History of Medicine: Read 3 Articles and answer 3 questions about the articles

Readings:Laennec, René T. H. 1821. “On the Diagnosis of Disease of the Chest.” In A Treatise on
the Diseases of the Chest and on Mediate Auscultation. Translated by John Forbes,
281-293. London: Thomas & George Underwood.
Virchow, Rudolf. 1860. Cellular Pathology: As Based Upon Physiological and
Pathological Histology. Translated by Frank Chance, vii-xxviii; 1-23. London: John
Churchill.
Hsu, Elisabeth. 2000. “Towards a Science of Touch, Part I: Chinese Pulse Diagnostics in
Early Modern Europe.” Anthropology and Medicine 7.2: 251-268.
1. In “On the Diagnosis of Disease of the Chest,” how did Laennec associate with
his innovation with his predecessors who inspired him? How (what steps did he
take) did he improve the diagnostic technique? What medical and non-medical
consideration facilitated him for the improvement? What is the significance of his
improvement in the field of anatomy? (Think about that Laennec could achieve
but his predecessors could not.) How do you connect Laennec’s medical practices
and the invention of stethoscope with his pathological view of chest diseases?
What were the three classes of application of the invented stethoscope, according
to Laennec? What remained limited for Laennec to examine the chest cavity with
his new instrument? What do you think the purpose of which Laennec wrote this?
Who would be the target reader?
2. In the preface of Virchow’s Cellular Pathology, could you tell who was the target
audience of this work/lecture series? What was the purpose of this work/lecture?
What was Virchow’s pathological view of diseases? What was Virchow’s method
of conveying his pathological view? How did Virchow prove (what were the
evidences) that “cells as the ultimate active elements of the living body”? How
did Virchow compare with and contrast to the humoral and solidistic views of
pathology? How would you associate his view on science/ medicine with his
political view?
3. According to Hsu, what was Jean Baptiste Du Halde’s foundational understanding
of medicine? (Think about how Du Halde seemed to impose the Galenic
understanding of pulsation on the Chinese pulse patterns.) Compare Du Halde’s
remark on Chinese pulse diagnostics in a basis on a conception of the body as a
kind of lute with René Laennec’s mediate auscultation in diagnosing of a living
body. What are the similarities? According to the author, how does Chinese tacit
perception/experience of pulse taking achieve a diagnosis in a detached and
descriptive way? How does a Chinese physician “calibrate” himself or herself
when taking a patient’s pulse? What are the differences between “active touch” in
Chinese pulse taking and “passive touch” in psychophysical practice?
Anthropology & Medicine
ISSN: 1364-8470 (Print) 1469-2910 (Online) Journal homepage: http://www.tandfonline.com/loi/canm20
Towards a science of touch, part I: Chinese pulse
diagnostics in early modern Europe
Elisabeth Hsu
To cite this article: Elisabeth Hsu (2000) Towards a science of touch, part I: Chinese
pulse diagnostics in early modern Europe, Anthropology & Medicine, 7:2, 251-268, DOI:
10.1080/713650587
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Published online: 09 Jun 2010.
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Date: 13 September 2016, At: 14:05
Anthropology & Medicine, Vol. 7, No. 2, 2000
Towards a science of touch, part I: Chinese pulse
diagnostics in early modern Europe
(Accepted date: 15 April 2000)
ELISABETH HSU
Faculty of Oriental Studies, University of Cambridge, UK
ABSTRACT This paper is about a pre-modern `science of touch’ Ð Chinese pulse diagnosticsÐ
which was the aspect of Chinese medicine most admired by physicians in early modern Europe.
The paper ® rst provides some historical information on Chinese pulse diagnostics in Europe and
then details how it was presented to an 18th-century readership. At last, it points out that
Chinese physicians had developed an elaborate system for distinguishing between various
experiences of touch. From an outsider’ s viewpoint, one could say that they already had an idea
of calibration and made measurements in respect of a calibrated condition. Since they put their
® ngertips on the wrist of their patients and actively palpated it, one can say that their `science
of touch’ was developed in respect of `active touch’ . This in contrast to the `science of touch’
developed by psychophysicists of the modern West, who have been interested primarily in
`passive touch’ .
Introduction
Science is, in common parlance, a phenomenon of modernity and accordingly
one would trace the beginnings of a `science of touch’ to 19th-century experiments on the psychophysics of touch. This now well-established ® eld has set the
trend for 20th-century research on touch in the West, and a section at the end
of the paper will summarise what this modern science knows about touch and
what it tends to neglect. However, `science’ also designates practices that are
pre-modern and not necessarily occidental, and the aspects of the `science of
touch’ at the core of this article concern a pre-modern attempt to assess in a
descriptive way the tactile sensations, perceptions, and experiences that a
physician makes with the sense organ of the skin (more precisely, the glabrous
skin of the hand and the ® nger-tips), when he or she engages in pulse
diagnostics.
Correspondence to: Elisabeth Hsu, Faculty of Oriental Studies, University of Cambridge,
Cambridge CB3 9DA, UK. E-mail: elh25@cus.cam.ac.uk
ISSN 1364-8470 (print) ISSN 1469-2910 (online)/00/020251-18 Ó
2000 Taylor & Francis Ltd
252
E. Hsu
The Paradox of a `Science of Touch’
Touch differs in important ways from other modalities of perception: I can see
you without you seeing me; I can hear you without being heard. Likewise in
order to smell or taste one need not be tasted or smeltÐ but whatever you touch,
touches you too. ª In touch, the distinction between touching subject and
touched object blursº (Mazis, 1971). This aspect of touch may explain its
prominence both in love relationships and aggression, where it has the emotionally highly laden positive or negative attributes of pleasure or pain. And in turn
it may partly explain its prohibition in social behaviour when boundaries
between individuals are emphasised. Yet precisely this involvement between
subject and object makes it dif® cult to account for touch in a detached and
descriptive way, and because of this it appears paradoxical for pulse diagnostics
and, for that matter, any descriptive science to rely on differentiations between
sensations of touch.
I am not the ® rst to point to this peculiarity of touch. Merleau-Ponty (1992,
p. 316) states that ª tactile experience ¼ adheres to the surface of our body; we
cannot unfold it before us and it never quite becomes an objectº and he opposes
this to visual experience, which ª pushes objecti® cation further than does tactile
experienceº . But Merleau-Ponty has in fact little to say about touch in his over
four hundred page oeuvre on the Phenomenology of Perception.
This melding of subject and object makes touch an excellent non-verbal
means for communicating one’ s own, and recognising the other’ s, temper and
disposition, not only because the social contact is governed by what Hall (1966)
called ª intimate proxemicsº , but also because ª there is a feeling of control in
verbal discourse that is absent with physical intimacyº (Young cited in Autton,
1989, p. 8). Even in situations other than those governed by intimacy, touch has
been shown to have great signi® cance in both social interaction (e.g. Montagu,
1971) and therapeutics (e.g. Older, 1982). While these aspects of touch
certainly deserve to be more extensively explored, this paper focuses on another
aspect, which appears as a paradox of any `science of touch’ : one would expect
that the experience of touch, marked by melding of subject and object, poses
dif® culties for its representation in a descriptive and detached, generalising and
`objectifying’ way.a
Pulse diagnostics is here treated as a form of scienti® c inquiry that identi® es
and describes different tactile experiences. In many pre-modern societies it was
highly elaborate. Thus, ª sphygmology was perhaps the single most important
diagnostic aid in Galen’ s repertoire and the technique to which he devoted most
space in his theoretical expositions of medical practice ¼ a whole series of
sixteen books on the pulseº (Nutton, 1993, p. 12). Galen related the tactile
experience of the doctor during pulse diagnostics to anatomical and physiological speculation: the pulsations at the wrist were attributed to the movement of
the arteries, which in turn had been put into motion by the life-force that came
from the heart. His understanding of the pulses was different from our own, and
also different from that of the Chinese (Kuriyama, 1986, pp. 40± 57, 1999).
Science of touch, part I
253
I. The Historical Cadre
Attitudes to Chinese Pulse diagnostics
The 17th century saw the ® rst translations of treatises on Chinese Pulse
diagnostics into Latin and French, and even if the attitude towards them was
not uniformly positive (e.g. Winau, 1978), we ® nd that they were often praised
as superior to those of scholastic medicine (e.g. Lu & Needham, 1980, pp. 36±
37). Thus Jean Baptiste Du Halde ([1735] 1941) in his Description of the Chinese
Empire ¼ begins a chapter on `The Art of Medicine among the Chinese’ b with
a mixture of admiration and condescension:
It cannot be said that Medicine has been neglected by the Chinese, for
they have a great Number of ancient Authors who treat of it, having
applied themselves thereto from the Foundation of the Empire.
But as they were very little versed in Natural Philosophy, and not at
all in Anatomy, so that they scarce knew the Uses of the Parts of the
Human Body, and consequently were unacquainted with the Causes of
Distempers, depending on a doubtful System of the Structure of the
human Frame, it is no wonder they have not made the same Progress
in this Science as our Physicians in Europe. (p. 183)c
Yet the introduction to this chapter ends with an eulogy of Chinese Pulse
diagnostics:
They [the Chinese] pretend, by the Beating of the Pulse only, to
discover the Cause of the Disease, and in what Part of the Body it
resides: In effect, their able physicians predict pretty exactly all the
Symptoms of a Disease; and it is chie¯ y this, that has rendered Chinese
Physicians so famous in the World. (p. 184)
Chinese Pulse diagnostics was certainly the aspect of Chinese medicine that
attracted the main interest of the Jesuit missionaries who had travelled to China
and were knowledgeable in both medicine and the Chinese language, for several
works of 17th-century Europe provide detailed and systematic accounts of it
(Grmek, 1962; Despeux & Obringer, 1997, pp. 10± 11). In this context, it is
worth mentioning that there possibly were precursors: Avicenna (Arabic: Ibn
Sina) (AD 980± 1037) used vocabulary in his Canon of Medicine strikingly similar
to that in the later Persian treatise by Rashid ad-Din Fadlallah’ s (1247± 1318) on
Chinese Pulse lore, and a chapter in his Canon as well as his Treatise on the Pulses
(ar-Risala ® n Nabad) are considered to enumerate pulse qualities which resemble the Chinese ones in the Rhymed Pulse Lore (Maijue) of the 10th century.
Although Avicenna nowhere explicitly acknowledges Chinese writings as source
material, it is possible that his works testify to knowledge transfer of Chinese
Pulse diagnostics into Europe, predating those of the 17th and 18th centuries by
more than half a millennium.d
Was it the case that Avicenna and some of the later physicians of scholastic
medicine considered Chinese Pulse diagnostics superior to Galenic sphygmology? If this was so, what was it that made Chinese Pulse diagnostics so highly
254
E. Hsu
respected? From an empiricist viewpoint, one could argue that the doctrine of
Chinese Pulse diagnostics was closely linked with empirical knowledge derived
from medical practice, and that the doctors who applied it were therefore
therapeutically more successful. However, if one hesitates to attribute much
empirical value to either the Galenic or the Chinese form of sphygmology, one
has to investigate the social conditions that facilitated its transmission from East
to West.
This paper does not seek to answer the above question of why Chinese Pulse
diagnostics was so highly regarded in the West, even though it is concerned with
Pulse diagnostics as represented in some of the many editions of the Maijue
(Rhymed Pulse Lore) just mentioned. Du Halde renders it in translation as ª The
Secret of the Pulseº and presents it in three instead of the usual four parts
(pp. 184± 207).e The treatise discusses a whole variety of different Pulses, but in
this paper we will discuss only a few sections and focus, in particular, on the
editor’ s introduction to it.
To be sure, this paper is not primarily concerned with the problem of how
Chinese Pulse diagnostics were translated into the vocabulary of the scholastic
Galenic medicine that was then prevalent nor does it address the equally
important question of the history of the reception of Chinese Pulse diagnostics
in Europe. Rather, it intends to contribute to an anthropology of sensory or,
more precisely, tactile experience. It centres on the problem of how, despite the
blurring of subject and object in touch, touch can be described in a detached
and `objective’ way. This is done by exploring some examples of how a
pre-modern Chinese `science of touch’ Ð Chinese Pulse diagnosticsÐ assessed
tactile experience. However, before turning to the representations of touch in
Chinese Pulse diagnostics, let us outline its rationale.
Du Halde’s introduction to the Chinese ª antick, but erroneousº system of medicine
Du Halde gives a summary of the Chinese ª antick, but erroneousº system of
medicine in a two-page introduction in small script, without, however, indicating the textual source material on which it is based. Since the information he
provides coincides largely with what is currently known from Chinese sources,
it is outlined here for the reader unfamiliar with Chinese medical doctrine.f
Thus, Du Halde remarks that Chinese Pulse diagnostics are based on a
conception of the body as a kind of lute:
They ¼ suppose that the Body, on account of the Nerves, Muscles,
Veins and Arteries, is a kind of Lute, or musical Instrument whose
Parts yield diverse Sounds, or rather have a certain kind of Temperament peculiar to themselves, by reason of their Figure, Situations, and
various Uses; and that the different Pulses, which are like the various
Tones and Stops of these Instruments, are infallible Signs whereby to
judge of their Disposition, in the same manner as a String, which is
touch’ d in different Parts either strongly or gently, gives different
Sounds, and shews whether it be too slack or too streight. (p. 183)
Science of touch, part I
255
This comparison of the body to a lute is not given in any of the Chinese texts
known to me, but it captures aptly the kind of tactile perception Chinese
physicians were interested in, which, from a bio-physiological viewpoint, was
primarily vibration. With regard to yang and yin, Du Halde says that they are the
two ª natural Principles of Lifeº ; qi, which is translated as ª Spiritsº , and xue,
ª Bloodº , are considered their ª Vehiclesº . Du Halde then proceeds to explain that
the Chinese conceive of the body (a) by dividing it into a left and a right part; (b)
by dividing it into three parts: an upper, middle, and lower part (ª from the top of
the Head as far as the Breastº , ª from the Breast to the Navelº , ª from the Navel
to the Sole of the Feetº ); and (c) by dividing it into ª Members and Intestinesº ,
or ª Entrailsº , elsewhere also referred to as ª Springs of Lifeº (see Table I).
With regard to these ª Intestinesº or ª Entrailsº , Du Halde says from a
bird’ s-eye view: ª After they had establish’ d these twelve Springs of Life in the
Body of Man, they searched after outward Signs, whereby to discover the
inward Dispositions of those twelve Parts.º (p. 183) Du Halde mentions the
correlations between ª the Tongue and the Heart, the Nostrils and the Lungs,
the Mouth and the Spleen, the Ears and the Kidneys, the Eyes and the Liverº
(without explicitly indicating that they are characteristic of reasoning in terms of
the ª Five Elementsº ), and explains that ª the Colour of the Visage, Eyes,
Nostrils, and Earsº , ª the Sound of the Voice, and the Relish which the Tongue
either feels or desiresº are such ª outward Signsº ; they are found in the head
which, according to Du Halde, ª is the Seat of all the Senses that perform the
animal Operationsº .g Diagnostics in those cases are based on visual and auditory
perception, or in the case of tongue diagnostics, according to Du Halde, on the
patient’ s subjective disposition.h Du Halde speaks of such diagnostics as relating
ª outward Signsº to ª inward Dispositionsº .
In Pulse diagnostics, one would expect the Pulse patterns to be the ª outward
Signsº of the ª Springs of Lifeº Ð they were felt at three positions on the left and
right wrist, in analogy to their position in the body (see Table I)Ð but Du Halde
does not take the different Pulses as ª outward Signsº :
It is Motion, say they [the Chinese], that makes the Pulse, and this
Motion is caused by the Flux and Re¯ ux of the Blood and Spirits,
which are convey’ d to all Parts of the Body by the twelve Canals [¼ ].
(p. 183)
TABLE I. The Twelve ª Springs of Lifeº (Du Halde [1735] 1741, p. 183).
Left
yang
Small Guts or Pericardiuma
Gall-bladder
Ureters
a
Right
yin
Heart
Liver
Kidneys
yang
Great Guts
Stomach
The third part of
the Body
yin
Lungs
Spleen
Gate of Life 5
Right Kidney
The pericardium is mostly considered a yin entrail that corresponds with the sanjiao,
here given as ª The third part of the Bodyº .
256
E. Hsu
Each of these ª Canalsº or ª Passagesº or ª Ductsº or ª Waysº , as Du Halde refers
to them, have been established because ª it is necessary to explain in what
Manner they [the Chinese] think this radical Moisture [yin] and vital Heat
[yang] are communicated to other Parts of the Bodyº (p. 183).i Soulier de
Morant (1934) called them `meridians’ and this is how they are generally
referred to among medical practitioners in Europe. Porkert (1974) speaks of
`sinarteries’ ; Unschuld (1986) of `conduits’ ; Lu and Needham (1980) of `tracts’ ;
and Sivin (1987) of `circulation tracts’ . One of the reasons why historians and
anthropologists of Chinese medicine hesitate to call them `meridians’ Ð which
invokes the metaphor of meridians that are `lines of orientation’ projected onto
the body of the globeÐ is that Pulse diagnostics, unlike the other diagnostic
methods mentioned above, is supposed to be based on the investigation of a
postulated reality, and not imagined lines of orientation: it detects the motions
of the ª Bloodº and ª Spiritsº in those Canals or Passages:
By a thorough Knowledge of these Beatings and Percussions, the
Dispositions of the Body, and the Affections which they receive from
the Elements are discovered. By these Beatings, one may know the
Nature of the Blood and Spirits, with the Defects and Excesses that
may happen therein; ¼ (p. 184)
The ª Elementsº are not the elements of early Greek philosophers nor of modern
chemistry but rather spatio-temporal `rubrics’ (Granet, 1934) according to
which the dynamics and changes in the universe are assessed, today generally
referred to as ª Five Phasesº (Porkert, 1974): Wood,j Fire, Earth, Metal, Water
(see Table II). Du Halde explains that they are ª the exterior Bodies, which may
cause Alterations in the Body of Manº and that ª all these Elements unite in
composing the Human Body, which is disposed in such a manner, that one
Element prevails more in some Parts than othersº (p. 183).
Such were the foundations of Chinese medicine in Du Halde’ s view. At the
time, he could say: ª They reason much in the same manner as we do,
concerning the Agreement and Disagreement of these Elements with the Body
of Man, to account for the Alterations and Diseases incident theretoº . He
obviously had a different foundation for understanding Chinese medical doctrine, but none the less his outline contained surprisingly similar contents as
those currently taught to students of Traditional Chinese Medicine (Hsu,
1999). In one aspect, however, Du Halde’ s understanding differs from that of
present-day interpreters of canonical medicine. This concerns Pulse diagnostics.
The Tactile Experience
Touch and the melding of subject and object
Du Halde stresses that Pulse diagnostics is not based on identifying ª outward
Signsº Ð beatings and percussionsÐ and linking them to ª inward Dispositionsº Ð the disposition of the body. In this respect Pulse diagnostics differs from
Science of touch, part I
257
TABLE II. The Five ª Elementsº (Du Halde [1735] 1741, p. 183).
Thus Fire predominates in the Heart, and the chief Viscera, which lie near it; and the South is the
Point of the Heavens that principally hath respect to these Parts, because Heat resides there: They
also observe the Affections of the Heart in Summer.
The Liver and the Gall-bladder are referred to the Element of Air, and both have a Relation to the
East, which is the Place from whence the Winds and Vegetation proceed; and the Disposition of those
Parts ought to be observ’d in Spring.
The Kidneys and Ureters belong to the Water, and correspond to the North; whence Winter is the
most proper Time to observe their Indications.
The Lungs and Great Intestines are govern’ d by the Metals as well as by the West, and the Autumn,
which is the Time of their Indications.
Lastly,a the Spleen and Stomach participate of the Nature of the Earth, and are referr’ d to the middle
of the Heavens, between the four Cardinal Points; and the third Month of every Season is the
particular Time of their Indications.
a
Despite this adverb, Du Halde (p. 183) thereafter includes one more paragraph on Fire and Water:
ª The Gate of Life and the third part of the Body are subject to Fire and Water, and receive the
Impressions of the Heart and Kidneys, which they communicate to all the other Partsº .
diagnostics based on examination of ª Colourº , ª Soundº , and ª Relishº : the
motions of the Pulse are considered to be those of the inside processes
themselves. Du Halde may have made this distinction because in his understanding that the Chinese Pulses were linked through ª Ducts to the Life
Springsº in the body in what we are inclined to call a `mechanistic’ way, while
Colour, Sound, and Relish related to those Life Springs according to laws of
correlative correspondences between the Five Phases. Du Halde may thus have
imposed the Galenic understanding of pulsationÐ as a movement of the arteries
that were directly connected to the heart and its life-forceÐ on the Chinese
Pulse patterns.k
On the other hand, it is worth noting that throughout the history of Chinese
medicine the examination of the Complexion has remained closely related to a
rationale of ® ve-phase correlations, but not that of Pulse patternsÐ one may
argue that in some early texts Pulses were categorised primarily in respect of the
® ve phases, but hardly in the text known to Du Halde and certainly not in
contemporary teachings of the People’ s Republic of China. In the Records of the
Historian (Shiji, p. 105) from the 1st century BC, which contain the ® rst extant
text on Pulse diagnostics (Hsu, forthcoming), Pulse patterns are often directly
linked to what Du Halde would have called the Life Springs, and they are
ascribed qualities of the ® ve phases. In modern teachings of Traditional Chinese
Medicine, however, the rationale of Pulse diagnostics takes hardly any account
of Five Phase doctrine: rather, one of the main schemata for attributing Pulses
to internal dispositions is that of the ª Eight Rubricsº (Farquhar, 1994, pp. 76±
83), a schema which is not grounded in exactly the same kind of correlative
reasoning that underlies Five Phase doctrine.l Admittedly, the teachings of
Traditional Chinese Medicine are to a certain extent based on innovations
258
E. Hsu
dating to the late Ming (16± 17th centuries), while the Rhymed Pulse Lore was
popular from the Song to the Ming (960± 1644; see above), and Du Halde
provides a translation of one of the many versions of the latter. At the time,
Pulse diagnostics was de® nitely not as much dominated by Five Phase correlative reasoning as was Complexion± Colour diagnostics.
It is also possible that in singling out Pulse diagnostics Du Halde pointed to
characteristics of tactile experience that are distinct from visual or auditory
perception. In the article ª The Pulse as an Icon in Siddha Medicineº Daniel
(1991) makes a distinction reminiscent of Du Halde’ s: he explains that the
ª signº in Peirce’ s sense entails a ª leaping activityº between two correlates, a
ª jumpº from one universe of discourse to another, i.e. from the correlate of the
sign to the sign itself, while the stable relation of meaning between them often
presupposes a more or less arbitrarily set-up code.m Daniel points out that a
Siddha doctor who takes the pulse is not, in effect, detecting a `sign’ , in contrast
to the doctor who inspects the iris and takes his ® ndings as signs of the patient’ s
inner disposition. Daniel describes a process that has three stages ending in one
in which the physician’ s pulse beat melds with that of the patient. The physician
takes on the pulse condition of the patient and through the experience that his
own self thereby undergoes he is able to recognise the patient’ s health condition.
Although in Chinese medicine the process of taking the Pulse is nowhere
described as ending in a state of melding or, in Daniel’ s words,
ª consubjectivityº , no one would deny that the diagnostic method of relying on
tactile perception of Pulses consists of a direct contact between the doctor’ s
® nger-tips and the patient’ s wrist (see Fig. 1) and thus, to an admittedly limited
extent, a melding between doctor and client. In corroboration of this we notice
that Du Halde stresses the great care with which physicians undertook the
procedure and that it required ª a considerable Time to examine the Beatingº
(p. 184), time enough for physician and patient to start to feel one.
Of course, the diagnostic value of touch during Pulse diagnostics could also
lie in the verbal information elicited through touch: ª If you examine peopleÐ
and that means touching themÐ they’ ll often open out and tell you things that
they quite clearly wouldn’ t have told you beforehandº (Older, 1982). This
aspect of Pulse diagnostics is certainly not to be underrated as various studies
focusing on the micro-social aspects of the clinical encounter have indicated,
though without pointing out that touch may have been a constitutive factor (e.g.
Trawick, 1987).
Probably touch was not only meaningful for the doctor but also for the patient
to whom the encounter may have communicated the doctor’ s calmness or trust
or other feelings conducive to self-healing forces. ª When the doctor touches the
patient both parties have the `feeling’ that something is being doneº (Autton,
1989, p. 55); its diagnostic value may prevail for the doctor while, as electrocardiograms have shown, it has a calmingÐ and hence possibly therapeuticÐ
effect on the patient (Autton, 1989, pp. 81± 82).
To summarise, Du Halde’ s claim that the motions of the Pulses are not to be
taken as `outward signs’ of `inward dispositions’ raises the question of the
Science of touch, part I
259
FIG. 1. The positioning of the hands during Pulse diagnostics. The upper illustration is questionable
in light of ethnographic observation in contemporary China, because doctors would always use three
® ngers simultaneously when taking the Pulse, even when they pressed them down independently of
each other. The lower illustration is faulty because the ® nger closest to the hand is always the index,
followed by middle and ring ® ngers. The index ® nger on the left wrist detects motions of the Heart,
on the right motions of the Lungs; the middle ® nger on the left wrist detects motions of the Liver,
on the right motions of the Spleen; the ring ® nger on the left wrist detects motions of the Kidneys,
on the right motions of the Gate of Life. Plate in Cleyer (1682). Photocopy courtesy of the University
Library, Cambridge.
premisses on which Pulse diagnostics rely. Possibly, Du Halde’ s singling-out of
Pulse diagnostics may derive from the Galenic anatomy-oriented understanding
of pulsation. However, it is also possible that the rationale of Pulse diagnostics
began to be separated from that of other forms of diagnostics in the Chinese
context itself. As established at the beginning of this paper, tactile perception
differs from other sensory perceptions in important ways, and we have seen that
260
E. Hsu
the Siddha doctor exploits this peculiarity of touch: the fusion between two
individuals that it entails makes it possible that the patient’ s pulses (and thereby
the clues to his distemper) are transferred to the doctor. Yet Chinese Pulse
diagnostics does not claim to rely on a doctrine of touch as a form of melding
between two individuals. Is it the concomitant verbal information that makes it
viable practice? Is it other non-verbally transmitted information during the
process of touching? One wonders how tactile experience, based on a blurring
of subject and object, can be assessed in a detached and objective way. It
appears blatantly contradictory to the prerequisites of any objectifying science.
The self-calibration of the physician and other instructions for feeling the Pulse
The treatise on the ª Secret of the Pulseº seems to address precisely this problem
of the melding of subject and object in the section ª Seven Cautions to a
Physician about feeling the Pulseº . This advocates the `self-calibration’ n of the
physician as one of the ® rst steps towards the Chinese medical `science of
touch’:
1. He must be in a calm Disposition of Mind.
2. He must be as attentive as possible, and free from the least Distraction of
Thought.
3. With respect to his Body he should also be in a state of Tranquillity, so as
to ® nd his Respiration free and regular. ¼ (p. 190)
Evidently, the physician himself must be in a calm and attentive state of mind.
As we will see below (citation from p. 191), it is the physician’ s respiration that
is taken as the standard against which the frequency of the beatings of the Pulses
are measured. In the section ª The Manner of feeling the Pulseº it is furthermore
said that: ª The Physician himself should be healthy, and in a State of Tranquillityº (p. 187), an aspect which is elaborated in a letter by John Floyer (1707,
pp. 339± 424) with contents taken from Andreas Cleyer’ s (1682) publication:
ª The Chinese direct the Physician to come to the Patient in the Morning to feel
the Pulse, when he is Fasting; and the Physician ought to be Healthful, free
from Caresº (p. 340).
The following four cautions in the section ª Seven Cautions to a Physician
about feeling the Pulseº are rather elaborate in the original and I summarise
them by citing the second paragraph of the section on the ª Instructions for
feeling the Pulseº :
He [the doctor] begins by placing the middle Finger exactly where the
Wrist-Bone locks with the Cubitus, then claps the two next Fingers, one
on each Side. At ® rst, he presses gently [corresponds to caution 4],
then a little harder [5], and at last very hard [6], taking Care that his
Fingers be rightly adjusted; after which he may proceed to examine the
Pulse in the three Places appointed, laying it down for a Principle, that
a regular Pulse beats four, or at most ® ve, times to one Respiration [7].
(p. 191)
Science of touch, part I
261
Obviously, the physician was not only required to calibrate himself, but also to
examine a patient by applying standard methods of touching. He was instructed
to take the Pulse with each of the three ® ngers (index, middle ® nger and ring
® nger) at different levels by ® rst pressing `gently’ , then `a little harder’ , and
thirdly, `very hard’ . In psychophysical jargon this means that the doctor was told
to engage in `haptics’ or so-called `active touch’ . In other words, the `science of
touch’ on which Chinese Pulse diagnostics is based is `active touch’ , an aspect
of touch that has not enjoyed the same attention in the modern Western
sciences of touch as `passive touch’ . This becomes obvious by a brief excursus
into recent researches on the psychophysics of touch.
The Psychophysics of `Passive Touch’
E.H. Weber (1795± 1878), who conducted experiments on the `touch-organ’
skin with systematic rigour, is now celebrated as a pioneer in the psychophysics
of touch (e.g. Stevens & Green, 1996). In particular he applied a now standard
two-point threshold task for mapping the different bodily sensibilites with
respect to discrimination of sensation, localisation, temperature, and (to a lesser
extent) pain onto different skin regions (Ross & Murray, 1996, p. 11), and with
it he set up the model case for the investigation of `passive touch’ . Weber’ s
theorising, however, has in parts been revisedÐ at the time none of the cutaneous receptors had been identi® ed, except for the Pacinian corpuscules,
though there was doubt as to whether they were sensory organs at all (Ross &
Murray, 1996, p. 176). Weber postulated, much in line with Galen, that the
skin housed at least two different `sorts’ of `sensations’ : pressure or traction and
warmth or cold (Ross & Murray, 1996, p. 106). This postulate was increased to
four independent sense modalitiesÐ for perceiving pain, pressure, warmth, and
coldÐ at the beginning of this century (Krueger, 1982), and several more have
since been found.
The research of 20th-century skin psychophysics has largely been guided by
M. von Frey’ s (1852± 1932) claim of four speci® c sense receptors for the above
four sensory qualities. This claim is ¯ awed (Krueger, 1982), but it was appealing for its simplicity and its goal of localising function in histological and
anatomical structure, much in tune with the neurological research of the time
(e.g. Pen® eld & Boldrey, 1937). The sensory receptors that are now depicted,
not only in textbooks, but even in children’ s booklets (Rius et al., 1985?), tend
to be attributed very speci® c functions (Fig. 2): Merkel’ s disks in the epithelium
detect pressure; Meissner’ s corpuscles, situated in the dermal protrusions where
dermis and epidermis interdigitate, detect contact; Ruf® ni capsules pressure;
Pacinian corpuscles, located in the deepest layers of the dermis, vibration. Only
the free nerve endings are considered to have a whole variety of different
functions: they transduct thermal stimuli or noxious (strong mechanical, thermal, and/or chemical) stimuli as well as speci® c types of tactile stimuli (when
acting as C-mechanoreceptors) (Greenspan & Bolanski, 1996).o
Research of the above kind has, however, serious limitations, and more
sophisticated investigations have now come to conceive the above mechano-
262
E. Hsu
FIG. 2. Sensory receptors of the skin (see Rius et al.).
receptors as an ensemble (e.g. Vallbo & Johansson, 1978). The attribution
of different tactile functions to independent structures is particularly dif® cult
to maintain in the light of the many different perceptions provided by the
sensitivities of the skin. The phenomenon of so-called `touch blends’ highlights
this. For instance, the simultaneous application of coldness and pressure to
adjacent spots results in the perception of wetness, and the application of
warmth and pressure yields the perception of oiliness. ª Temperature looms
larger at the liquid extreme and pressure at the solid extreme of the series of
touch blends: vaporous, wet, oily, gelatinous, slimy, greasy, syrupy, muddy,
mushy, soggy, doughy, spongy, and dryº (Krueger, 1982, p. 11). This shows
that a science of tactile perception requires more than the exploration of
separate stimuli and corresponding receptors. Even Weber, who instigated this
kind of experimental research on `passive touch’ , was well aware of the interdependence of different stimuliÐ his prime example was that the ª Joachimstalerº
placed on the forehead felt much heavier when it was cold (Ross & Murray,
1996, pp. 169± 170).
It is impossible to do justice to the 20th-century `science of touch’ on only
one page, but this is enough to show that psychophysical research focused on
`passive touch’ , i.e. the application of external stimuli to the skin, and that it
neglected `active touch’ , i.e. explorations of tactile perception through movements of the sense organ skin itself. David Katz (1884± 1954), a `psychological
phenomenologist’ , is generally held responsible for stressing the importance of
Science of touch, part I
263
active touch: ª Movement is as indispensible to touch as light is to visionº
(Krueger, 1982, p. 8).p Katz (cited in Krueger, 1982, p. 2) declared that he was
ª more concerned with perceptual contents than with the functions through
which we apprehend themº . He deplored the atomism of the science of passive
touch, interested only in identifying receptors for speci® c stimuli, and emphasised the need to explore more complex phenomena of tactile perception; this
led him to investigate the interrelations between different senses and the
perceptions they yielded. He pointed out that by moving the hand stimulation
was elicited rather than imposed and that movement brought other qualities of
tactile perception into play: he was the ® rst to postulate that the skin had a sense
modality for vibration separate from that for pressure (the Pacinian corpuscles
were only later identi® ed as vibration receptors). The pressure sense established
the presence of a surface, but the vibration sense determined its properties.
With Finger-tips on Ducts: `Active Touch’
It is noteworthy that modern research on touch paid little attention to vibration
and that the recognition of its importance came only with David Katz and his
emphasis on active touch. Vibration is, however, an aspect of touch in which
people in pre-modern societies took great interest.q Chinese Pulse diagnostics,
which is directed towards identifying different properties of the surface of the
patient’ s wrist, primarily informs us about perceptions made with the vibration
sense.
The translation of the ª Secret of the Pulseº in Du Halde advised the physician
to engage in vertical rather than horizontal motion, by pressing with three
different strengths onto the ª Ductsº . Considering that earlier works on Chinese
Pulse diagnostics had encouraged the doctor to move his hand with a horizontal
motion over the skin (Shiji, p. 105, case 19, uses the word xun, to stroke, to
describe this motion; see also Suwen, p. 18), it is possible that differences in the
pressure and vibration that a doctor could feel at the wrist were eventually viewed
as more informative than differences in the texture of the skin. The horizontal
active touch had informed the Chinese physicians about variables like the skin’ s
warmth, humidity, or hairiness which can vary considerably with individual
constitution and ephemeral circumstance and are therefore, from a biomedical
viewpoint, not always to be taken as reliable signs of the patient’ s illness
condition.r The vertical active touch, by contrast, detected the motions of the
ª Ductsº at the wrist. Although the Chinese physicians did not conceive of the
body in biomedical terms, the movements of the ª Ductsº that they sensed at the
wrist may well have coincided with those in the biomedical arteries. From an
empiricist viewpoint, one may therefore postulate that over time the differences
in heart beat and pulsation were considered to provide more relevant information
about the patient’ s disposition of health and illness than the variables of skin
texture, and that therefore Chinese physicians were told to focus on the
perceptions made by a vertical rather than a horizontal active touch.s
Among Chinese physicians, tactile perception was geared not only towards
264
E. Hsu
identifying the frequency of pulsationsÐ though its importance in Chinese Pulse
diagnostics cannot be overstated (see above quote from p. 191). Rather, they
were interested in an integrated assessment of the Pulses by examining the
properties or qualities of ª Pulseº or ª Vessel movementsº (maidong), the term
used in the Classic of Dif® cult Issues (Nanjing; Unschuld, 1986), or by identifying
their individual appearances, as the current wording ª Pulse imagesº (maixiang)
would suggest (TCM Diagnostics; Deng Tietao, 1984, p. 72). In contrast to
Western physiologists interested in the psychophysics of passive touch, who
until recently conceived of touch as a composite of separate modalities of
sensation for which they have found separate anatomical structures, Chinese
physicians aimed at an integrative assessment of their tactile experiences. An
example of the ingenious ways of accounting for them will be given in Part II
of this paper, which will discuss four modes of representing the tactile perception of the ª Seven Chinese Pulses indicating Danger of Deathº (see forthcoming
December issue, Vol. 7, No. 3).
Discussion
Given that touch consists of a partial melding of subject and object, tactile
experience is dif® cult to describe. Tactile experiences would therefore seem
quite unsuitable to establishing a descriptive science. Indeed, Siddha pulse
diagnostics exploits precisely the mutual involvement of subject and object in
touch, which allows the skilled doctor to merge with the patient to the extent
that he experiences the patient’ s internal disposition. However, Chinese physicians intended to objectify the tactile perceptions of Pulse taking to a common
standard, and they provided descriptions of generally discernible Pulse movements. Simultaneously they formulated rules in account of the dif® culties in
obtaining such standard Pulse movements. From an outsider’ s viewpoint it
looks as though they spoke of the necessity to `calibrate’ the physician.
According to Du Halde’ s understanding of Chinese Pulse diagnostics, the
motions that a doctor would sense at the wrist were those of the internal
ª Springs of Lifeº themselves; they were not outward signs of an inward
disposition in the same way as, for instance, the different hues of a patient’ s
ª Complexionº . Signs, in Peirce’ s sense, can be quite unrelated to the correlate
of the sign; they depend on convention, as for instance the convention that
relates the Complexion± Colours of the ª Five Phasesº to conditions of the
internal ª Springs of Lifeº . The tactile perception of different movements in the
ª Ductsº was, in Du Halde’ s rendering of Chinese medical doctrine, considered
to permit a far more direct access to the internal states of the body. Regardless
of whether or not Du Halde may have imputed a Galenic understanding of the
Pulses into Chinese Pulse diagnostics, he simultaneously highlighted peculiarities of tactile experience.
Chinese physicians, with ® nger-tips on ª Ductsº , were trying to detect motionÐ they engaged in `active touch’ by applying different degrees of pressure to
the skin’ s surface. While much of the `science of touch’ of modern psycho-
Science of touch, part I
265
physics conceives tactile perception as a composite of sensations evoked through
stimulation of speci® c structures in the skin, the `science of touch’ of Chinese
Pulse diagnostics was interested primarily in recurrent patterns of motion
detected by touch. It notably has af® nity with the phenomenologist approach to
touch, which speaks of `tactile perception’ in terms of an integrated `tactile
experience’ . By postulating that there are movements of Pulses, Chinese Pulse
diagnostics aimed at providing an integrative assessment of a doctor’ s experience of touch.
Acknowledgements
I am indebted to Ma Kanwen, whose expertise was invaluable for getting me
started on this piece of research, and the organisers and participants of the
seminar on the `History of Unconventional Medicine’ , held 11± 12 September
1998 in NorrkoÈping, Sweden, who encouraged me to make a presentation on
the history of Chinese medicine in the West. I would also like to thank the two
anonymous reviewers and Soraya Chadarevian, Geoffrey Lloyd, Sybilla Nikolow
and Robert Hinde for their critical comments on earlier drafts.
Notes
(a) The relation between objectivity and subjectivity is at the centre of Merleau-Ponty’ s writings.
Objecti® cation is seen as a process of increasing the distance between the perceiving subject
(which is always embodied) and the world. On touch, see pp. 315± 317.
(b) This chapter on Chinese medicine comprises also extracts from the Pen tsau kang mu
([Hierarchically] Classi® ed Materia Medica) (1596) and other materia medica (pp. 207± 236)
and a discussion of ª Chan seng: Or, The Art of procuring Health and Long Lifeº (pp. 236,
229± 235). See Du Halde (1741), Vol. II, pp. 183± 236 and 229± 235 [erroneous page
numbering].
(c) In citations the spelling, with all its inconsistencies, is rendered as given in the original;
throughout this paper capital letters have been used to refer to speci® c Chinese medical
concepts; the `Pulse’ that the Chinese doctor perceives is not the same as the `pulse’ that a
Galenic, scholastic, or biomedical doctor takes.
(d) See Lu and Needham (1980, pp. 35± 36), their cross-references to various volumes of Science
and Civilisation in China, and Terzioglu (1978). See also the summary of current research in
progress by Zhu Ming and Felix Klein-Franke, IASTAM Newsletter 1998: Avicenna
apparently also included items of Chinese materia medica in his writings.
(e) Du Halde attributes it to Wang shu ho whom the translator P. Hervieu, ª an ancient
Missionary in Chinaº (p. 184), presents wrongly as having ª lived under Tsin shi whangº and
as ª the most antient Author on this Subjectº (p. 196): Qin shi huang di ruled the Chinese
empire, after having uni® ed it, between 221 and 207 BC and Wang Shuhe lived in the 3rd
century AD. The translated treatise, known as Wang Shuhe Maijue, was not composed by him
but is attributed to a certain Gao Yangsheng (10th century) (Li Shizhen [1564] 1956, p. 140)
and considered one of the many versions of the Maijue (Rhymed Pulse [Lore or Canon]) that
were then in circulation (Lu & Needham, 1980, p. 277) but have now lost in signi® cance. Its
contents do have af® nity with Wang Shuhe’ s Pulse Canon (Maijing) (3rd century AD) and also
with the Canon of Dif® cult Issues (Nanjing) (2nd century AD), but some of its contents cannot
be traced to either of these two classics of Chinese medical doctrine.
(f) When Du Halde stresses aspects of Chinese medicine not emphasised elsewhere to the same
degree, footnotes have been added.
(g) Du Halde here appears to allude to a combination of an Aristotelian and a Galenic rather
266
(h)
(i)
(j)
(k)
(l)
(m)
(n)
(o)
(p)
(q)
(r)
(s)
E. Hsu
than a Chinese viewpoint. According to Aristotle, ª Animals had senses; but the distinctive
characteristic of humans was the faculty of reasonº (Synnott, 1991, p. 62); and according to
Galen, the central organ of perception (and mental activities) was not the heart, but the brain
(Siegel, 1970, p. 175). See also Lloyd, 1996, pp. 126± 137.
In general, however, tongue diagnostics are considered to be based on visual perceptionÐ
Cleyer’ s (1682) Specimen medicinae sinicae, Part 6, contains a systematic account of it.
Du Halde’ s terms ª radical Moistureº and ª vital Heatº are again reminiscent of Aristotelian
natural philosophy: ª Aristotle rated the heart as the hottest region of the body, harboring the
vital ® re, while the cool elements, earth and water, prevailed peripherallyº (Siegel, 1970,
p. 175). The ª Canalsº refer to the Chinese term mai or jingluo.
Notice that Du Halde (p. 183) speaks of ª Airº instead of ª Woodº ; his understanding of the
Five Phases is clearly tainted by the Aristotelean understanding of Elements.
Kuriyama (1986, 1999) has repeatedly contrasted this Galenic de® nition of pulses (linked to
anatomical knowledge) with the Chinese conception of Pulses.
It is, for instance, speci® cally used in medicine and does not have as evident politicophilosophical implications.
Daniel also discusses the biomedical notions of the objective `sign’ (as perceived by the
doctor) that is opposed to the subjective `symptom’ (as communicated by the patient) and
points to ¯ aws in-built to them.
Calibration is a problem central to experimental science; see for instance Shapin and Schaffer
(1985, p. 244ff.).
Psychophysics of this kind may explain the use of tactile perception in pre-modern medicines.
In Galenic medicine, for instance, touch was used in three ways: ª in taking the pulse, taking
the temperature, and in palpating the bodyº (Nutton, 1993, p. 11). In respect to ª taking the
pulseº (and to a certain extent also ª palpating the bodyº ), the ® nger-tips were important, and
we note that those stand out for their slow adaptation to continuous stimulation or, in other
words, their high sensitivity that persists over time (see Greenspan & Bolanowski, 1996,
p. 34). The temperature tended to be taken with the palm, which was said to be the
ª best-temperedº , and hence the best measuring rod to evaluate temperature (Nutton, 1993,
p. 13). Psychophysics con® rms that the palm rather than the back of the hand is highly
temperature sensitive (e.g. Ross & Murray, 1996, p. 119).
E.H. Weber’ s ® rst postulate in his summary of De Tactu reveals awareness of the importance
of `active touch’ when he said that ª Tactile acuity depends partly on the structure of the
organ and partly on movements of the organ made deliberately and consciouslyº (Ross &
Murray, 1996, p. 106), but his experiments did not explore it.
Classen (1997) has emphasised this repeatedly, though it is misleading to say that the Hopi
emphasise ª the sensation of vibrationº . The Hopi make a linguistically encoded distinction
between punctual events and the repetition of the same event: for instance, yo’ ko (he gives
one nod of the head) is distinguished from yoko’ kota (he is nodding), and Whorf comments
that ª The Hopi actually have a language better equipped to deal with ¼ vibratile phenomena
than is our latest scienti® c terminologyº (Whorf, 1956, p. 55). Whorf speaks of ª vibratile
phenomenaº in a metaphorical way, and from an outsider’s point of view.
In China, the temperature of the patient is now indirectly established, for instance, through
Pulse patterns marked by high-frequency pulsation (Deng Tietao, 1984, p. 72). Terzioglu
(1978, p. 79), in contrast, contains a plate from Persia which shows that the temperature was
taken by laying the palm onto the patient’ s front.
Along such lines of argumentation, the empiricist can explain why biomedicine, Galenic
medicine, and 17th-century Chinese medicine all converge in their method of taking the
pulse by means of applying vertical active touch to Ducts (in Chinese medicine) or arteries
(in the biomedical and Galenic sense): the heartbeat and pulsation that are thereby detected
may indeed contain empirically valid information about the patient’ s condition, more than
many other signs that can be obtained from a non-invasive examination. Why all three
traditions converge in detecting heartbeat and pulsation at the wrist may, however, depend
on other factors.
Science of touch, part I
267
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