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The centuries before the unification of China under the Qín Dynasty in 221 BCE witnessed far-ranging changes. The Warring States Period, as this time is commonly called, was instrumental in shaping the foundations not only for the social, political, and economic organization in imperial China but also for its philosophy, religion, art, literature, science, and, last but not least, medicine.

Change was fueled by such factors as the technological innovations of the Iron Age, increased transportation and communication, rapid population growth, and the decline of the ancient Zhōu Dynasty that had ruled as the representative of Heaven among humanity over a federation of aristocratic courts on the basis of familial and ritualistic ties. The struggle to fill the power vacuum left by the decline of Zhōu political and religious authority led to an increasingly ruthless civil war between warlords. The fight for survival overrode all concerns for traditional morality and ancient codes of conduct.

It was in this period of intense upheaval and existential worry that Chinese philosophy was born. It must be seen in this historical context as a response to an often desperate search for a way out of the prevailing disorder and into a future of unity, stability, and peace. All early philosophers agreed that this goal was not only desirable but also possible, since it would replicate a golden age of peace in the past.

One of the earliest answers was offered by Confucius (Kǒng Zǐ 孔子) in the sixth century BCE. He constructed a system of philosophical and ethical teachings, known in English as Confucianism, that was to become the most influential philosophy for the development of Chinese culture throughout its history. Given the influence of China far beyond its own borders, one could even argue that Confucianism has been the most influential philosophy throughout the East Asian region.

In the modern world, Confucian core values remain strong. Although many ceremonial rites have disappeared, filial piety and respect for seniors are still core values in the Chinese-speaking world.

The Confucian Dào: A Path to Social Order

Confucius was the first thinker in early China to propose a Dào 道, literally a way or path to a goal. For Confucius and his followers, this Dào was a system of teaching that would lead the ruler and everyone else to a moral society by returning to a perfect past when this Dào had flourished. Since traces of this ancient wisdom could still be found in the transmitted writings as well as in traditional rites, Confucius advocated the meticulous observation of rites (礼 lǐ), from the perfect execution of mourning rituals for deceased ancestors down to table manners. The rites expressed sharp social distinctions and deference to those higher in the hierarchies of the family, community, and state. Partly to promote the rites, Confucius recommended the continuous study of literature from the past, including poetry, historical documents, and ritual instructions. He longed for and dedicated his life to a return to a past that he believed had been marked by social order, stability, and balance.

For Confucius, this ideal order or Dào, which included the way of the ancient sages, the old rituals, and strictly ordered hierarchies in government as well as family relationships, was one in which every individual was firmly aware of and acted in accordance with their position in a complex web of social hierarchies. All human interactions were regulated by the five relationships (五伦 wǔ lùn)—between ruler and subject, father and son, husband and wife, elder brother and younger brother, friend and friend. These relationships determined the multiple responsibilities of loyalty and obedience to those above and compassionate caring for those below. The state, and therefore the role of the ruler, was interpreted as an extension of the basic model of the family as the root of all social order. The Chinese for state or country is 国家 guó jiā, kingdom family.

The core value in Confucianism, for the sake of social harmony and the common weal, was filial piety (孝 xiào), almost absolute obedience and service to one’s parents and the family line. Filial piety was always placed unquestioningly above an individual’s personal interests. Respect for one’s elders in the family, still a common characteristic in East Asia, extended to the deceased ancestors. Through the practice of ancestor worship, the dead remained integrated in the lives of the living members of the clan.

However, the power that was granted superiors and elders in the Confucian social hierarchy was tempered by the equally demanding call for social morality (义 yì) and benevolence (仁 rén) towards those below, an extension of parental love in the family. In government, the humanitarian rule of an enlightened Son of Heaven (天子 tiān zǐ) who governed not by force, but by the almost magical power of his virtue (德 dé) was likened to the wind effortlessly swaying the grass. In this we see a reflection of the notion of the unity of Heaven and Humankind. Just as Heaven dominates humankind, so within the human realm the ruler dominates the people. Social harmony was established by subservience of the people and benevolence of the ruler.

The Ideal Man of Benevolence and Virtue

Confucius advocated the pursuit of this Dào with the intention of molding oneself into a superior person (君子 jūn zǐ, often rendered as gentleman). He spent all his life single-mindedly pursuing this goal. The characteristics of a superior person included profound wisdom, reverence for the past, impeccable personal habits and social interactions, moderation, disdain for profit, and great benevolence and virtue. In addition to the study of the ancient texts and rites, an adherent of the Confucian Dào was continuously engaged in a program of self-cultivation, acquiring skills in such traditional arts as music, archery, and writing that contributed to the formation of a well-rounded personality.

Confucius and his followers trusted firmly in the power of personal example and teaching to influence the hearts and minds of others. Therefore, they laid great emphasis on education to nurture this ability to place the common interest above one’s own.

In the Confucian view, men of benevolence and virtue were the people best suited for public service. After the unification of the country under the Qín, China was increasingly administered by a large bureaucracy that any man of any background could join provided they passed the required imperial examinations, which tested applicants on their knowledge of literature and of rites and ceremonies. Although Confucianism endorsed the rule of hereditary monarchs upholding the Mandate of Heaven, it promoted meritocracy in the national administration and in public life.

Human Nature

While Confucius merely stressed the importance and power of education for molding human nature towards morality, his disciple Mencius (孟子 Mèng Zǐ), went further and affirmed the inherent goodness of human nature. Mencius explained the current state of disorder and immorality by likening human nature to a mountain that had been deforested so many times that it appeared barren but sprouted new shoots if nurtured by the flood-like qì of spring rains. Given a nurturing environment, namely the satisfaction of basic human needs and moral education, the germs of virtue will grow in the human heart like rice plants sprouting in watered and fertilized fields.

Xún Zǐ (荀子) , a Confucian scholar who lived somewhat later in the Warring States Period, was more pragmatically inclined, and refuted this belief in inherent human virtue, claiming instead that human nature was naturally inclined towards personal satisfaction. To balance this selfish trend of human nature, however, the sages of the past had realized that humans would benefit if they transcended this basic urge and cooperated instead in the interest of society at large. Thus, in Xún Zǐ’s view, morality was not natural, but an externally imposed value requiring instruction. However, by providing mankind with the tools to function in society, this acquired morality was the defining characteristic that gave humans their elevated position between Heaven and Earth. Thus, for both Mencius and Xún Zǐ, education assumed a key role in shaping human nature towards morality, and the classics and rites of the past provided the tools for this endeavor.

Hierarchy, Patriarchy, and Authoritarianism

As we have said, all human interactions were regulated by the five relationships (五伦 wǔ lùn)—between ruler and subject, father and son, husband and wife, elder brother and younger brother, friend and friend. Four of these five relationships are defined by dominance, while only the relationship between friends can be considered egalitarian. Given this, Confucianism created a society that was hierarchical, patriarchal, and authoritarian, little concerned with issues of personal freedom or social equality and even less with gender equality.

As to the position of women in society, several features of traditional Chinese culture, such as polygamy and foot-binding were never seriously questioned until the modern era. Although these practices were not actively advocated in Confucian doctrine, their prevalence in a society dominated by Confucian values suggests that they were tacitly accepted.

Traditionally, marriage was subject to the control of the family elders. Arranged marriage was customary. The wife often severed ties with her own family, and her solemn duty was to produce a male heir. Men of wealth and power often had multiple wives and concubines. Divorce was permitted if both parties agreed to it. According to the Hàn Dynasty Confucian classic, Dà Dài Lǐ Jì (大戴礼记), a man could unilaterally divorce his wife if she lacked filial piety toward his parents, failed to bear a son, was lewd or adulterous, was gossipy, was jealous (including objecting to the husband taking another wife or concubine), had committed theft, had a serious illness, or (不侍公婆、无后、淫行、口舌、妒忌、盗窃、恶疾 bù shì gōng pó, wú hòu, yín xíng, kǒu shé, dù jì, Dào qiè, è jí). A woman had no such rights and was not allowed to remarry after her husband died. The safeguard against divorce was to have no maiden family to return to, to have had completed of three years of mourning for the husband’s parents, and to have married her husband when he was poor before he later acquired wealth (无所归不去、与更三年丧、贱娶贵不去 wú suǒ guī bù qǔ, yǔ gēng sān nián sāng, jiàn qǔ guì bù qù).

The Confucian principle of not looking at, listening to, saying, or doing anything that does not accord with the rites (非礼勿视，非礼勿听，非礼勿言，非礼勿动 féi lì wù shì, féi lì wù tíng, féi lì wù yán, fēi lǐ wù dòng), to which the English adage see no evil, hear no evil, speak no evil, can be traced, ensured a certain flexibility in adherence to moral standards, at least for men.

Foot-binding, a fashion that started in the 10^th century, lasted nearly a thousand years. In the Qīng Dynasty, attempts by China’s foreign Manchu rulers failed to eliminate the practice or even prevent its growth. When the fashion reached its peak, an estimated 50% of the female population had bound feet. Some foot-bound women survived into the 21^st century.

Slavery was widespread in China up till the mid-twentieth century, despite occasional efforts to combat it. Slaves were mostly criminals, foreigners, or destitutes.

Since a major tenet of Confucianism is What you do not want [done to] yourself, do not do to others (己所不欲勿施于人 jǐ suǒ bù yù wù shī yú rén), these phenomena have plainly not been entirely the result of Confucianism, but rather of patriarchal and authoritarian attitudes in the culture that Confucians were reluctant to oppose. See box on Confucianism and the West further ahead.

Confucianism and Religion

Being a social philosophy that focused exclusively on the practical issue of shaping human behavior in such a way as to concretely improve life in human society, Confucianism promoted secularity. Confucius himself, though advocating ancestor worship, was extremely reticent to discuss questions about the ultimate meaning of life, the existence of god or gods, or how the universe came into being. Xún Zǐ, by contrast, decidedly supported contemporary philosophers in doubting the existence of gods, spirits, or demons.

While so many cultures, not least those of the West, have relied on the shared values of a particular religion for social order, China has maintained social cohesion for two millennia by an almost completely secular doctrine. This remains unchanged to this day. In stark contrast to monotheistic religions, such as the Abrahamic faiths, which, by encouraging the belief among adherents that their values are absolute and universal, tend to foster religious intolerance, Confucianism sets nothing as absolute. Religious oppression has only rarely occurred in China by comparison with lands to the west of it. Primarily because of the influence of Confucianism, modern Chinese discussions about abortion, the death penalty, or sex and gender issues are far less heated than in the West.

As a set of values shared by a large segment of the population, Confucianism, secular though it is, shares much in common with religions. Since religions as we conventionally conceive of them each contain similar as well as different elements, precisely what constitutes a religion is a matter still debated. Hence, the question as to what elements of religion, if any, Confucianism possesses is pertinent. Most religions involve worship of a deity or deities, adherence to hallowed moral precepts, beliefs in an afterlife, performance of rituals (worship, rites of passage), prayer or meditation, study of holy scriptures, and pilgrimages to holy places. Most encourage the curbing of human desires, in some cases promoting celibacy and/or vegetarianism, encouraging the practice of fasting, and in extreme cases demanding asceticism. Many offer narratives explaining creation.

From the point of view of evolutionary psychology, belief in powerful omniscient gods encourages adherence to moral precepts even when other people are not watching. Belief in an afterlife provides the solace of retribution for good or bad behavior in the hereafter. Worship, meditation, contemplation, prayer, dance, group rituals and festivities, and, in some religions, the use of psychedelic drugs facilitate altered states of consciousness such as self-transcendence. These experiences de-prioritize personal interests and bestow a sense of spiritual elevation above the profane, of communion with fellow humans, surrender to the deity, or oneness with nature. Religious festivals not only achieve this in a communal context but also punctuate the drudgery of yearly toil with things to look forward to. Shared religious values promote group identity and social cohesion, though in excess this can lead to the demonization of outgroups.

Although Confucianism has no deities, its belief that ancestors hold the highest position in the family hierarchy relates the supernatural world to the material world. Ancestors, like deities, watch over the living. Despite the absence of deities, Confucian tolerance of religious belief allows the freedom for people to get what it fails to provide from other sources. Confucians erected temples to commemorate the Founder, but these were never bustling centers of constant social activity seen in Daoist temples. For this reason, Confucianism never totally replaced other religions and philosophies.

As a worldly doctrine intended to promote social cohesion and harmony, Confucianism regards the pursuit of pleasure as natural so long as propriety is observed. It never prescribed any form of ascetic practice for the attainment of spiritual goals, as is common in many religions. Celibacy is an anathema to many Confucians because it entails failure to carry on the family line, which is considered disrespectful to parents.

Despite its secular nature, Confucianism performs many of the psychological functions of religion. Its insistence on the sanctity of a social hierarchy fosters reverence in all human interactions. Confucian rites provide pomp and circumstance that nurture group identity and social cohesion. In so doing, Confucianism provides for many of the social and personal needs more often met by religions that center around deities.

Sanctity invested in gods, rituals, and values bestows on them power and majesty that inspire awe. However, religion is not the only source of such emotion. Nature, with its high mountains, vast oceans, and powerful forces, has always inspired people with feelings of awe. By extension, ideas such as the big bang, quantum theory, multiverses, and evolution can conjure the same passion. Political and social power, as invested in the presidency or the monarch, do so too, as do widely shared values in a group, such as freedom and justice in our modern world. In fact, any value shared by a whole group, nation, or culture that holds the community together can become elevated to the level of sanctity.

Viewed in this light, the belief in the principles of loyalty to those above and benevolence to those below as the way to ensure social harmony is in the Confucian mindset what the belief in freedom of thought and speech is in our modern Western culture. Confucian values were the core values of the Chinese people for centuries, as, to a large extent, they still are to this day. Their universality and persistence in the Chinese world bestow on them a high degree of sanctity.

Confucianism Today

Confucianism even in the modern age represents the core values of Chinese society. Western and, in mainland China, Marxist influence has had major consequences for Chinese society. The strictness of the social hierarchy has weakened, social rules have become fewer, formality has softened. One of the biggest changes is the emancipation of women, who now, at least in terms of the law, have equal rights with men, have access to professional occupations, and engage in public and political life.

The highest and most enduring value of Confucianism is filial piety, the respect and reverence for one’s parents. In education at home and in school, greater emphasis is placed on social cohesion on individualism. The relationship between parents and children usually remains close even through the awkward years of adolescence. Young Chinese people will usually live with their parents until they marry unless work takes them to other places. Parents will often live with their son after he marries. Chinese parents have a far greater say in their children’s lives well into adulthood. They provide guidance in career choice and financial decisions. There is much less financial independence between the generations than in the West. Depending on needs, Chinese parents will buy property for their children, while children will often give their parents money once they are working. They are also diligent in caring for parents in their old age. Although arranged marriages are much rarer than they once were, parental acceptance of a candidate is a high priority for most people, especially since it is quite normal for three generations to live in the same house or apartment.

Expression of respect for elders and superiors is ubiquitous in all social interactions. One obvious expression of this is the use of titles and the avoidance of names when addressing elders and superiors and even, though less commonly, when addressing younger people and inferiors. Parents, siblings, aunts, uncles, cousins, and in-laws are rarely referred to or addressed by name. Thus, older siblings are usually addressed as great sister/brother (the eldest sibling), second sister/brother (second eldest sibling). Different terms for aunts, uncles and their siblings on the mother’s or father’s side helps to avoid the use of names. In the workplace and public life, superiors are referred to by their title (with or without the surname). In professional circles, colleagues who have worked with each other for years will often still call each other by their titles, even if they engage with each other socially or become close friends. They rarely ask others to call them by their first name, as is common in Western countries. In formal situations, it can even be impolite to address a superior as you. Amongst workers, older people are addressed as Old Lǐ or Old Wáng, while younger people are called Little Lǐ or Little Wáng. Even students will address older students as senior (学长 xué zhǎng, 学姊 xué jiě). The increasing Western practice of addressing superiors in the workplace, aunts and uncles and even parents by their first name is almost unthinkable in Chinese society. Personal names are largely restricted to friends and lower-ranking family members. Even though with increased social equality rank now counts for much less, linguistic usage continues to reflect the original Confucian family and social hierarchies.

Ancestor worship is an extension of the Confucian concept of filial piety into the supernatural world. Ancestors occupy the highest rank in the family hierarchy. Grave-sweeping day is still a major public holiday in China, when families go to their ancestors’ graves to clean them and make offerings of food, incense, and paper money. Some Chinese still have an altar in their homes on which stands a photograph of a recent ancestor. People pray to or communicate with their ancestors asking them to watch over them and preserve them. Many feel that failure to perform these rituals results in a guilty conscience and even bad luck.

The most widely held core values amongst Chinese people are all cast in a Confucian mold. They are the defining characteristics of Chinese ethnicity.

Confucianism and Medicine

Confucianists believed that appropriate behavior through abidance by the rites and moderation of desire through personal discipline were the way not only to social harmony but also to the health of the individual. In this vision of the world, which emphasized the effects of individual behavior on the degree of harmony within society, there was little room for concern about supernatural forces beyond human control. Thus, Confucianists’ endorsement of determinism moved medical thought away from supernatural causes toward natural factors to create a medical model that explained health and sickness in terms of natural laws.

Medicine, though frequently defined as a way of overcoming illness and restoring health, more often than not, involves two parties—the healer and the healed. Socially, medicine is part of the human caregiving activity. Confucianism posits that human beings, in their pursuit of happiness, have a fundamental right to a healthy body and a balanced life as the foundation for virtuous conduct. Any effort to increase the well-being of others, whether indirectly through government services or directly in the act of caregiving, is an expression of benevolence and therefore a worthy application of a superior person’s talents and efforts. What could be a more concrete expression of filial piety and service to the family line than caring for the health of elders, women, and children?

Moreover, the oft-stated axiom that medicine is a benevolent art (医乃仁术 yī nǎi rén shù) had powerful ramifications for medical ethics. Beginning with Sūn Sī-Miǎo in the medieval period, medical writers called on professional physicians to treat their patients like their family, to disregard profit, and to give all patients equal care regardless of their economic or social status. Physicians were to spare no effort in their personal quest for virtue and knowledge. Further, they were expected to teach by the personal example of a flawless lifestyle.

It is true that, at least in the early centuries, the Confucian ideal of a well-rounded education and disdain for applied technical knowledge negatively affected the attitude of the literate elite towards any sort of professional specialization and occupation. On the other hand, the importance of education, the respect for elders and tradition, and the preservation and transmission of the classics were powerful factors that shaped not only the individual program of a scholar-physician’s continuing education but the direction of Chinese medicine as a whole.

As we remark in numerous places in this book, in the context of Chinese medicine, the importance of the past and the role of traditional knowledge can hardly be overemphasized. For centuries, Confucianism’s focus on respect for social superiors such as elders and teachers, as well as its ancestor worship, created an intellectual climate of reverence for those who pioneered medical thought in antiquity. In that atmosphere, outright criticism or accusations were always discouraged and, if at all possible, circumvented. In the West, by contrast, scientific argumentation emerged in pre-Christian Greece, where natural philosophers were forced to compete for patronage by disproving their rivals’ theories. In China, Confucianism instilled respect for teachers and for the founding authorities of medicine.

Despite its reverence for the teachers of the past, Confucianism was always tolerant of new ideas. Medical knowledge advanced not by refuting prior knowledge, but simply by adding to it. When Wáng Bīng in the Táng Dynasty wrote his annotated version of the Nèi Jīng, he added a whole section on the five periods and six qì doctrine. The Shāng Hán Lùn, Zhāng Jī’s cold damage doctrine composed some 1800 years ago, was greatly refined through the commentaries of successive generations of medical scholars. The warm disease doctrine of externally contracted disease that developed much later in history was presented as a complement to cold damage and incorporated many of its ideas. Thus, in sum, Confucianism did much to define the style of medical discourse and the arbitration of competing doctrines.

Lastly, medical writings about the human body that focused on regulating, balancing, and moderating its desires and thereby ensuring physical harmony not only within the body but also with society and the macrocosm as a whole resonated strongly with Chinese social, political, and cultural ideals. Let us recall the Confucian political ideal of an empire with interdependent functional centers and bureaucracies in harmonious and balanced relationships, linked by vital channels of transportation and communication. The influence of this view in medicine created a model of the body in which organs functioned interdependently in hierarchic fashion and were linked together by a channel system. Thus, medical discourse was regarded as an important aspect of a sound education. The integration of the mind and body in the Confucian educational program gave rise to writings that devoted considerable attention to the care of the body.

Despite its general overall promotion of a deterministic medicine, one criticism has been leveled against Confucianism, namely that it discouraged anatomical dissection of the body. According to Confucian belief, the body is given by one’s parents and that dissection is an unfilial act. Nonetheless, it is clear from copious anatomical descriptions of the internal organs presented in the Nàn Jīng that dissection was performed by early medical scholars. Furthermore, since Confucius himself did not oppose capital punishment absolutely and crimes in every dynasty were punishable by death or amputation, the argument that the lack of dissection and the failure to develop a model of functions based on anatomical structures is attributable to a taboo against dissection is not wholly convincing. The doctrine of the Unity of Heaven and Humankind with its focus on the big picture may well have held greater sway in the development of a medical system that did not focus on anatomical detail.

Neo-Confucianism and Its Effects on Medicine

The arrival of Buddhism during the Hàn Dynasty and the subsequent growth of organized religion in Chinese society coincided with and perhaps accelerated a decline of Confucianism. As a result, it was eventually forced to break out of its exclusive concern with human society. In response to the metaphysical challenge posed by Buddhist and Daoist discussions on such topics as the ultimate source of the universe and the nature of reality, thinkers of the Song period widened their scope to look at the natural world around them. In a revitalized form of the doctrine, which is known as Neo-Confucianism, reality was seen as the interplay between principles (理 lǐ), universal patterns of either moral or physical nature, and qì, the substance that allowed for their concrete materialization in this world. At last, Confucians realized the value of an empirical approach to nature, to facilitate an investigation of the principles in their concrete manifestations as qì. This opened the door to an acceptance of specialized and applied knowledge with consequences that reached far beyond the sphere of medicine. Combined with a Neo-Confucian emphasis on filial piety, procreation, and the continuation of the family lineage, the medical fields of gynecology, pediatrics, and geriatrics in particular witnessed much progress in their development into professionalized medical specialties.

Especially during the Sòng Dynasty, the imperial court actively supported medicine as an expression of the government’s humanistic concern with the welfare of the population. It promoted, supervised, and controlled medical education, sponsored major projects to publish medical classics and formula collections, established a national network of pharmacies, and controlled and distributed prepared medicines for the health care of the common people. Because of the general rise in literacy that came with advances in commercial printing and increased wealth, elite medical literature and knowledge were popularized. This was the first time it affected the lives of more than the select few. In addition, improved communication caused a standardization of knowledge as well as the collection, preservation, and publication of popular medical ideas and practices from all areas of China.

Lastly, the political turmoil and occupation of China by foreign rulers like the Mongols (Yuán Dynasty, 1276–1368) and Manchus (Qīng Dynasty, 1644–1911) encouraged the rise of scholar-physicians: Nationalistically inclined intellectuals were unable or refused to serve their often cruel and, from the Chinese perspective, barbaric overlords. Barred from their traditional roles in the national bureaucracy, they were forced to look for other occupations. Consequently, they turned to art, medicine, writing, or publishing instead. For the first time in Chinese history, medicine became a respected profession that a member of the educated elite could engage in without a loss of prestige.

Confucianism and the West

Unlike Daoism, Confucianism has attracted little popular interest outside of East Asia. Its apparent conservatism manifest in a hierarchical social structure and in emphasis on qualities such as obedience and loyalty have made it unattractive to modern Westerners who favor liberalism, individualism, and democracy. Yet Confucianism appears in a much more favorable light when one considers that Western liberalism and democracy appeared only recently, after a long period of oppressive religious domination typified by the dark ages, which Confucianism spared China. Confucian ideas of loyalty to superiors ensured its perennial patronage of the ruling classes. Being secular and rational, Confucianism offered no prescriptions or proscriptions about metaphysical issues, and hence had the effect of deflating potential conflict between religions. The secular Confucian values of China and its traditional satellites, Japan and Korea, have made these countries much more open to Western influence than other countries where religious beliefs are strong. Their startling economic success over recent decades is testimony to this, as is the emancipation of women. Nevertheless, a Confucian conservatism still resists total acceptance of Western ideas of personal freedom. This applies not only to modern China, where Western-style democratization is strongly resisted by the Communist Party, but also, though less so, to openly capitalist countries such as Japan, Korea, and Singapore. In East Asia, strict social norms and acceptance of authority are generally viewed as essential to the preservation of economic and social stability and the avoidance of political chaos. The fear of social and political chaos explains why defenders of the one-party system in China believe that this system of government is superior to liberal democracy. They point out that China’s present system of government is the continuation and refinement of a two-thousand-year tradition that was inspired by Confucianism. The proof of its superiority, they argue, lies in the fact that, of the millions of people who have been lifted out of poverty over recent decades, most have been Chinese. It remains to be seen whether this argument holds true in the long term.

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