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Which medicine? Whose standard? Critical reflections on medical integration in China
  1. Ruiping Fan1,
  2. Ian Holliday2
  1. 1Department of Public and Social Administration, City University of Hong Kong, Kowloon, Hong Kong
  2. 2Faculty of Social Sciences, The University of Hong Kong, Hong Kong
  1. Correspondence to:
 Professor Ruiping Fan
 Department of Public and Social Administration, City University of Hong Kong, Kowloon, Hong Kong; safan{at}cityu.edu.hk

Abstract

There is a prevailing conviction that if traditional medicine (TRM) or complementary and alternative medicine (CAM) are integrated into healthcare systems, modern scientific medicine (MSM) should retain its principal status. This paper contends that this position is misguided in medical contexts where TRM is established and remains vibrant. By reflecting on the Chinese policy on three entrenched forms of TRM (Tibetan, Mongolian and Uighur medicines) in western regions of China, the paper challenges the ideology of science that lies behind the demand that all traditional forms of medicine be evaluated and reformed according to MSM standards. Tibetan medicine is used as a case study to indicate the falsity of a major premise of the scientific ideology. The conclusion is that the proper integrative system for TRM and MSM is a dual standard based system in which both TRM and MSM are free to operate according to their own medical standards.

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Footnotes

  • i As will be made clear, what we are focusing on is long-standing and genuinely embedded forms of indigenous TRM, such as Tibetan, Uighur, and Mongolian medicine. This does not include forms of CAM that have been grafted on to healthcare systems, and often have few or no underpinnings in the society in which they are now being practised. We fully understand the scepticism with which such forms of medicine are often greeted by physicians,3031 and we have no interest in saying how they might be integrated into established healthcare systems.32 The three forms of TRM under discussion are actually founded on the concept of “knowing practice” analysed by Farquhar33 and the forms of transmission examined by Hsu.34 Our concern is how these forms of TRM should be brought within contemporary policy frameworks.

  • ii To summarise this complex history, four phases can be distinguished to indicate different official attitudes toward MSM and TRM integration in China. Phase I (from the mid-19th century to the collapse of imperial China in 1911) was a TRM standard based integration. Chinese medicine was taken to hold the correct foundations, purposes and principles of all medicines, and MSM treatments were only admitted as useful therapeutic means.35 Phase II (1911–1949) moved to the opposite position. The Nationalist government offered “unconditional support” to MSM, whereas TRM was taken to be a “feudal” practice or the “collected garbage of several thousand years” that should be prohibited from practice.36 Phase III (1950s–1980s) was marked by a Maoist campaign to create a “new medicine” through a combination of the best aspects of both Chinese and Western medicine. It attempted to produce a new standard based integration from mixed TRM and MSM standards, while being “fully scientific without being foreign or elitist”.37 Phase IV (from the 1980s to now) is apparently characterised by a “three roads” policy. The drive to create a new medicine was substantially downgraded in the early 1980s. Officially, all TRM forms, MSM, and a conjunction of TRM and MSM have since been granted the freedom to exist. However, the three roads are not accorded equal importance. Rather, MSM has the upper hand, and TRM is required to prove its effective properties using the MSM standard.36 In this phase, TRM and MSM integration has thus taken an MSM standard based form.

  • iii It should be noted that the ideology of science has never been explicitly expressed in an official Chinese document as it is summarised in this argument. However, premise 1 has generally been accepted by both the government and society. Premise 2 is controversial in academic discussions, but the opposite view barely has any practical influence. In addition to being supported by the two premises, the conclusions have been carried out in the medical practice in China.

  • iv In mainland China, such arguments are readily heard. For instance, there is a contention that TRM is more scientific than MSM because TRM holds a holistic view, whereas MSM holds an atomistic and reductionist view. Such an argument does not possess solid intellectual strength because the key concepts appealed (such as holism and atomism) are often unclarified.

  • v Is this also accredited by the MSM standard? Seemingly, yes, because this is consistent with the MSM requirement of cleaning any medical instrument used in contact with the body. However, if we take into account the fact that the practice of acupuncture cannot make sense in the MSM system, and thereby cannot be accredited as a therapeutic practice by the MSM standard, the answer would have to be ”No”.

  • vi Looking back through history, three great strands of medical practice provide the ultimate foundations for the various forms of medicine found in the world today: Chinese, Greek and Indian. The conceptual bases of all three traditions are fundamentally at variance with each other. Beyond that, subsidiary medical traditions have also developed, often based on subtle religious and philosophical distinctions that set them apart from the mainstream that originally inspired them. Mongolian, Tibetan and Uighur medicines belong to the latter category.

  • vii The cardinal classic of Tibetan medicine, Four medical tantras (compiled in the 8th century, comprising four treatises: the Root Treatise, the Explanatory Treatise, the Practice Treatise, and the Appendices Treatise) can reasonably be taken as using basic Buddhist principles to reorganise all existing medical materials, including local Tibetan practices and practices learnt from Indian and Chinese medicines. For information about the source of this classic, see Rinpoche (2001) pp. 3–4; Cai (2002)pp. 54–70 and Qiangbachilie (1996(pp. 1–18.383940 We have not found a reliable complete translation of the book into English; for a Chinese translation, see Li (1983).19

  • viii Ritual treatment is taken to be very effective in Tibetan medicine. A prominent example is regular kneeling in prayer. Differing from other prayers in which one kneels only a few times, the Tibetan way is to do it hundreds or thousands of times. Although this is primarily a religious activity, it is also taken as a very effective medical treatment, especially for digestive diseases (see Ga (1996) p.156).41

  • ix According to Tibetan medicine, health has two flowers and three fruits. The first flower is freedom from disease, the second long life. The first fruit is Dharma, including Worldly Dharma (the development of noble human characteristics) and Divine Dharma (the following of the Buddhist religious path). The second is wealth, including both material and spiritual wealth. The third is happiness, having the capacity to free oneself from confusion and ignorance and attain liberation (Enlightenment).27

  • x Some TRM experts do not agree with this assumption. For instance, an expert from the Tibetan Medical School told us that the current model of practice is problematic. In Tibet, integration at the clinical level takes place particularly when a physician is faced with a critical situation. In such cases, MSM may well be used initially to stabilise the patient, before switching to Tibetan medicine for longer-term care. The expert argued that the effective critical care techniques of Tibetan medicine have been curbed from application and development by this model of integration.

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