Traditional Chinese Medicine

The Human Dimension

Big Leung

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317324874
• Topic: Medicine
• Subtopic: Health Care Delivery

Traditional Chinese Medicine (TCM) is a great treasure of China's ancient history and culture. Written for health professionals, researchers, social scientists and educators, this book elaborates a view that TCM is embodied in diverse and complex human dimensions and meanings in Chinese culture. Encircling Cultural Meaning includes the TCM concept 'Qi', the holistic approach, which embodies culture in medicine.

The book identifies intricate human dimensions of TCM in: the life stages of youth, adulthood and old age, as family connections, as identity, as balancing /harmonising life, as complementary and knowledge transmission roles. In particular, TCM is seen through the lens of leadership - as refining human relationships, as self, as moral practice, as good management practice, and as embracing the cultural environment. Underlying these categories, shared meanings are revealed, as well as core values and health beliefs in Chinese culture. The complex human dimensions of TCM are shown to be deeply rooted in social, cultural and historical contexts in the Chinese diaspora.

The Spirit of Chinese Culture: its Human Centredness

Conceptions of Leadership in Traditional Chinese Medicine

TCM for Youth, Adults and the Elderly

TCM in Family Connectedness

Chinese Identity, Body Image and Gender

Balance/Harmony/Knowledge

Underlying Beliefs and Roles

Social-Cultural Significance

The author draws from and extends her PhD research on lived Chinese experiences and conceptions of TCM across diverse individuals, populations, two focus groups in Australia, and three focus groups in Macau and Hong Kong. Encircling Cultural Meaning reveals rich and profound values in Chinese culture manifested at all levels of life, including: the reciprocal care of filial piety, trust, respect, considerations for others, the quest for self understanding, and the strive for peace and harmony.

These inner virtues in human relationships offers a soothing refuge and solution to the modern world which is often punctuated with imbalance, the overdependence on material acquisition, distrust, violence, and man's inhumanity towards man.

chapter one
Traditional Chinese Medicine: The Connections
連

(Pronounced as lin, which means ‘connections’)

Traditional Chinese Medicine is a human phenomenon, connecting people in the world.

Ancient Chinese people developed the wisdom of Traditional Chinese Medicine through their timeless efforts in coping with health and illness. Traditional Chinese Medicine has become a system of healing and a Chinese health discipline grounded in ancient philosophical texts. Early Chinese medical thought has been greatly influenced by Tao and yin and yang theory, which emphasise harmony with nature and co-operation, and that all relationships are complementary. An excess or a deficiency in either yin or yang is thought to be a prelude to illness.

Practitioners and users of Traditional Chinese Medicine characteristically focus on the whole person, the close correspondence between the individual and nature, and the core principles of balance and harmony which contribute to health and wellbeing. The main effect of disease, according to tradition, is the blockage of qi, the vital life force, which permeates our bodies, as well as the universe.

The influence of Traditional Chinese Medicine is widespread throughout the world. According to one estimate, up to one quarter of the world’s population, including Chinese, Korean and Japanese people, are thought to be using Traditional Chinese Medicine (Jones & Vincent 1998). The significance of Traditional Chinese Medicine is revealed in its connectedness with Chinese heritage and identity, and as a continuous cultural achievement from China (Leung 2004). Traditional Chinese Medicine plays a significant role as a preference in the delivery of health care among Chinese people both within China and throughout the Chinese diaspora.

To provide a background for understanding the participants’ perceptions of Traditional Chinese Medicine presented later in this book, it will be helpful to have an understanding of the historical influences of Western medicine in China and how policy impinges on the concurrent use of these two health systems in China. Further to this, the use of Traditional Chinese Medicine reveals an attachment to traditional Chinese culture by Chinese people throughout the Chinese diaspora and in former European colonies. The extent of Traditional Chinese Medicine use in Australia and in Hong Kong and Macau is also provides perspective for this discussion.

Western Medicine in China

‘Western medicine’, as a body of theory and practice, started to be consolidated in Western Europe during the fifteenth and sixteenth centuries, incorporating ideas and practices developed by and diffused from various cultures (Ho & Lisowski 1993). Western medicine was introduced to China through the influence of missionaries, the Chinese government, and Chinese individuals interested in learning Western medicine (Andrews 1996).

When the Jesuits brought Western medicine to China in the sixteenth and seventeenth centuries, it was seen as a curiosity; the medical teachings were preserved in a library (Ho & Lisowski 1993). Western medicine was not appreciated at first because of the vast differences between the two medical models in terms of theory and practices. At first, Western medicine was mainly used by low status and poor people who could not afford local doctors, as reported by a missionary:

While the wealthier people do call native doctors, and will continue to do so to some extent, the great class of poorer people, whose conditions of life render them more liable to disease, and who would or could not go to the native doctors, are glad to put themselves under our care.

(Andrews 1996)

Western medicine was introduced through the efforts of some notable people: Dr Alexander Pearson, who introduced vaccination to China (1805); Benjamin Hobson (1816 to 1873), who was believed to have introduced Western medicine into China through his works Outline of Western Medicine, New Anatomy of the Human Body, New Discourse on Internal Medicine, and Simple Discourse on Gynaecology and Paediatrics; Dr Parker (1834), who introduced chloroform in surgery; John Fryer (1839 to 1928), who translated a great number of the Western medical texts into Chinese (Ho & Lisowski 1993), and the medical missionary John Kerr, who went to Canton in 1854 and ran the Boji Hospital. He worked there for forty-seven years, treating more than one million patients and training medical students (Wikipedia Encyclopedia 2007).

It was during the second half of the nineteenth century that Western medicine underwent a period of further development. Some Western doctors and medical missionaries were successful in coping with infectious diseases by means of vaccination and improved standards of hygiene and public health, establishing the reputation of Western medicine (Porkert & Ullmann 1982).

Western medicine was in a favourable position in China at the turn of the twentieth century for two reasons: firstly, the Chinese government provided support for medical science and a public health program was established; and secondly, scientific methods promised an optimistic outlook (Unschuld 1985).

Dr Sun Yat-sen, the ‘Father of Modern China’ in Taiwan and China and founder of the Republic of China in 1912, graduated from the Hong Kong College of Medicine for Chinese and received training as a Western medical practitioner at Boji Hospital. He recognised the importance of science in the Republic’s Constitution and asserted that: ‘What we need to learn from Europe is science, not political philosophy’ (in Creel 1975:243). Under the Nationalist regime, Western medicine was favoured. An unsuccessful attempt was made to abolish Traditional Chinese Medicine in the year 1929. The ‘unscientific’ nature of Traditional Chinese Medicine was one of the reasons it was marginalised at that time. Various institutions were set up for the purpose of incorporating science into Traditional Chinese Medicine, such as the Research Society for the Improvement of Chinese Medicine, established in 1919, and the Institution for National Medicine, established in 1931 (Penny 1993).

Having Traditional Chinese Medicine working alongside Western medicine became a major health policy in Communist China. During the civil war in the 1930s, Mao Zedong, Chairperson of Communist China, required all medical workers ‘to serve the people’ (Porkert & Ullmann 1982:260). Driven by necessity, it became obvious that more than one type of health care was needed to serve the massive population:

In the countryside, where trained physicians were in desperately short supply, the old-style doctors were used on a large scale, but they were almost entirely excluded from the large urban hospitals and government medical institutions.

(Penny 1993:176)

In 1958 Mao Zedong delivered this famous dictum: ‘Chinese medicine is a great treasure house! We must make all efforts to uncover it and raise its standards’. In the same year, the Central Committee of the Chinese Communist Party endorsed the co-existence of Western medicine and Traditional Chinese Medicine, stating that they ‘should serve side by side’ (Porkert & Ullmann 1982:260). In 1982, the Constitution was redrafted to include ‘developing modern medicine and traditional medicine of our country’, a policy that placed Western medicine and Traditional Chinese Medicine on an equal footing (Shi 1995:9.2).

In recent years the popularity of Western medicine has risen among the younger Chinese generation. In modern China the two medical models not only co-exist, but co-operate to serve the Chinese people (Liu 2006). Three types of medical science are available: Traditional Chinese Medicine, Western medicine, and ‘integrated medicine’, offering flexibility in health care.

Traditional Chinese Medicine in Australia

Traditional Chinese Medicine is categorised under complementary therapies by the Australian Bureau of Statistics (2001). In 2003 in Australia, an estimated $2.3 billion was spent on complementary alternative medicine (Adams, Sibbritt, Easthope & Young 2003). This figure is more than double the estimate for the year 2000 of $1 billion and, according to research conducted by Australian Consumer Associations about the same time (Choice 2001:1), more than half of the population had used complementary alternative medicine.

Around two-thirds of the amount spent on complementary alternative medicine in Australia is for Traditional Chinese Medicine, according to the Xinhua News (19 April 2001). The report on a 1996 stage one research project into Traditional Chinese Medicine practice, commissioned by the Victoria Ministerial Advisory Committee (1998), revealed there are around 2.8 million Traditional Chinese Medicine consultations yearly Australia-wide, which amounts to an annual turnover of $84 million in this sector of Australia’s health economy.

As categorised by the Australian Bureau of Statistics, Traditional Chinese Medicine encompasses diverse modalities such as acupuncture, Chinese herbal therapy, massage therapy, dietary therapy, scraping, moxibustion, and exercise therapy such as Qi Gong and Tai Chi. A Traditional Chinese Medicine practitioner is defined under Complementary Health Therapists by the Australian Bureau of Statistics (2006) as:

[One who] treats imbalances of energy flows through the body by assessing the whole person and using techniques and methods such as acupuncture, Chinese herbal medicine, massage, diet, exercise and breathing therapy. Registration or licensing may be required.

In Australia Traditional Chinese Medicine is used, alone or to complement Western medicine, for treating and preventing disease, especially chronic diseases such as cancer, allergies, heart disease and AIDS.

Traditional Chinese Medicine in Hong Kong and Macau

In Hong Kong (a British colony before 1997), a statistics report in the year 2000 indicated there were 1 050 600 persons using Traditional Chinese Medicine, representing 15.5 per cent of the population (C&SD 2000). The number of consultations for Traditional Chinese Medicine was 322 000, accounting for 22.7 per cent of the 1.43 million doctor consultations. Traditional Chinese Medicine was mainly used for regulating the body (63.3 per cent). The majority of users were women between 35 and 54 years of age.

Macau was under Portuguese administration before 1999. The number of Traditional Chinese Medicine consultations in Macau in 2003 was estimated at 597 407, including 63.7 per cent for general treatments, 26.4 per cent for bone-setting, 5.5 per cent for acupuncture, and 4.2 per cent for massage (DCEC 2004).

Investigation of Traditional Chinese Medicine in this book

The discourses of Traditional Chinese Medicine are socially and culturally constructed, as are those of Western medicine. They are complex and conceptual, and require referencing to more concrete social and cultural practices grounded in participants’ experiences, beliefs, and interactions with others. The intricate meanings of Traditional Chinese Medicine are congruent with the view that medical experiences, as expressed in Nei Jing, the first Chinese Medical Classic, are replete with symbols and meanings and are connected to multiple contemporary ideas (Bary & Bloom 1999). As pointed out by Sivin (2003), the strength of Traditional Chinese Medicine involves complex relationships and is best evaluated through its analysis of how functions on many levels, including the body, emotions, natural and social environments, are related.

Understanding social, cultural and historical contexts helps us to uncover the actions and meanings of individuals in the social world, and to see and feel in a more humane way. Cooley (1926:64) spoke of this as the ‘sympathetic elements’ which make us ‘distinctively human’. Exploring the social knowledge of Traditional Chinese Medicine helps us excite our sociological imaginations (Wright 1959:32) in order to see Traditional Chinese Medicine, a familiar and natural experience to some of us, with new significance.

Traditional Chinese Medicine was often perceived as Chinese culture by participants in this book, and as an important vehicle for realising idealistic principles that connect with significant traditional Chinese cultural values. Understanding these philosophical meanings will help us to appreciate the social and human side of participants’ connections with Traditional Chinese Medicine, and with traditional Chinese culture as a whole. Therefore, the book will present the core values in Chinese culture, starting with a detailed discussion of human centredness and its philosophical underpinnings, providing the framework for the exploration of Traditional Chinese Medicine in the following chapters. The various meanings ascribed to Traditional Chinese Medicine by Chinese participants in two studies conducted in Australia (chapter three to seven) and Hong Kong and Macau (chapter eight) are presented. Each chapter features a Chinese character, the meaning of which encompasses the key message of that chapter.

Other features provided at the end of this book — the glossary of Chinese terms, supplementary notes on Chinese philosophers and classic literature, and Chinese metaphors and sayings — contain enlightening reading to further enhance the reader’s appreciation of Chinese culture.

chapter two
The Spirit of Chinese Culture: Its Human Centredness
仁

(Pronounced as lans, which means ‘benevolence’ or ‘humanism’, and ‘two people’)

The essence of Chinese culture resides in humanism, the human heart.

Tang Chun-I 唐君毅 2000

Introduction

The human dimension of Traditional Chinese Medicine uncovers some of the core values of Chinese culture. This chapter serves as the backbone for the following chapters by highlighting how many aspects of traditional Chinese culture are applicable to this modern world. I believe the beauty of Chinese culture is that its essence resides in humanism, in the human heart, a view in line with those of Tang Chun-I (唐君毅), a modern Chinese philosopher, in his monumental work on the spiritual value of Chinese culture (Tang 2000).

Humanism is prominent in Traditional Chinese culture. In the following sections, the relationship of Chinese culture with humans is defined. The historical development of humanism is described, supported by the teachings of Confucianism, Taoism, and Mohism, the main schools of humanistic thinking. The contribution of the underpinning concept of yin and yang to balance and harmony in life and health is considered. The core values of Chinese culture are explored, embracing the three main human relationships of human and self, human and others, and human and the universe. Finally, the significance of human centredness as applied to this modern world is examined and discussed.

Throughout this chapter, references are drawn primarily from these Chinese classics:

• ■ I Ching (易經)
• ■ Tao Te Ching (道德經)
• ■ The Confucian Canon or the Four Books of Confucianism (四書):
  • — The Great Learning (大學)
  • — The Doctrine of the Mean (中庸)
  • — Analects (論語)
  • — Mencius (孟子)
• ■ Mohist Doctrines (墨學)
• ■ Nei Jing or Yellow Emperor's Canon of Internal Medicine (內經/黃帝內經)
• ■ Sheung Shu (尚書)
• ■ Shijing or Book of Odes (詩經)...

Table of contents

• Cover Page
• Half Title page
• Dedication
• Title Page
• Copyright Page
• Foreword
• Foreword
• Contents
• About the author
• About the cover design
• Preface
• Acknowledgements
• Chapter One Traditional Chinese Medicine: The Connections 通
• Chapter Two The Spirit of Chinese Culture: Its Human Centredness 仁
• Chapter Three Beliefs 信
• Chapter Four Balance and Harmony 和
• Chapter Five Youth, Adulthood and Old Age 力
• Chapter Six Family Connectedness 孝
• Chapter Seven Identity 同
• Chapter Eight Conceptions of Leadership in Traditional Chinese Medicine 師
• Chapter Nine The Human Dimension 人
• References
• Chinese Dynasties
• Chinese Classic Literature and Philosophers
• Chinese Metaphors and Sayings
• Glossary
• Index