The Modern History of Chinese Medicine
By Robert L. Felt
Co-author Understanding Acupuncture
Although the history of the conflict between China's old and new philosophies would be written by the CCP (Chinese Communist Party) and the eventual communist government of China, that conflict was not essentially created by communism. Both communism and biomedicine were being acculturated in a shift from the now-repudiated traditional values to newly adopted concepts that had found favor in the West. The Marxist theory of dialectical materialism was seen by many as a scientific expression. No less an authority than Mao would proclaim that communist culture was based in science. Thus it interested many, not just those politically active as Communists. In effect, Western ideas that seemed rooted in science were replacing the cultural foundations of Chinese medicine.
However, faith in the new medicine and its encompassing science were not sufficient to create a working medical system. Although both the national government and the European concessions made constructive attempts, these were so small, so poorly funded, and so late as to have no effect. When the Japanese invaded in 1937, there were only 77 health centers and 144 rural care stations in a nation that consisted of 2000 cities and 100,000 villages. Yet, Chinese medicine was not without its heroes. The zhong yi movement proposed innovations that would later be incorporated into what is now called Traditional Chinese Medicine (TCM). During the 1920s a number of traditional practitioners -- among them Qin Bowei  , who would later contribute to the modern technical description of TCM -- sought to salvage traditional medicine. They attempted to reconcile many traditions under a single banner, zhong yi, creating a solid front that could resist the encroachment of xi yi, Western medicine. Although not then successful, this movement laid the foundation of the modern development of Chinese medicine after the Second World War.
During the revolution and into the first days of the People's Republic, among the first orders of business was health care for a huge society, the already threadbare fabric of which had been reduced to an unraveled mass of disconnected threads. The social structures that had supported traditional medicine were in ruins. Traditional thought could not support its own weight, much less a model of medical reality under constant attack. The islands of traditional skill that Soulie de Morant  had known, the last physician scholars, the current generation of lineal apprentices -- so many had drowned beneath violent waves of war, social collapse, epidemic, and famine. Thus, during the war and after the Liberation of 1949, China's political leaders were faced with the seemingly insurmountable problems of serving a half-billion population with less than 40,000 Western-style physicians and upwards of 500,000 disorganized and discursively trained traditional practitioners. This is the health-care crisis that the United Nations Relief Organization called "the greatest and most intractable public health problem of any nation in the world." Here was the clear, pragmatic reason for the CCP to promote traditional medicine; there was no other choice.
Although the experience of war and providing health care to a vast nation would make Mao Ze-dong the most reliable political advocate for traditional medicine, even admired members of the CCP would continue to oppose it. Mao would need to purge party leaders and state officials in defense of TCM. However, in the CCP generally there was a strong feeling for preserving the essence of Chinese culture against the onslaught of Western creations. These feelings helped save traditional medicine from immediate outright abandonment or prohibition. But in the CCP's political environment traditional medicine could not survive without being scientized. This was the political compromise that evolved between conservatives who saw medicine as an aspect of Chinese culture to preserve and modernists who saw it as, at best, a collection of empirical tricks, some of which might be useful. In short, TCM was given a chance to survive by cultural pride, but if it were to survive, it would have to prove itself in a climate of intense skepticism and scrutiny.
Starting in the 1950s traditional medical schools with standardized curricula were established to teach basic biomedical sciences, traditional pharmacotherapy (herbal medicine), and acupuncture. To accomplish this the theoretical basis of acupuncture and herbal medicine had to be standardized and adapted to classroom training. For the first time in history a united medicine was abstracted from the materials of tradition. The zhong yi movement, which had begun to describe a coherent mode of practice in the 1920s, triumphantly re-emerged. Their work is the foundation of treatments used today. In the process, however, political compromise would guarantee the exclusion of many traditional ideas that did not fit party doctrine
Meanwhile, many Western medical schools were established. Creating a Western medical system was such a priority that today only 30% of China's medical colleges are traditionally oriented, and Western physicians outnumber traditional practitioners by more than two to one. Since 1949, the number of traditional doctors trained in China has fallen by nearly half to 270,000, while the number of Western-trained doctors has jumped twentyfold to more than 1.7 million.
These pressures changed traditional herbal medicine profoundly, because it was the increasing demand for medical services, not the preservation of traditional methods that occupied the nation's resources. Better training, the supervision of apprentice programs, prosecution of medical drug smuggling, and the policing of ineffective herbal remedies were the priority undertakings. By providing doctors of TCM with an opportunity to research and publish, the government gave them status. However, the state exercised control, and biomedical doctors earned two to three times greater salaries, a policy which continues to direct China's best students away from TCM.
Perhaps one of the best examples of the problems traditional medicine presented was the barefoot doctor movement. These worker-doctors received much attention in the West, perhaps more than the movement may have objectively deserved, but just as it appealed to the people-to-people ethic of young Chinese it appealed to populist sensibilities in Western democracies and thus received a very positive reception in the West.
In theory Barefoot Doctors were worker-doctors. Their salary, education and repertoire of medicines and equipment were to be financed through the local work units each Barefoot Doctor served. These units, called "brigades," needed to be freed of the bourgeois burden of fee-based medicine; but the state needed to be free of the cost of its rural medical operations. In theory, the utilization of acupuncture and natural drugs would reduce expenses to a level subsistence populations could afford. Practice did not prove the theory and the problems encountered are a useful indication of the difficulties faced in integrating traditional medicine with communist philosophy and the economic exigencies of post-liberation China. Acupuncture demands physical and sensory skills that are not quickly or easily achieved without quality training. Quality control in the selection and preparation of naturally occurring drugs is a skill that has always taken time to acquire. These facts, coupled with the popular bias expressed in the nearly universal labeling of biomedicine as `modern medicine' in Chinese meant that the Barefoot Doctors had a tendency to mostly use biomedical treatments.
Despite these difficulties, the Barefoot Doctor movement was eventually successful, accounting for upwards of 70% of illnesses by 1975, with the reliance on traditional medicines helping to lower costs and increase services. It is an apt metaphor for the problems faced by health care planners in the P.R.C. The political imperatives called for a native solution, as well as an expansion of health care services. t the same time, traditional medicine could no longer be transmitted by the ancient methods, and explanations, because these were no longer acceptable politically. In this environment traditional medicine needed scientization not only to please the political demands of the communists but also to satisfy the demands of the populace. The effect of these social, political and cultural trends was pressure to integrate traditional techniques with biomedicine. Traditional medicine was saved, not like an ancient artifact on a museum shelf, or like a carefully preserved Asian art like calligraphy, but as a pragmatic adaptation to the demands of the time.
(Continued in Part Three  )
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