public transcripts of traditional medicine, and the hidden transcripts of local healers. The hidden transcripts have enabled me to uncover a story that goes beyond the progressive narratives and indicates the complexity of colonial modernity. While hidden transcripts have contributed to my study’s important insights, many limits of this study stem from hidden transcripts. First of all, it is difficult to identify undocumented medical practices, especially those associated with folk medicine and the medicine of Taiwanese plains indigenous peoples, who influenced and later assimilated with Han people. It is also difficult to detect the practices and tools of traditional female healers. Even though we can detect from the infant mortality rate that their practices were

300 James Scott, “The Hidden Transcript of Subordinate Groups,” Asian Studies Association of Australia, 10, no. 3 (1987): 23–31.

104 not as noxious as the colonial authority claimed, there is no record detailing their care for women and children. Thus, the present study should be seen as just the beginning, not the end, of efforts to uncover and explore the hidden transcripts of medicine and healers in colonial Taiwan.

Recommendations for Future Research This study indicates at least two important directions for future research. First, one finding in this study is that colonial Taiwanese chose certain kinds of health care for various reasons, including the individuals’ social, cultural, and economic backgrounds. Thus, patients’ general preference for traditional medicine was not always a simple function of, for instance, their under-education or their distrust of modern medicine. As is the case with many people today, some colonial-era Taiwanese alternated between conventional medicine and multiple kinds of alternative medicines depending on the illness or injury requiring treatment. And it was not unusual for these decisions to run counter to “expert” regulations and “expert” advice. One factor that has motivated people to choose alternative medicine is the limits of conventional medicine. In colonial Taiwan, as shown in Chapter 1, modern medicine was unable to successfully treat various infectious diseases, and as shown in Chapter 4, even many Western-educated, financially comfortable patients decided to alternate between modern and traditional medicine. If we leap forward about one hundred years, we find that, today in the United States, people often take traditional medicine for chronic diseases, cancers, mental health, and pain, which conventional medicine often fails to resolve satisfactorily.301 The parallels between colonial Taiwan and the contemporary United States are telling: people’s preference for alternative medicine over conventional medicine reflects the disease being treated and the cost of the treatment more than an overall trust in or distrust of a certain kind of medicine. Current studies that generalize about contemporary or alternative medicine often miss the subtle dynamics that guide people’s related decision-making steps. 302 Another common generalization that researchers make is the assumption, not borne out by facts, that trust in conventional medicine is incompatible with trust in alternative medicine. Chapter 4 addresses this very issue, noting that trust in modern medicine and trust in traditional medicine were not mutually exclusive in colonial Taiwan. In contemporary contexts, scholars have found that trust in alternative medicine is not significantly associated with vaccine hesitancy.303 These findings and studies show that, in order to determine whether a patient embraces conventional or alternative medicine, we must first identify issues specific to each proposed treatment in a specific social and economic context.

301 Brand Essence Market Research & Consulting, “Alternative Medicines Market Size Worth $293.56 Billion by 2026,” November 19, 2020. 302 For example, many studies treat a person’s preference for an alternative medicine as an indicator of the person’s broad trust in alternative medicine, even though evidence suggests that a specific preference often reflects a partial, conditional trust, with other contextual factors playing important roles in the matter. See, for example, Evelien van der Schee and Peter Groenewegen, “Determinants of Public Trust in Complementary and Alternative Medicine,” Bmc Public Health 10, no. 1 (2010): 1–12. 303 Matthew J. Hornsey, Josep Lobera, and Celia Díaz-Catalán, “Vaccine Hesitancy Is Strongly Associated with Distrust of Conventional Medicine, and Only Weakly Associated with Trust in Alternative Medicine,” Social Science & Medicine 255 (2020): 113019.

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The second direction that future research would do well to pursue is the further identification of boundaries between modern and traditional medicine—boundaries shaped by imperialism and, later, the commercialization of medicine and health care. Consider, for example, the commercialization of alternative medicines and supplements: nutraceuticals, especially those made from traditional substances such as reishi mushrooms from Asia, seem to boost the immune system; and maca from South America is said to improve men’s energy and sexual stamina. Are these products medicine or not? Perhaps they are “in-between things.” Regulatory agencies categorize the products as dietary supplements, but producers and sellers claim that the “supplements” have health benefits much stronger than those of food; these alternative products have been tested by practitioners of modern medicine and food science, but are already regarded as effective among practitioners of traditional medicine; the products are retrieved through cutting- edge Western technology but are frequently marketed as natural non-Western materials. In the global context of imperialism, the evolution of these products is inextricably linked to the formation of modern medicine and traditional medicine, as these products often come from bioprospecting, which is the systematic search for natural resources such as plants, microorganisms, and animals. In bioprospecting, scientists transform the resources into commercial products according to a process that often depends on global and local inequity: biomedical companies use aboriginal knowledge to hunt for natural resources and then monopolize patents that yield hefty profits, few or none of which go to aboriginal communities. Bioprospecting is especially evident in Latin America, where many US companies undertake these questionable activities.304 Through bioprospecting, communities unwittingly cede indigenous medicine to foreign cultures, resulting in a hybrid of traditional and modern medicine. The regulation and status of these products simultaneously reflect and challenge the boundaries determining what officially counts as medicine.

Policy Implications My study has several important implications for government policy. First of all, the study shows that the colonial encounter was pivotal in transforming traditional medicine into alternative medicine or non-medicine, in large measure because many colonial medical systems, such as the one in colonial Taiwan, privileged modern medicine over traditional medicine, which thus became “alternative.” And since alternative medicine, by definition, is not completely legitimate, it is limited in its extension and often operates under the table, so to speak. However, a benefit to this alternative status is that the products are sometimes subject to fewer regulations or develop ways to avoid government oversight. We see that this very process unfolded in colonial Taiwan during the early 20th century, when practitioners of traditional medicine hid “in plain sight” in licensed pharmacies. A similar process is unfolding at this moment, as RespireAid has managed to market itself in North America, where governments label the product a dietary supplement, yet customers in Taiwan, where the product is widely considered to be a medicine, required a prescription in 2020. These examples show how, in the world of medicine, a product’s inferior status can create opportunities, as well as obstacles, for the product.

304 Cori Hayden, When Nature Goes Public: The Making and Unmaking of Bioprospecting in Mexico (Princeton: Princeton University Press, 2003).

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The inferior status of traditional medicine thus causes potential safety issues for providers and patients. In the early 20th century, the Japanese colonial government refused to continue licensing or practicing clinical trials of traditional Han medicine under the agenda of medical modernization. For practitioners of traditional medicine, Japan’s rejection of traditional medicine led not only to economic insecurity but also to inconsistent training quality, as the practitioners had to seek mentorship on their own or study overseas. It also worsened the distrust between the colonial authority and local people, as well as the problem of insufficient medical resources, especially for lower social classes and those in rural areas. Today in many countries, most traditional prescriptions are considered non- medicine. In the United States, the government regards most traditional Han (Chinese) prescriptions as dietary supplements, which are subject to regulations governing not drugs but food. These products are available in the marketplace without prescriptions, even though the governments of other countries regard Han medicine as drugs. Because modern medicine is the gold standard for judging other kinds of healings, any official assertion that traditional medicine is not actual medicine carries a slew of health risks for customers. Dietary supplements rooted in traditional medicine evade rigorous drug- approval processes, as described in Chapters 3 and 5. Dietary supplements rooted in traditional medicine have a curious characteristic: they are widely perceived to be “natural” products possessing medical functions. The apparent naturalness of the products suggests that they are free of side effects and of undue political and economic controls. During the 1970s, a growing commitment to nature and to all things natural emerged in the United States. During this period, many Americans had grown “universally distrustful of traditional, patriarchal authority and often skeptical of science and industry.” 305 The inferior status that modern medical institutions have assigned to traditional or alternative medicine presents consumers with a tricky decision: should they take or reject laxly regulated healthcare products? Contemporary societies thus face a pressing dilemma of their own: should they recognize traditional medicine as legitimate biomedicine and actively manage it, or should they persist in assigning an inferior position to traditional medicine, which can then enjoy a degree of marketplace freedom that regulated drugs cannot? This dilemma echoes the history of colonial Taiwan, where the issue of what counts as medicine was profoundly intertwined with changing political, economic, and intellectual dynamics.

305 Tamara Venit Shelton, Herbs and Roots, 233.

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