A Digression: The Politics of Chinese Medicine in the People’s Republic of China (The Early Years)
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A Partial Book Review: Chinese Medicine in Early Communist China, 1945-63: a Medicine of Revolution, by Kim Taylor
Mao’s was a complex personality. He was by nature a control freak, highly secretive, quickly suspicious, ruthless in revenge. These were all personal characteristics that were to determine the flow of politics in early Communist China. (Taylor, p. 4)
We have already seen that attempts to create ‘acupuncture anesthesia’ began in the People’s Republic of China (PRC) in 1958. As suggested by the title of this series, this resulted from neither rigorous research nor the serendipity that occasionally heralds important discoveries. Rather, the apparent prominence of acupuncture in health care in the PRC was a matter of governmental fiat. Even before the Communist victory in 1949, it was clear to Chairman Mao Zedong that there were not enough ‘Western’ trained physicians to handle the massive health problems of the country, which included an infant mortality rate of 1 in 5, an overall death rate of 30 per 1000 per year, and widespread disability. Most of this was due to malnutrition and infectious diseases, including many that sound exotic and ominous to the modern ear:
…schistosomiasis, filariasis, ancyclostomiasis, Kala-azar, encephalitis, plague, malaria, smallpox and venereal disease…measles, dysentery, typhoid, diphtheria, trachoma, tuberculosis, leprosy, goitre, Kaschin-Beck’s disease…(Taylor, p. 103)
Pre-scientific Chinese medicine, acupuncture in particular, was identified by Mao and other Communist leaders as worthy of cultivating:
Our nation’s health work teams are large. They have to concern themselves with over five hundred million people [including the] young, old, and ill. This is a huge enterprise, and one that is extremely important. Thus our responsibility weighs heavily…At present, doctors of Western medicine are few [10,000-20,000], and [thus] the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine. –Mao Zedong, 1950, quoted in Taylor (p. 33)
Taylor writes that there may have been 500,000 doctors of ‘Chinese Medicine’ at the time. It is tempting to conclude that Mao’s call for the ‘unification of Chinese medicine’ was a cynical way to make it appear that the Chinese Communist Party (CCP) could provide adequate health care in a much shorter time than would be required to train sufficient numbers of modern physicians and to build and equip modern facilities. This is undoubtedly true, but Taylor argues that there were additional considerations:
…Mao evidently saw the profession of Chinese medicine not so much as a therapeutic practice, but more as a large, and therefore significant, body of people. Mao’s support of Chinese medicine during this time can be linked to a concern for adequate health care manpower, and by extrapolation, to a concern for social stability. If the Chinese medical practitioners were ignored and not forcibly, as it were, integrated into the new Communist society, and if their medicine was not encouraged, it would mean hundreds of thousands of people would be without a livelihood. Including their dependents, this would mean that there would be hundreds of thousands of people without any means of support. It is likely that Mao interpreted the more serious problem to be one of economics, and the importance of keeping people usefully employed within society, rather than the dangers of supporting a potentially ineffective medicine. (Taylor, p. 35)
Mao also wrote:
Although we should have an all-round and correct understanding of Chinese medicine, Chinese medicine also has to transform itself. We must accept this slice of our old heritage critically. To look down upon Chinese medicine is not correct. To claim that everything about Chinese medicine is good, or too good, this is also not correct. Chinese and Western medicines must unite. (Mao Zedung, 1954, quoted in Taylor, p. 35)
Thus there was, according to Taylor, to be a ‘scientification’ of Chinese medicine. This did not mean ‘scientific’ in the familiar sense:
In Mao’s definition of this ‘new democratic culture’, he was to use three words which were to describe its development. These were ‘new’ (xin), ‘science’ (kexue), and ‘unity’ (tuanjie). The term ‘new’ implied free from superstition and the heavy links to a feudal past. Instead the components of the new culture would have to be forward moving and enterprising. Mao advocated that such a change would be possible through the use of ‘science’. By ‘science’ Mao was not so much referring to the science linked with the Western investigation of nature, but more to the Marxist ideal of science as the criteria for true knowledge. For Mao stated that ‘this type of new democratic culture is scientific. It is opposed to all feudal and superstitious ideas; it stands for seeking truth from facts, it stands for objective truth and for unity between theory and practice’. ‘Unity’ was the third criterion in the building up of a new China. Everybody had to join together and fight for the same cause, and this included all classes of Chinese society, from the upper bourgeoisie to the peasantry, so long as their beliefs were not against those of the Party. It also implied a unity of knowledge, and this had particular implications for the revolutionary intellectual. (Taylor, pp. 15-16)
In other words, as Mao later asserted,
In the future there will be only one medicine; that is to say a [single] medicine guided by the laws of dialectical materialism, and not two [separate] medicines. (Quoted in Taylor, p. 35)
The ‘New Acupuncture’: Simplified and ‘Scientified’
Taylor gives several examples of the sort of ‘science’ that was applied to acupuncture in the early years of the PRC. Zhu Lian, a Western-trained physician, wrote a book on The New Acupuncture, published in 1949. It was filled with military and administrative metaphors, as befitted the book’s conception during the civil war. According to Taylor,
This tendency illustrates the way in which the perception of the body and the language used to describe it will reflect prevailing ontological concepts of a society. Shifts in these philosophical orientations will lead to shifts in the explanation of health and disease, and accordingly the medicine is reshaped to suit the values and customs of the new society. (Taylor, p. 20)
I agree with that assertion when it is applied to pre-scientific views of health and disease. Previous treatises on Chinese medicine were also filled with administrative and military metaphors, as well as meteorogical ones (‘wind’, ‘dampness’, ‘heat’, ‘cold’). Ancient acupuncture treatises even included correspondences between the number of days in a year and the number of acupuncture ‘points’ on the body, and the relation of these to the four seasons. See here (p. 130) for an example, ca. 200 C.E., of several of these metaphors used to ‘explain’ acupuncture. I can’t tell, from reading Taylor’s book, if she appreciates the difference between this and the reality of scientific medicine: in the latter case, some of the language may consist of metaphors referable to social structures and familiar events, but the science, i.e., the “perception of the body,” is not “[shaped] to suit the values and customs of the…society.” Rather, the science precedes any such metaphorical descriptions.
For Zhu Lian, however, as for her ancient predecessors, social metaphors preceded ‘science’:
Zhu Lian’s form of the ‘new acupuncture’ had in many ways been an attempt at reducing acupuncture to a few basic principles in order to facilitate its application. She made significant inroads in simplifying the presentation of the layout of the acupuncture points on the body by dividing the body into ‘sections’ (bu), ‘divisions’ (qu), ‘lines’ (xian) and ‘stimulation points’ (cijidian). The most period-relevant of these were the ‘divisions’ in which acupuncture points that could not conveniently be placed on a line were enclosed in a ‘division’, reminiscent of the army divisions and border regions of wartime China. (Taylor, p. 49)
During the early 1950s others continued these sorts of revisions, in some cases to the point of absurdity:
Such a structural layout continued to characterize the ‘new acupuncture’ after Liberation, but where Zhu Lian had been responding to the military influences of her time, other physicians now responded to the bureaucratic, systematic outlook of the period of reform in China. The result, in some cases, was the portrayal of the body as a form of drawing chart. Ma Jixing in particular took pains to reduce the body to measurable terms, and described the body and its functions, this time not in relation to war but rather with the values of the mathematical art of quantity surveying. The result was a complete disembodying of the human figure, so much so that Ma Jixing did not produce a single illustration of the human body. Rather, it was reduced to a chart of measurable statistics, and it was through such a listing of well-defined criteria that he described the human body… (Taylor, pp. 49-50)
His description of the body is pervaded with mathematical terms. Obviously it lent some status to the ‘new medicine’ but it is not exactly clear in what way, apart from the distinction given by maths [sic] as the purest form of natural science… (Taylor, p. 52)
From ‘Co-operation’ to ‘Integration’
Mao’s ‘unification’ edict was not merely pragmatic, but ideological. It has persisted until this time, with Party slogans marking the different epochs in its history:
1945-50 ‘The Co-operation of Chinese and Western Medicines’
1950-8 ‘The Unification of Chinese and Western Medicines’
1950-53 ‘Chinese Medicine studies Western Medicine’
1954-8 ‘Western Medicine studies Chinese Medicine’
1958- ‘The Integration of Chinese and Western Medicines’
(Taylor pp. 12-13)
In the early years of the PRC, doctors of Chinese medicine were recruited and trained to help introduce modern public health measures to the enormous population, particularly in the most underserved rural areas, but they were not expected to use their Chinese medical knowledge in this effort:
Chinese medicine…was to be used at the least medical level of Western medicine–public health. Chinese medical practitioners were enlisted to give inoculations and to educate the peasants in basic hygiene. Their own skills in indigenous medicines were not required by the Ministry of Health in the face of these acute diseases. This would accord with general Western medical prejudices. It is likely that the Ministry of Health, not convinced of the efficacy of Chinese medicine, but bound by official decree to include it within national health care projects, was determined not to give the Chinese medical practitioner any healing autonomy of his/her own. (Taylor pp. 34-5)
Taylor argues that this led to Mao’s attack, in 1953, on the Ministry of Health. Although his objections were several, one was this:
The Central Committee’s directive concerning the unification of Chinese and Western medicine has not as yet been put into effect, and the genuine unification of Chinese and Western medicines had also not been realized. This is wrong. The problem definitely must be solved, and the error definitely must be corrected. First of all, every level of health administration must change its ideology. (Mao Zedong, Jan. 1954. Quoted in Taylor, p. 44)
Thus, according to Taylor,
…Chinese medicine was used as a political tool during the excesses of the Anti-rightist Campaign and the Great Leap Forward, in order to correct the bourgeois thought of Western doctors of medicine. (Taylor, p. 109)
Mao’s Personal Physician Weighs In
Mao’s ‘complex, control freak’ personality is illustrated by his own, ambiguous view of Chinese medicine, which differed substantially from what was suggested by his public persona. Another useful reference for those interested in Mao and the early years of the PRC is a memoir written by Mao’s personal physician, the Western-trained Li Zhisui: The Private Life of Chairman Mao. In 1955, during one of Dr. Li’s “countless nocturnal chats” with Mao (who “had no friends”), was this exchange:
Mao attributed China’s large population to the efficacy of Chinese medicine. For thousands of years, he told me, China had gone through continual war and natural disaster. But our population now was more than 500 million. Was it because of Western medicine that we had this many people? Western medicine had been practiced in China for only one hundred years. For thousands of years before, our people had depended on Chinese medicine. Why were there still people who dismissed Chinese medicine? The only Chinese books he had not yet read, he said, were those on Chinese medicine and Buddhism. He wondered if I had read books on Chinese medicine.
My ancestors had been devoted to Chinese medicine, but my training had been Western and I had never given much thought to the contributions of traditional medicine. But I did not believe that China’s large population was the result of Chinese medicine. I told Mao that I had read some ancient Chinese medical books but could not really understand them, especially those relating to the theory of the five elements–metal, wood, water, fire, and earth. I did not understand the theory.
Mao laughed. ‘The theory of yin and yang and the five elements really is very difficult,’ he said. ‘The theory is used by doctors of Chinese medicine to explain the physiological and pathological conditions of the human body. What I believe is that Chinese and Western medicine should be integrated. Well-trained doctors of Western medicine should learn Chinese medicine; senior doctors of Chinese medicine should learn anatomy, physiology, bacteriology, pathology, and so on. They should learn how to use modern science to explain the principles of Chinese medicine. They should translate some classical Chinese medicine books into modern language, with proper annotations and explanations. Then a new medical science, based on the integration of Chinese and Western medicine, can emerge. That would be a great contribution to the world.’
He paused to reflect. ‘Even though I believe we should promote Chinese medicine, I personally do not believe in it. I don’t take Chinese medicine. Don’t you think that is strange?’
I agreed that it was strange. Publicly, the Chairman was the leading advocate of traditional medicine, but he refused to use it himself.
The Modern Introduction of ‘Traditional Chinese Medicine’
It is tempting to quote voluminously from Kim Taylor’s book, which is a great treasure-house of information about medicine and policy in the early years of the PRC. I’ll limit this discussion to another key point, which will lead us back to ‘acupuncture anesthesia’: The ‘Traditional Chinese Medicine’ (TCM) that has been fostered in the PRC is not traditional. The very adjective ‘Traditional’, in regard to Chinese medicine, was not formally used in China until the mid-1950s, and even then was applied “exclusively in English language literature produced by the Chinese mainland press…” (Taylor, p. 86)
The term, moreover, heralded a ‘standardization’ of Chinese medicine for which there was no historical precedent. In 1955, the Research Academy of Traditional Chinese Medicine opened its doors:
The setting up of the Research Academy was declared to be ‘a pivotal measure in developing the medical legacy of the motherland, enriching medical science, uniting and improving Chinese and Western medicine’. The role of the Research Academy was to organize systematically Chinese medical and herbal knowledge, and to compile Chinese medical and herbal books. It would also serve to train teachers… In other words…Chinese medical knowledge could be sculpted and moulded into a format more conducive to the teaching and practising of Chinese medicine in modern Chinese society, in preparation for its ultimate union with Western medicine. (Taylor, p. 87)
Taylor quotes Lu Zhijun, a Western-trained colleague of Zhu Lian, speaking at the opening ceremony of the Research Academy:
‘Every tiny result in the research into it [Chinese medicine] adds to the glory of our nation’s medical legacy. It increases [our] contribution to our nation’s people and to the whole of mankind. At the same time, it will further prove the mistakenness of those who look down upon and [want to] obliterate our nation’s medicine. [It will also] incite more people to come and correctly understand and take on the enterprise of our nation’s medicine’. (pp. 89-90)
(Veteran SBM readers will recognize, in that passage, a plausible basis for some of the findings of this study).
In 1956, four Academies of TCM were created, and shortly thereafter standard curricula and textbooks appeared. These were, necessarily and arbitrarily, simplified distillations of myriad Chinese medicines that had existed in various places and times for hundreds of years. This was done, in keeping with the ‘integration’ edict, to reconcile Chinese medicine with ‘Western’ notions of analysis, and also to conform to ‘revolutionary’ ideology:
The theories [of TCM] had to be, first and foremost, politically correct, and in this revolutionary society, all scientific investigation was to be guided by the Communist philosophy of dialectical materialism (bianzheng weiwu zhuyi). Dialectical materialism holds that change is the result of opposing forces, the resulting dynamic of which produces change. In terms of medicine, this found an expression in a ‘new’ form of diagnosis…
The streamlining of Chinese medicine according to Communist criteria was to take place at every level of diagnosis…(Taylor, p. 148)
Egg on the Faces of Honkies
Taylor states that at least three books about ‘Traditional’ Chinese Medicine, written by Westerners in the aftermath of James Reston’s acupuncture experience, were based on PRC-generated textbooks–and were therefore less about traditional Chinese medicine than they were about contemporary Chinese textbooks “created as part of a revolutionary programme”: specifically, the program known as ‘Western medicine studies Chinese medicine’. (Taylor, pp. 144-147) Those books by Westerners are this, this, and this.
It is interesting to compare the history discussed here, especially the comments made above about PRC-promoted research in Chinese medicine, with this passage on pp. 19-20 of one of the books published in the West:
After the victory of the Chinese Revolution in 1949, the Chinese decided to take a fresh look at their traditional medical system. Many of China’s new leaders were tempted to discard their prescientific medical inheritance, along with other old-fashioned practices and remnants of underdevelopment. Their overall desire was to emulate the developed countries–to industrialize, electrify, and modernize. Another faction of the leadership, however, saw that although China did need to accept modern medicine, there might also be some practical and theoretical usefulness in the traditional medicine. The issue was whether or not it would prove efficacious from a modern perspective. To answer that question, the Chinese performed thousands of experiments and clinical studies during the fifties. The result was that in 1958 the Central Committee decided to give traditional and modern medicine equal respect and place in China.
The medical reports are still produced incessantly…
The pages of such studies fill entire libraries, yet it is not their quantity that is important, but rather their conclusions: that traditional Chinese medicine can hold its own, that it does work clinically.
It is now evident that Chinese medicine is an effective healing method.
When that passage was published in 1983, its author perhaps could have been forgiven for not having known the timeline of Mao’s advocacy of Chinese medicine, and perhaps even for not having appreciated the intimate relation between ideology and ‘science’ in TCM research. Such forgiveness no longer applied to the 2nd edition of the book, published in 2000 with slight revisions (in bold):
After the victory of the Chinese Revolution in 1949, the Chinese decided to take a fresh look at their traditional medical system. Many of China’s new leaders were tempted to discard their prescientific medical inheritance, along with other old-fashioned practices and remnants of underdevelopment. Their overall desire was to emulate the developed countries–to industrialize, electrify, and modernize. Another faction of the leadership, however, saw that although China did need to accept modern medicine, there might also be some practical and theoretical usefulness in the traditional medicine. At least partially, the issue was whether or not it would prove efficacious from a modern perspective. To answer that question, the Chinese performed thousands of experiments and clinical studies during the 1950s. The result was that In 1958, for reasons that included scientific as well as cultural and economic concerns, the Central Committee decided to give traditional and modern medicine equal respect and place in China.
The medical reports, which are still used to support the official adoption of Chinese medicine, are still produced incessantly…
The pages of such studies fill entire libraries, yet it is not their quantity that is important, but rather their conclusions: from the modern Chinese perspective, traditional Chinese medicine can hold its own; that it does work clinically.
Even for thoroughly modernized Chinese, Chinese medicine has come to be accepted as an effective healing method.
‘Standardizing’ Chinese Medicine: a Dubious Proposition
If some Western authors have been duped by Communist ideology, others, more scholarly, have asserted the impossibility of ‘standardizing’ Chinese medicine, both because it is such a large amount of disparate material and because there is no basis for determining what might be valid and what is not:
…the question arises as to what “Chinese medicine” should be transmitted to the West. The practices and theoretical conceptions that in the political climate of the People’s Republic of China have been chosen from the heterogeneous heritage as meaningful? The varied practice free of political influence, based on personal interpretation of traditional opinion and techniques among representatives of Chinese, for example, on Taiwan? The pragmatic approach that is widespread in Japan? Or any of the various Chinese approaches of the last two millennia? In trying to answer this question, one problem lies in the fact that there is no criterion for judging any one of these approaches in relation to another. They all have their effects. Practitioners of each of them can point to satisfied patients. Failure is of course common to them all. (Unschuld, Paul. Chinese Medicine. pp. 118-9)
Taylor herself laments the project as a “petrifying of Chinese medical knowledge” (p. 127) and worse:
The reduction of its theories to a few easily identifiable syndromes, many of which have been designed to correlate with major Western disease categories, has greatly undermined the potential to plumb the considerable depths of TCM theory. Nowadays, in many cases, before the patient has even stepped into the clinic, his/her bianzheng lunzhi pattern has already been ascribed…The medicine is also taught in an increasingly formulaic manner. (Taylor, p. 149)
In general, the main aim of these ‘Basic Theories of TCM’ was to simplify Chinese medicine and to reduce two thousand years of controversy and debate into one easy-access nutshell. This compromises every level of the physician’s encounter with the patient, from examination to diagnosis through to prescription. (Taylor, p. 150)
It will not surprise the reader to learn that although I accept Taylor’s assertion about the simplification of real Chinese medicine, I don’t share her apparent conviction that this has resulted in a diminution of its power to heal–which was never, I would argue, substantial in the first place.
Back to ‘Acupuncture Anesthesia’
As suggested above, there was also a mercantile flavor to the PRC’s standardization project:
The approach shifted from creating One, New Medicine, to exploiting the therapeutic assets of Chinese medicine, and having these work in conjunction with Western medical science, to perform miracle cures. These ‘miracle cures’, such as acupuncture analgesia, were then loudly advertised abroad. (Taylor, p. 109)
…it becomes obvious that TCM was being advertised to the West in foreign-language publications as a medicine capable of greater feats in science than the scientific medicine of the West. (Taylor, p. 137)
One of the CCP’s biggest publicity generators for its modernized Chinese medicine was acupuncture analgesia. (Taylor, p. 138)
Thus we’ve come back to the point of this series. Before leaving Taylor altogether, let me quote from her conclusion:
It is hoped that by this stage in the reading of this book, the reader will have formed a different impression of the nature of Chinese medicine than that with which he/she had perhaps started. The main impact which this book is hoped to have had is to dispel the notion that the availability of Chinese medicine in China and abroad was simply a matter of course. It was, rather, the product of an undetermined and piecemeal process which was more a careful manipulation of its value as a ‘cultural legacy’ with the particular political, social and economic circumstances of the early PRC, than any consideration of its actual therapeutic value. The fact that circumstances led the CCP to promote Chinese medicine during the 1950s accounts for its continuing presence in mainland China. (Taylor, p. 151)
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However, as we enter into the twenty-first century, we are approaching a stage where the original revolutionary criteria which legitimated Chinese medicine in CCP China begin to no longer apply. This declining political justification exposes the medicine as belonging to an outdated philosophy of life. In modern Chinese society, in those areas of life where the use of Chinese medicine is optional, Chinese medicine appears to continue to function on a level of general well-being and for the treatment minor illnesses. In cases of distress, Chinese medicine comes a resounding second to the more popular Western medicine. This attitude is evident both in terms of the form of treatment patients seek, and also in its declining popularity as a subject of study for prospective medicine students. Thus while the institutional system set up during the 1950s still maintains the presence of Chinese medicine in Chinese society, one wonders at the future of the medicine if the Communist values of the present government system are to continue to erode. The ‘medical legacy of the motherland’ could indeed become a legacy of China’s past. (pp. 152-3)
As mentioned above, I have some disagreements with Kim Taylor that in other contexts would be formidable: her lamentation about the ‘standardization’ of TCM implies that she believes that the real versions were better—not just in the poetic, metaphorical sense, but for medical care. I don’t. Her assertion that medicine reflects “prevailing ontological concepts of a society” suggests that she subscribes to a kind of medical relativism. Unless I’ve misinterpreted her, she would, presumably, include modern medicine as merely reflecting “prevailing ontological concepts.”
I disagree. Modern, scientific medicine is different from all traditional medicines, because it is founded in biological facts common to all times and places, not in metaphors peculiar to particular times and places. I suspect that ‘real’ Chinese medicine is about as effective as the formulaic TCM of the 20th century PRC, and that each of those is about as effective as the humoral medicine of 18th century Europe or the homeopathy of the 19th century (risks may differ).
For those who are interested in the recent history of something akin to Chinese medicine, however, particularly during the early Communist era and particularly regarding its advocacy in the West, Ms. Taylor’s book is essential.
Next: The Cultural Revolution
We know from John Bonica’s writings that although ‘acupuncture anesthesia’ was first tried in 1958, it was rarely used until the Great Proletarian Cultural Revolution, which began in 1966. It is that era, and its aftermath, that we will discuss in the final part of this series.
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The ‘Acupuncture Anesthesia’ series:
1. “Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part I)
2. “Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part II)
3. “Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part III)
4. “Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part IV)
5. ‘Acupuncture Anesthesia’ Redux: another Skeptic and an Unfortunate Misportrayal at the NCCAM