My thesis takes the Shishan yi'an by the physician Wang Ji (1463-1539) as the basis for an examination of gender in medical practice. In my analysis of this collection of medical case histories from the Ming dynasty I am interested in how the sex of the patient affects the physician's approach to the illness, and what factors might account for the differences between the sexes that are revealed. It is my contention that an understanding of gender difference within a medical context will contribute towards a greater appreciation both of the operation of gender relations within society, and of the interaction between medicine and the cultural context in which it is practised. The thesis itself is divided into four main chapters. I begin with a review of relevant secondary literature in order to situate my research in the wider context. In chapter two I examine the background of the text, including the social and economic situation of sixteenth century Anhui in which it was written, and what is known about the life of Wang Ji himself. Chapter three focuses on the picture of clinical medicine that emerges from the text, including the dynamics of the patient/physician relationship, interactions with other healers, and the actual logistics of practising medicine at that time. Finally, in chapter four I make a detailed analysis of gender differences in the Shishan yi'an, examining in turn each of the five main components of the case histories: diagnosis, aetiology, illness mechanism, treatment, and outcome. The results of this analysis would indicate that in certain areas of clinical practice there were significant differences between the sexes, and that to a large extent the reason for these differences lies not in medical theory, but in the specific social, economic, and cultural context of sixteenth century Arihui

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There are difficulties in the standardization of traditional Chinese medicines (TCM) because of the complexity of TCM preparations. This leads to regulatory problems. In the present work, several Chinese medicinal plants were investigated including Danshen (Salvia miltiorrhiza Bunge), Sanqi (Panax notoginseng Burk.), compound Danshen dripping pill, and several species of the genus Panax. Plant materials and commercial products containing these taxa were analysed by a range of techniques, including chemical- and activity-based standardization methods: the chemical techniques used include high performance liquid chromatographic (HPLC), nuclear magnetic resonance (NMR) spectroscopic and infrared (IR) spectroscopic methods, followed by chemometric analysis. Different brands of Danshen finished products, Danshen plant root materials of different origin, and Sanqi plant root materials with different production dates were successfully discriminated from each other. Asian and American ginseng were successfully discriminated, and arginine was found for the first time as a main difference, together with other primary and secondary metabolites, using 1H-NMR-PCA. For wild and cultivated American ginseng which had reputed activity in diabetes, an activity-based standardization method based on a cell viability test and proteomic analysis (using two-dimensional difference gel electrophoresis (2D-DIGE) analysis) of mouse insulinoma (MIN6) cells was performed. 83 proteins were found to be significantly up or down-regulated. This work shows that HPLC, and NMR and IR spectroscopy coupled with PCA methods are applicable to standardization methodologies. The advantages and disadvantages of HPLC, and NMR and IR spectroscopic technology are discussed and compared. The 2D-DIGE protein profile can be correlated with TCM treatments. This work contributes to the current problem of regulatory control of TCM preparation as traditional medicines and may suggest a practical way forward.

Traditional Chinese medicine (TCM) is a rapidly developing global health care practice. This reflexive ethnographic study is one of the first to explore the transnational identity processes that align practitioner and consumer relations in the UK-Chinese medical encounter.

This doctoral dissertation forges and explores connections, flows and frictions between two seemingly unrelated manufacturers of Tibetan medicines: Men-Tsee-Khang, the Tibetan Medical and Astrological Institute in Dharamsala (Himachal Pradesh, India), and PADMA AG in Wetzikon (Zürich, Switzerland). Adopting a translocal, multispecies approach by positioning plant-medicines as the central actors in this ethnography, I trace how four plants - aru, ruta, tserngön and bongnak - become part of medicine in and between these two establishments of Sowa Rigpa of similar age and output volume, situated in highly diverse contexts at a stereotypical 'periphery' and 'core' of Western technoscience respectively. Inspired by Science and Technology Studies and by Pordié and Gaudillière's (2014a) 'reformulation regime' of industrial Ayurvedic proprietary products, I analyse the on-going material, technoscientific, and regulatory reformulations of Tibetan materia medica as they are actualised in contemporary recipes based on classical texts. In this thesis, I describe how both PADMA and Men-Tsee-Khang refer to Tibetan medical texts yet also rely on botanical taxonomy for plant identification. Both face the uncertainties of sourcing raw materials in bulk from growers and traders on the Indian market, skilfully mass-produce pills by means of machines for grinding, mixing, sieving and packaging, and depend on in-house laboratory analyses and each-other's expertise in the construction of hybrid 'qualities'. They are also forced to interact with technomedical conceptions of drug safety and toxicity, and with European medicine and food registration legislation to varying degrees. I argue that in performing this series of technoscientific reformulations, Tibetan medicines are becoming 'alternative pharmaceuticals': liminal, paradoxical yet politically subversive things oscillating betwixt and between tradition and modernity, orthodoxy and innovation, East and West. Men-Tsee-Khang and PADMA could thus be interpreted as two possible instantiations of a quasi-industrial techno-Sowa Rigpa, but only if one distinguishes 'Big' from 'Small Alternative' Pharma, and never without leaving crucial contradictions and identity politics behind.

Interest in Traditional Chinese Medicine (TCM) is global. The burgeoning international trade in its crude and processed plant ingredients (Chinese materia medica - CMM) reflects demand across all sectors of healthcare, yet the identification of source plants and CMM has been overlooked for many years leading to problems in safety, quality, efficacy and sustainable sourcing. The Guide (Chinese medicinal plants, herbal drugs and substitutes: an identification guide, Leon & Lin, Kew Publishing, 2017), which forms the core of this dissertation by publication, presents a fresh approach to the identification of 226 internationally traded CMM (officially recognised in the Chinese Pharmacopoeia, CP2015) along with their 302 official source plants. Identification criteria are developed using macroscopy, and are based on authentic reference specimens created as a result of extensive fieldwork in China. Inclusion of 99 comparative descriptions of unofficial substitute plants and drugs (including adulterants and counterfeits), with their counterparts for official species, enable key distinguishing characters to be highlighted and thereby strengthen the rigour of identifications made. The approach demonstrates that macroscopy can be used to reliably identify and differentiate over 70% of official (CP2015) CMM from common substitutes and that macroscopy is a fast and cost-effective authentication method with many applications. The research highlights the essential role of herbarium-vouchered reference drugs in CMM authentication as opposed to the use of market-obtained drugs whose botanical identity is inherently uncertain. The research’s taxonomic review of all official species in the Guide demonstrates a significant disparity (16%) between the taxonomy adopted in the CP2015 and current plant taxonomic opinion, while a review of species conservation rankings and causal effects found that the wild populations of 23% of official species native to China (63 of 270 official species in the Guide) have become threatened as a direct result of over-harvesting for medicinal use. In addition, the research reveals the underlying causes of CMM substitution are dominated by clinician preference, followed by supply problems arising from over-harvesting of official species with unregulated markets trading in inferior or inappropriate look-alike items, together with issues of confused identification and nomenclature. Direct consequences of the inadvertent use of CMM substitutes include misleading clinical and research outcomes, serious adverse reactions and, in some cases, fatalities. Reliable identification of CMM therefore remains paramount for high quality research as well as safe and efficacious clinical practice. While for some CMM (ca. 30% of CMM in the Guide) robust identification requires analytical methods (e.g. chemical- and DNA-based ones), the research concludes that macroscopy continues to be a powerful tool for reliable and cost-effective identification of CMM in international trade.

This case study examines the challenges facing Chinese medicine in UK; the response of Middlesex University as a leader in the provision of Chinese medicine education and training in Europe when in 1997, it added a degree in Chinese medicine into its academic portfolio; and the processes of developing and implementing two substrategic projects which will lay the fOlilldation for Middlesex University to extend its professional education and practice in Chinese medicine. Chinese medicine has always been available to the Chinese population in UK. After a long period of stable and incongruous existence, Chinese medicine began to experience rapid growth in the early 1980s, stimulated by increased consumer interest in self sufficiency, and back-to-nature to manage their own health. There is also an increase consumer dissatisfaction with the side effects of the chemical drugs. However, in UK as it is the case in Europe, Chinese medicine is not licensed as a medicine and not accepted by orthodox medical practitioners. The case study confirmed that Middlesex University is on course to own a sound strategy to nurture the development and growth of the professional education and practice in Chinese medicine within the higher education sector. The groundwork is being prepared by these two projects in the case study, the European Centre for Chinese Medicine and the Chinese Medicine Association of Suppliers to enable the University to be the Chinese medicine education and research "hub" for Europe. The case study supported the notion that insider knowledge can help smooth the complex and complicated human relations to achieve collaborative partnership with different nationals with their attendant cultural beliefs, practice and values, socioeconomic and political systems. The projects were neither developed nor managed as conventional projects rather the case study advocated for a flexible approach when managing innovative, collaborative and multi-nationals projects.

This thesis examines Tibetan perspectives on the causation, management and treatment of mental illness (Tib.: sems nad) within a Tibetan exile community in Darjeeling, northeast India. Based on two six-month periods of ethnographic fieldwork conducted in 2011 and 2012, it examines common cultural understandings of mental illness and healing, and how these are reflected in health-seeking behaviour. To date, research on lay Tibetan perspectives of mental illness and their impact on health-seeking behaviour has been limited, especially in relation to the concept of smyo nad (‘madness’). Following on from work by Jacobson (2000, 2002, 2007) and Millard (2007), the thesis investigates lay Tibetan perceptions of the causation and treatment of various kinds of mental disorders through the use of indepth semi-structured interviews and participant observation, comparing and contrasting Tibetan approaches to those of biomedical psychology and psychiatry and their accompanying classification systems, the American Diagnostic and Statistical Manual of Mental Disorders (DSM) and European International Classification of Disease (ICD). Four case studies of individuals labelled with different Tibetan and biomedical diagnoses related to mental health conditions are described in order to illustrate a number of key concepts in Tibetan approaches to mental illness and its healing. The research found that that a number of informants successfully combined different – sometimes opposing – explanatory frameworks and treatment approaches in response to an episode of mental illness. However, the thesis concludes that the Tibetan and biomedical categories remain difficult to correlate, due in part to their culturally-specific nature, based on significantly different underlying assumptions regarding individuals and their relationship to the environment.

Traditional Chinese Medicine (TCM) has been criticized for being unscientific because the theory on which it is based involves entities like qi and ’meridians’ that appear ambiguous and because the internal ‘organs’ like the kidney and the spleen are very different from those of modern anatomy and physiology. Even more so, TCM methods of therapy based on the yin-yang principle, the model of the five elements, and the classification of illnesses according to standard constellations of symptoms (TCM “syndromes”) are largely unproven by the protocols of modern evidence-based medicine. This dissertation attempts to reconstruct TCM theory by: (a) providing explanations of TCM entities as abstractions and constructs that relate to observable body functions and illness symptoms and (b) interpreting TCM theory as comprising heuristic models that were constructed from clinical experience to fit empirical observations of illnesses and their treatments with herbal medications and acupuncture. It suggests that scientists should be less concerned with the ontological status of TCM entities and the epistemic credentials of TCM models than with the ability of these concepts and models to guide physicians in therapy. More importantly, it makes the argument that these models are testable using the methods of evidence-based medicine. There are methodological difficulties associated with randomized controlled trials partly because TCM treatments tend to be individualized and syndromes are dynamic in nature; observational trials may be more appropriate in some situations. It is also possible that, for patients who are more culturally attuned to TCM, the placebo effect is strongly at play and may render the real effects of TCM treatments harder to tease out in clinical trials. The dissertation concludes that the main postulates of TCM should be put to rigorous test. The result may be a leaner but more robust theory, with parts that do not stand up to the test being rejected or modified, and a possible acceptance of its more modest therapeutic claims for a limited range of pathological conditions like pain and chronic illnesses.

How the world of experience, text-based medicine, and the social world came to interact with each other in a historically situated way is the subject of this doctoral thesis, which studies what I shall call zhang ("miasma") medicine in Song China (960-1279 CE). By the phrase "the world of experience," I refer to the bodily experience of the environment in a given region as well as to experiences of medical practices. "The social world" broadly refers to concomitant social, intellectual, and political events or trends. This thesis proposes a new approach to the study of the environment within the history of medicine in Imperial China (around 202 BCE-1911 CE), an approach which is inspired by anthropological analytical concepts. It highlights individuals' world of experience, treating their knowledge about environmental medicine as the culmination of a dynamic collaboration of their experiential world and existing culture-specific concepts, such as those deriving from scholarly medicine. This new approach dictates a re-examination of the sources that have received intensive attention in the history of medicine in Imperial China: texts up to the thirteenth century on the aetiology, therapies, and prevention methods of zhang as disorders endemic in Lingnan (in Guangdong and Guangxi provinces). Based on this re-examination, I contend that the Song period witnessed the emergence of a pronounced explanatory mode among authors of writings about zhang medicine about how their world of experience informed and affirmed their medical knowledge and practices relating to zhang. This Song explanatory mode embodies, I argue, the endeavor of Song scholar-officials and physicians to extend the proliferation of scholarly medicine at that time to zhang medicine, which lacked widely acknowledged textual references and therapies of medicinal effectiveness. The findings in this thesis firstly broaden our understanding of the development of environmental medicine in Imperial China and, secondly, extend our knowledge of the expansion of scholarly medicine into southern China in Song times.