External influences 6: Communism

外来影响6：共产主义〔外來影響6：共產主義〕 w wài lái yǐng xiǎng 6: gòng chǎn zhǔ yì

Being a political ideology, Communism accounts for a different type of influence on Chinese medicine. China’s reformers in the early part of the twentieth century associated traditional Chinese medicine with the backwardness, rigidity, decay, and inefficiency of the old Qīng Empire. In their infatuation with Western science, they came close to abandoning it completely. The Communists under Máo Zé-Dōng departed radically from this view, motivated by a combination of ideological and practical reasons that proved to be a lifesaver for Chinese medicine. The Communist government thus became the first Chinese government in over a century to officially recognize acumoxatherapy as a valid medical treatment modality, to be supported, taught, and promoted for the welfare of the population. This politically motivated interest and involvement of the Communist Party in Chinese medicine has had both positive and negative consequences for its development, particularly since the founding of the People’s Republic in 1949.

The involvement of the Communist Party with Chinese medicine divides into three stages, roughly spanning the periods from the late nineteenth century to the Communist Liberation in 1949, from 1949 to the late 1970s, and from the late 1970s until today. In the first two of these periods, Communist ideology was a key factor in determining the direction of Chinese medicine for political goals. Only with economic liberalization did a more pragmatic approach emerge.

A New Scientific and Unified Medicine

Before the Communists defeated the Nationalists and gained control over China in 1949, they were involved in a bloody civil war during which their main base of support consisted of the rural peasants. To save China’s suffering masses from the twin exploitation by foreign colonial powers (the Western nations and Japan) and the capitalist and US-supported Nationalists, Máo called for the creation of a New Culture. To facilitate the Communist struggle for freedom and progress, every element of this culture had to be new, scientific, and unified.

As an integral part of culture and an important aspect of the Communist commitment to improving the welfare of the masses, medicine was deeply affected by this revolutionary ideal. For both practical and ideological reasons, providing Western medical health care for the masses was not a viable option in the early years of the Civil War for the Communist guerrillas in their rural bases. Doctors and politicians instead aimed at creating a new Communist medicine that broke with both the traditional medicine of China’s past and the imported Western medicine, yet conformed to Máo’s demands for innovation, scientization, and unification.

Innovation

As late as 1944, Máo considered Chinese medicine a part of the old, feudal system which was holding China’s masses back through illiteracy, superstition, and unhygienic habits, and thereby hindered the emergence of a new, democratic culture. To draw medicine into the revolutionary movement, he called for the remolding of traditional Chinese medicine and the re-education of traditional physicians. On the one hand, the new medicine was to adopt such progressive elements of Western medicine as sanitation and basics of biomedical physiology and anatomy. On the other hand, it was to abandon backward, superstitious and feudal aspects of traditional Chinese medicine that made it inefficient, elitist, or impractical for the health care of the masses.

Scientization

Contrary to what one might expect from the popularity of the term scientize (科学化 kē xué huà) in early Communist writings, this did not mean the wholesale adoption of biomedical theory and abandonment of Chinese medical theory. Instead, the term was applied in the Marxist sense of following the scientific principles of materialism and empiricism in the methodical pursuit of objective truth and progress. To be politically correct, Chinese medical scientists leaned most heavily on Soviet research, such as Pavlov’s theories in neuropathology. They rejected much of Western science, arguing for example that research on cell pathology expressed the capitalist emphasis on the individual over the group. Party cadres emphasized and celebrated the perceived holism of traditional Chinese medicine, contrasting it with the specialization and compartmentalization of capitalist biomedicine. In a powerful metaphor, they equated the ideal of a healthy body in which all organs work in mutual cooperation, balance, and harmony, with the ideal of an integrated society with no class conflict, the goal of the Communist revolution. This same argument is still popular among current proponents of Chinese medicine in the West, who also often implicitly or explicitly use it to criticize the more general aspects of Western culture.

Couched in military and revolutionary terminology, the scientific method was to be wielded aggressively as an essential weapon in the offensive against the enemies of disease, ignorance, and traditional customs. Despite these claims to objectivity, however, medical efficacy was often subordinated to ideology and the practical reality of providing health care for the masses with a minimum of material and human resources.

Unification

The last of Máo’s requirements for the new culture was that it should unite the population behind the shared dream of a democratic China in pursuit of progress and liberation. The new medicine fulfilled this ideal in several aspects: First, it could serve as a powerful symbol for the validity of uniting the best that traditional Chinese and modern Western civilization had to offer. Second, it was forged in a process of cooperation between ideologically motivated party cadres, traditional folk healers, and physicians of biomedical and traditional Chinese training, drawing all these various professionals together under the auspices of the Communist party. Third and most importantly, it served as a key tool for uniting the peasant base with the members of the Communist party because the peasants were familiar with acumoxatherapy. It was readily available, cheap to perform, and, in the ideal of the new medicine, easily learned and safe to use.

Integration of Chinese and Western Medicine

After the defeat of the Nationalists, party goals and requirements changed. Rather than aiming at the cooperation or joining the forces of Chinese and Western medicine zhōng yī xī yī tuán jié 中医西医团结 and drawing Western-trained physicians into the struggle for the new culture, the party now advocated an integration of Chinese and Western medicine (中医西医结合 zhōng yī xī yī jié hé). This shifted the government’s emphasis from practical attempts to utilize two coexisting bodies of medicine, to an ideological focus on modernizing Chinese medicine by eliminating what they considered unscientific aspects like magic and by developing holistic elements.

Especially during the Cultural Revolution, Western medicine was rejected because of its capitalist, imperialist, and colonialist agendas. For example, socialist scholars directed criticism at biomedical diagnostics for treating individual aspects of the body in isolation rather than looking at the body as a whole. They criticized biomedical etiology for focusing excessively on the invasion of external pathogens, and biomedical therapy for acting on a passive patient body rather than enlisting the patient in a cooperative struggle against disease with the assistance of the therapist to restore the internal equilibrium of the human body as a whole.

In contrast, Chinese medicine was regarded as a great treasure house that merely had to be swept clean of relicts from its feudalistic past and raised to the requirements of modern times by making it scientific. In the spirit of dialectical materialism, the Communist party stressed that Chinese medicine, in contrast to biomedicine, treated the body and disease holistically, encouraged the patient’s active involvement in therapy by restoring the body’s defense mechanism, and emphasized the value of practical experience as the basis for knowledge.

The Three Paths

Since the end of the Cultural Revolution and Máo’s death, the political climate has become considerably less ideological and more practical. The People’s Republic of China now has an official pluralistic health-care system with three tiers, Western medicine, Chinese medicine, and integrated Chinese and Western medicine. In theory, the three systems are valued equally. In practice, however, a heavy slant towards biomedicine is obvious in revenues as well as in the importation of biomedical knowledge and technology into the clinical practice of Chinese medicine.

The final verdict on the effects of these developments on the quality of Chinese medicine is still hotly disputed in China. On the one hand, people complain about an increasing distance from the classical tradition, a lack of familiarity with the classical literature and therefore a loss of ancient wisdom, and the disappearance of the highly educated, but elitist scholar physicians who trained at most a handful of disciples in years of personal apprenticeship. The adaptation of biomedical knowledge, especially the exclusive emphasis on the material aspects of the body, has been perceived as a gradual corrosion of the indigenous Chinese medical tradition.

On the other hand, Western medicine is not regarded as an adversarial medical system, but rather as a source for new technologies and research that can be applied for the benefit of both traditions. In China, Western science is overwhelmingly seen as a positive force with an invigorating effect on Chinese medicine that has stimulated it to develop and progress at an unprecedented rate. Like their Western counterparts, Chinese practitioners of Chinese medicine execute the integration of these two paradigms in an individual manner that reflects not only government policy but also their professional training, personal preferences, and the clinical realities of their practice.

As China has advanced into the 21^st century as an increasingly influential world economic power, the intellectual climate has been changing radically. At the close of the 20^th century, the Communist leadership loosened its ideological control and notably relaxed many restrictions on religious practice. Although this trend seems to be undergoing a reversal at the time of writing, growing nationalism has meant that traditional values once scoffed at are increasingly positively identified as part of what it means to be Chinese. In this process, Chinese medicine, having achieved more popularity in the West than any other Chinese cultural product, is increasingly identified as a vehicle for Chinese culture. This is a positive development for Chinese medicine, but what the future holds is not for anyone to tell.

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