Back to search result Search again Previous Next ↑

Modern Western medicine began to enter China from the early Qìng through the efforts of Christian missionaries who, by healing Chinese bodies, hoped to simultaneously influence Chinese minds. By 1850, ten missionary hospitals had opened. Their numbers gradually increased. It was not by the persuasiveness of the missionaries’ religion, however, that Western medicine gained a fast foothold in China. Rather, it was by the power of Western civilization based on the achievements of secular knowledge in science and technology. By the end of the 19th century, after decades of humiliation by Western powers and, finally, by Japan, China’s faith in its own intellectual traditions was deeply shaken. The values of modern science were seen by an increasing majority to offer the only possible solutions to the nation’s problems.

China underestimated the Western aggression for decades before finally formulating a clear response. If it was not to be pushed around by the West, it had to master the technology that was giving the West the upper hand. In the latter part of the 19^th century, numerous schools were established to teach European languages to provide Chinese people with access to Western knowledge, paving the way for the adoption of almost every branch of Western learning. This response rested on the recognition that language is the vehicle of knowledge and culture and that knowledge could only be transmitted from one culture to another if the transmitters were fully conversant with both languages. Interestingly, this was not a lesson that Westerners would be so eager to learn in the westward transmission in of Chinese medicine in the 20^th and 21^st centuries.

Important Events in China, 1894-1976
Sino-Japanese War: 1894–5 Overthrow of the Qìng: 1911 Japanese invasion of China: 1937 Communist takeover (The Liberation) and Nationalist retreat to Taiwan: 1949. Cultural Revolution: 1966–76

In the political realm, the loss of faith in traditional culture and institutions inspired the overthrow of imperial rule and the founding of the Republic, under the rule of the Kuomintang (KMT, 国民党 guó mín dǎng), often referred to as the Nationalists.

Amidst these upheavals, Chinese medicine was increasingly viewed as unscientific, elitist, and primitive. It all but met its demise. In 1929 a bill was presented by Yú Yún-Xiù (余云岫) calling for the abolition of the old medicine. Although opposition was strong enough to prevent the bill from passing, the challenge to Chinese medicine remained unabated and most students interested in medicine went abroad to Japan, Europe, or the USA to receive a Western medical education. In 1932, the Chinese government ordered that traditional Chinese medical schools be excluded from the mainstream education system. However, there were also efforts to modernize Chinese medicine, which was proudly called guó yī, National medicine, by its proponents, in contrast to the foreign biomedicine.

In the 1950s, after the Communist assumption of power on the mainland, Chinese medicine gained a new lease of life. Several reasons can explain the support of Máo Zé-Dōng’s government for Chinese medicine. One is that the Communist government lacked the resources to provide adequate Western medical care for the whole population, but at the same time was able to recruit many practitioners of Chinese medicine. Additionally, traditional Chinese medicine contained a strong pragmatic element and its yīn-yáng and five-phase theories could be interpreted as a kind of primitive dialectic. Furthermore, the holism of Chinese medicine was inherently attractive to a society in which collectivism was valued over individualism. Finally, while Chinese medicine was criticized for its feudalistic and bourgeois elements because of its ties to the Confucian society of the past, it was still Chinese and therefore free of the Western capitalist and imperialist values for which Western medicine was criticized in the Maoist era.^[23]

Nonetheless, not all traditional Chinese healing practices received Communist Party approval. Although Chinese medicine was considered a treasure house of experience in the treatment of disease, the grain still had to be separated from the chaff. The value lay in the techniques and experience, the treasure, rather than the conceptual edifice, the treasure house.

It is important to understand that although the government of the People’s Republic of China has actively supported the development of Chinese medicine, it has, with rare exceptions, always accorded much less importance to Chinese medicine than to biomedicine. Although Chinese medicine colleges have arisen in all major cities, the PRC currently trains at least twice as many doctors in biomedicine as in Chinese medicine.

The challenges of biomedicine and the scientific worldview have brought the need for research to establish the scientific basis of Chinese medicine. This has led to the scientific understanding of various therapeutic mechanisms and has provided ample evidence for the effectiveness of both acupuncture and medicinal therapy. Nevertheless, the theoretical infrastructure of the system as a whole has not been validated according to current scientific principles. Notably the entire notion of qì, the channel system, certain organ functions, and traditionally recognized external causes of disease have gained no substantiation. Modern research into acupuncture has led to the discovery of endogenous opioids (endorphins), but studies concerning the objective existence of traditional explanatory concepts of qì and its pathways are so rarely funded that no scientific consensus can be stated.

Policy makers in China have declined to draw the most radical conclusions of the scientific challenge, which would entail discarding all traditional theories of physiology and pathology and recasting traditional therapies in the mold of mechanisms recognized by biomedicine. Thus, the traditional edifice of Chinese medical theory has been left intact.

In the past, the teaching of Chinese medicine was based on a personal apprenticeship with a master. The classical tradition generally accorded more importance to the earliest knowledge than the latest because the authors of the early texts were considered to have knowledge so deep that later generations could only approximate it. Texts such as the Huáng Dì Nèi Jīng, Nàn Jīng, and Shāng Hán Lùn usually formed the focus of education and were closely studied and memorized. The shift into the framework of large teaching establishments has led to the creation of new texts that explain the subject systematically in modern Chinese. In the creation of modern textbooks and college curricula, the less rational elements of traditional theory have been minimized.

Today, education in basic theory still includes yīn-yáng and the five phases, the channels and network vessels, traditional physiology, and causes of disease, more or less according to the Nèi Jīng, but now presented in modern-style textbooks. Diagnosis is still presented in the form of the four examinations (inspection, smelling-listening, inquiry, and palpation), which combine a wealth of diagnostic criteria from a wealth of literature.

Central to diagnostic procedures in modern education is the practice of identifying patterns as the basis for determining treatment (辨证论治 biàn zhèng lùn zhì). Treatment by identification of patterns is a key element in modern Chinese medicine for three reasons: (1) because it is a theoretically based, rather than a symptomatic approach; (2) because it offers criteria for reliable treatments; and (3) not least because it is seen as a holistic complement to Western medicine that emphasizes the individual’s specific manifestations of disease.

Modern education notably includes courses on materia medica, medicinal formulas, internal medicine (about major 50 broad disease categories), history of Chinese medicine, and specialties such as warm disease (温病 wēn bìng), gynecology, pediatrics, ophthalmology. The Huáng Dì Nèi Jīng, Nàn Jīng, and Shāng Hán Lùn, and Jīn Guì Yào Lǜ are still studied, but only after the foundations of basic theory and diagnostics have been laid and with less memorization than in the past.

Over recent decades, the once distinct traditions of acupuncture and medicinal therapy have been more firmly integrated than ever before, creating a monolithic system of medicine based on a common corpus of physiology, pathology, diagnosis, and treatment principles, with differences only in treatment modalities. The clearest example of this integration is seen in the use of pattern identification in both treatment modalities. Although pattern identification had its origins in the medicine of systematic correspondence first described in the Nèi Jīng, its later development was influenced primarily by the needs of medicinal therapy. The use of pattern identification in modern Chinese acupuncture sets this practice apart from other acupuncture traditions in East Asia, where treatment is often based on a simple distinction between vacuity and repletion and oriented toward symptomatic relief.

Although the Chinese medicine practiced in today’s People’s Republic of China and from there exported to the West is often referred to in English as Traditional Chinese Medicine, we need to understand the sense in which the word traditional applies. The modern Chinese medicine of China is traditional in that its physiology, pathology, and therapeutics virtually all originated before the modern era and are rooted in the early classics. However, it is a collection of what is generally considered to be useful among different healing traditions (excluding supernatural healing practices) and integrated in a coherent way, with an unprecedentedly complex and refined system of pattern identification. Hence for followers of more classical practices, TCM paradoxically means modern Chinese medicine. In China, it is called 中医 zhōng yī, without the word traditional.

In promoting TCM, the government of the People’s Republic of China has been guided by the conviction not only that Chinese medicine can be purged of all irrational theories and ineffective remedies but also that it can be integrated with biomedicine to produce an even more effective synthesis. These efforts are still hampered by the ultimate challenge that modern science poses. Furthermore, traditionalists still hold considerable sway. For them, the abolition of traditional concepts that are unacceptable to the biomedical community would reduce the value of Chinese medicine to an assorted collection of folk remedies―a fate they would be unlikely to accept.

In Taiwan, the only part of China left under Nationalist rule after the Communist takeover in 1949, Chinese medicine has remained alive because of popular approbation. In recent years, it has been incorporated into the island’s national health insurance scheme. All in all, however, support for Chinese medicine is weaker in Taiwan than in the PRC: Taiwan had nearly three times as many Western medical doctors as Chinese doctors in 1954, and ten times as many in the early 1990s.^[24] No government-run university has a Chinese medical faculty, the four universities that do being private.^[25] Over recent decades, despite Taiwan’s political contentions with the mainland, the Taiwanese Chinese medical community has relied heavily on the mainland textbooks for teaching. Implicit in this is agreement with the developments pioneered by the mainland.

The fate of Chinese medicine in the rest of East Asia, specifically in Japan and Korea, has been broadly similar to that in China,^[26] though with differing degrees of modernization. Japan’s more rapid westernization increased the speed at which cultural support for acupuncture and Kampo, the Japanese variation of Chinese medicine,^[27] were weakened. The active suppression by the Meiji government from 1868 to 1902 was especially damaging. As part of this policy, for example, all medical practitioners—including those of Kampo—were forced to pass a difficult examination based solely on biomedical theories and practices to obtain a license to practice medicine. By 1926, the influential Japanese clinicians Takeshi Sawada, Sorei Yanagiya and later Shin’ichiro Takeyama had become outspoken critics of the restrictive laws passed in the late 19th century. By the 1930s a variety of movements had emerged, in particular, keiryaku chiryo or the channel therapy movement, which today remains one of the more powerful influences in Japanese acupuncture.

The Second World War halted all progress in traditional medicine in Japan. After 1945, however, these indigenous movements rose again and acupuncture and Kampo were set upon a course of legalization, licensure, and standardization. While Kampo has failed to rise again to its levels predating the arrival of Western medicine and the Meiji suppression, 240 Kampo formulas are routinely prescribed by Japanese medical doctors, widely available in pharmacies, and covered by health insurance.

Today, proponents of Chinese medicine in China, Japan, Korea, and Taiwan are in agreement about the efficacy and potential of Chinese medicine. They mostly believe that Western medicine excels under life-threatening circumstances. Most traumatic injuries and emergency situations affecting internal organs, as well as many specifically defined illnesses, are more effectively treated by Western medicine. By comparison, many chronic diseases affecting multiple systems, which are viewed as unrelated in Western medicine, may be clearly understood and concisely treated using the paradigm of Chinese medicine. Many conditions where quality of life is affected, but morbidity is absent (what has sometimes been called a sub-health state) are treated effectively by Chinese medicine. The areas where Chinese medicine has enjoyed comparatively high success compared to Western medicine include rheumatology, gynecology, infertility, and acute minor contagious diseases such as the common cold and influenza. The modern application of Chinese medicine has been highly successful in the proactive management of diabetes, hypercholesterolemia, hypertension, and post-stroke rehabilitation.

The future of Chinese medicine and its Japanese, Korean, and Vietnamese variants may entail continuing change under the pressure of modern biomedical knowledge and possibly the gradual disappearance of the social and cultural motivations for its traditional expression. The nature and scope of the changes, as well as the pace of change, still cannot be predicted.

• History 1: The Formative Period
• History 2: The Early Medical Classics
• History 3: Post-Classical Evolution
• History 5: Internationalization

Back to search result Search again Previous Next