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The Philosophical Basis of Modern Chinese Medicine Author(s): Richard Garfield Source: Science & Society, Vol. 43, No. 4 (Winter, 1979/1980), pp. 430-446 Published by: Guilford Press Stable URL: http://www.jstor.org/stable/40402205 . Accessed: 30/09/2013 05:37
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THE PHILOSOPHICAL BASIS OF MODERN CHINESE MEDICINE

RICHARD GARFIELD

THE 1950s AND 1960s the People's Republic of China became the firstmodern nation to promote an DURING ancient, traditional system of medicine. Never entirely accepted by the modern Chinese medical community,oriental medicine has nonetheless again become widely used in recent years. Since the Cultural Revolution of the late 1960s, joint treatment by orientaland westernstyledoctors, joint teachingin the medical and paramedical schools, and the development of combined treatmenttechniques were accompanied by an evolving critiqueof the nature of each original medical system. This philosophic frameworkis a necessary guide for the of a major Chinese medical goal: the creationof accomplishment a new single medicine whichcombines the benefitsof each original systembut is in itselfsomething new and differentfrom either one. This is a most formidabletask, for the concepts of disease and treatment, the methods of diagnosis, and even the basic concepts of the body are different in the two systems.1 At the base of this conflictis a differencein world views expressed by the medical systems.Western medicine reduces physicalfactors to theirsmallestparts in order to cause a predicted change throughalteringone or another component. Oriental medicine approaches the organism as a whole and, through a complex intuitive systemof analysis,attemptsto reasserta betterbalance. The formeris a materialist and mechanical view, the latteris a and flexible metaphysical perspective. As detailed elsewhere,
1 See M. Porkett,The Theoretical Foundations of ChineseMedicine(Cambridge, Mass.,

1974).

430

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these world views relate to the political and social conditions evolved.2 under which the two systems Since 1970 many attemptshave been made to combine both the technicaland theoreticalsystemsof the two medicines. The have been in the last two years withthe post-Mao largestefforts research and modernization. One result on scientific emphasis has been the developmentof a ten-yearplan for the integration into a new, unifiedChinese medicine of the two medical systems the philosophydeserves attenIf for this reason 1987.3 only by tion. That these are the leading views now in China does not Besides the probmean thattheyare shared by all practitioners. lems inherent in articulatingany new systemof thought,it is clear thatsome medical leaders do not support the new philosoof westernmedicinewhichfollowmight phy. While the criticisms also be made toward scientific practicein the United States,they relate more directly to debates occurring within the medical in the People's Republic of China. community Even among those subscribingto the philosophy,regional furtherlimitits coherent consolidavariationsin interpretation tion.4Perhaps thatis whythe Chinese have not yetsystematically While attemptarticulatedthese views to the world community. on medical Chinese views to philosophy, ing faithfully represent for the conceptual synI must thereforetake full responsibility thesis below. I have detailed the most important themes and supplementedthem withexemplarycase studies. No doubt some inaccuracieswillresultfromthisapproach, but it should help the reader develop a clear and generallyaccurate understanding. used to guide all sciencesin China is dialecThe framework of modern In addition to the basic materialism tical materialism. varied and views as this science, things changconceptualization ing processes. These processes are determined by relationships between factorswhich are at any time both in harmony and in
Medicine" unpubto Traditional and KoreanApproaches 2 See Richard Garfield,"Chinese lished manuscript. 3 New China Agency, Domestic Service, 8/19/77,"Public Health MinistryMeeting Service,8/24/77, Information Urges Health Work Improvement,"in ForeignBroadcast Volume I, #164, p. Ell. 4 In addition to these, there have been two national modifications in recent years: a of the "historicalapriorism"of Lin Piao, and of the "wholesale replacement criticism of theorywith philosophy"by the "Gang of Four."

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witheach other- a "unity of opposites." Ratherthan struggle in this framework entities the isolation, viewing quantifiable with with interacts and that each is interrelated object suggests dialecin other is defined the context Thus, of) (indeed, objects. of the natureof ticshelps providea qualitative understanding entities.5 material, quantitative
ChineseViewof theHistory ofMedicine

Medicineis thought by Chineseleadersto have developed to a superstitious from to historically simple complexand from the socialdebasis.This accompanied an increasingly scientific of the evolution of and societies sophistiincreasingly velopment of production. catedsystems Thus, thesupernatural conception in primitive societiesfirst of healthand disease existent prowhenanatomical disa materialist toward understanding gressed the feudal sectionof bodies was performed periodsof during 11th anatomical the and China. diagrams century By Europe Vesalius in Chinaand in the 16thcentury wereused forsurgery the of circulaand function and Servetus analyzedthestructure of humans. tory system in the 18th century of the microscope The development of for Mokani's the basis theory organsand Virchow's helpedlay of whichcalled forthe study of cells."But thismethod, theory thewhole. . . from variouspartsof thehumanbodyin isolation for the underpartialviewpoint gave rise to the metaphysical of indeBoth Mokani's of the human theory body."6 standing of thebodyas unrelated concept pendent, organsand Virchow's were views confederated cells democratically equal, metaphysical the and cells. withthe now observable associated Thus, organs reductionist methoddevelopedin Europe extendedmaterialism butnegateddialectical between variousbodyparts. relationships Traditional oriental medicine evolvedundermoreprimitive
Mate5 For a fullerdescriptionof dialecticalmaterialist philosophy,see M. Cornforth, rialismand the DialecticalMethod(New York, 1960); Mao Tse-tung, Four Essayson ofNature(New York, 1976); K. Marx,/I (Peking, 1974); F. Engels,Dialectics Philosophy ForMarx totheCritique Political Contribution York, 1971); L. Althusser, (New Economy of (New York, 1970). 6 Chin Wei, "The StruggleBetween Two Kinds of World Outlooks on the Understanding of the Human Body," Hung-cKi(Red Flag), No. 12, November 25, 1974; translated in Survey of China Mainland Magazines.

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conditionsone to two thousand years ago and contained many abstractsupernatural ideas. Yet it had a kind of dialecticalconception of body parts withinthe frameworkof Yin and Yang forces,the seven senses, and the six elements. "When studying these theories we must be aware not only of their acceptable dialectical viewpoints but also of their historical limitations."7 analysis . . . "Although these views did not amount to scientific they were far more correct than the metaphysical partial viewpointrepresentedby Virchow."8
Internal Forces on Health and Disease

In present-dayChina the relationsof various body parts to each other and to the body as a whole are seen as important practical and theoretical problems in integratingoriental and westernmedicine. Scientific developmentsof recent years in the nervous and hormonal fields of heredity,memory,immunity, as metabolism are seen key in this research. regulation,and method as applied to fractures The dialectical materialist is now highlightedin the followingcases: itis always we consider that thehumanbody, a unity of As we examine one to united another: are in oppoare Itsvarious they parts opposites. sition and at the same timedepend upon each other;theyare linked in one partof thebody A pathological and actuponeach other. process the or whole the other of can affect body.The condition parts, organs the courseof local pathological can modify of thebodyin itsentirety changes.. . . of fractures. the Take forexamplethehealing method, BytheWestern bones to merge for the in to wait limbis enclosed a cast again.The arm or evensixmonths ofabsolute ittakesthree and sometimes can'tmove, the articulation of the armhas Bythetimethebone has set, immobility. we put little wooden ... [In our present oftenbecomestiff. method] in itback position, and on thelimbto fixthebone after setting splints can beginas soon as thebone has set. It is a we makesure movement betweenstability the contradiction and movequestionof resolving ment.9
Medicinein Contemporary 7 Hsin Pien ChungI Hsueh Kai Yao (Traditional China) (China, 1973), p. 75; translatedin part by N. Sivin. 8 Chin Wei, op. cit.,p. 104. See also "Influence of the StruggleBetween Confucianand Legalist Schools of Traditional Chinese Medicine," ChineseMedicalJournal,No. 11, November 1974, p. 183. 9 M. Macciocchi,Daily Life in Revolutionary China (New York, 1972), p. 279.

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The application of materialist sciences through repeated x-rays and laboratorywork makes the process safer and more controllable. Study of the relationshipbetween the part and the whole also helps to develop a framework for understanding acupuncture. medical"authorities" In some textbooks bourgeois compiledby them, as the ear whoworship merely an organof hearing. regard foreigners and of experience accumulation . . . Throughlong clinicalpractice, the nerves itsnumerous we havecometo realizethat. . . with research, with the connections close and ear has extremely delicate, complicated, of the each and body.10 part body It is these connectionsbetween the part (ear) and the whole (the body) which provide a rationale and a research focus for acupuncture therapy. Another writerexplains: anesthesialies in the of acupunctural The basic contradiction usefulto the functions of oppositesbetweenphysiologic movement arousedby factors . . the . and disease resistance pathological against to the humanbody.11 woundsthatare harmful the surgical Practically speaking, the three opposites which acupuncture deals with are pain and the resistanceto pain, stimulationand inhibitionof supportive physiologicfunctions(blood pressure, corticosteroid tissueperfusion,antibodyformation, release, etc.), of muscle tone. Of these,the primary and tensionand tranquility is that of pain. contradiction an if we implant For example, The bodyhas itsown anti-pain system. the eliminate we can in the brain in a certainnerveplexus electrode withsome cancerpatients. of pain. This has been practiced sensation each form a contradiction, nervous and peripheral The central systems There nerve of in the transmission fordominance impulses. competing
Inherit and Develop Mao's Philosophical Chairman 10 WangChung,"Study Thinking.
Te Che-hsueh Ear Acupuncture Theory," in Yung Mao-chu-hsi Ssu-hsiangTung-shuai Mao's Philosophical I-laio Shih-chien (Put Medical PracticeUnderCommand of Chairman Vol. I, January 1971, p. 24; translatedin Survey of China Mainland Press, Thinking),

297. Supplement 11 Wang Chi-sheng,"A TentativeDiscussion of the Movementof Oppositesin in in Kuang-ming 29, 1975;translated Anesthesia," fihPao, December Acupunctural
Survey ofPeople'sRepublicof China Press, No. 6011, p. 226.

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thick and thinnervefibers in the periphbetween is also competition thick the fibers do not.For The thin fibers transmit pain impulses, ery. and around if one has a small it,thick injury putspressure example, and pain willnotbe felt.12 willbe stimulated fibers is not yetalwaysused in China on probStill,thisframework lems of relationsbetween a part and the whole. One school of can eventuallybe reduced to thoughtholds that all life activity alone. Others criticize thisapproach atomicor sub-atomicactivity view develof the one-sided partialist as a modern manifestation in the West in 18th cells and orthe century concerning oped it other is still On the considered hand, importantto critgans. icize the holisticconcepts found in traditionalmedicine because they "negate things of the part, regard the whole as detached as somethingmysterifromthe part, and look upon life activity ous."13 In summary: ofstrugof bodily diseasesare theresult The genesis and development in an contradictions of the internal transformation and organism. gle the the nerves, and thecerebrum, The humanbodyis a unified entity and of the bodyare interrelated and trunk and the members viscera A pathological on one another. interact changein one partof thebody or otherorganswhilethestate the whole on its effects have body may of localpathologon theprocess of thewholebodymayhaveitseffects ical change. No disease is an isolatedone and a disease and other factors are bound to act on and affect each other.But of the many in there mustbe a contradiction their a factors disease, part playing are and decisiveone whileothercontradictions thatis the principal for is measures one's illness wrong secondary. Taking onlypalliative thehumanbodynotas a wholeand loses becausethis approachregards between variouspartsof thebody.It is a of theinterconnections sight world outlook teaches us The dialectical mechanism. metaphysical of opposi tes in difmovement to and how observe analyze primarily to the methods indicate of such on the basis ferent and, analysis, things contradictions.14 forresolving
12 Jen K'ang-t'ung,"Chen Chih Ma Tsui Chung de Pien Cheng Fa" ("The CentralPlace of Dialectics in Acupuncture Anesthesia"), in Tzu Jan Pien Cheng Fa Tsa Chih, 9 Vol. 1, No. 1, 1974, p. 62, People's Health Press, Shanghai. (Dialectics), 13 Chin Wei, op.cit.,p. 106. 14 Wang Chung, op.cit.,p. 27.

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In every processof a partof thebody,one aspectis considfor ered primary at any giventime.In internal hemorrhoids, hemorrhoid is themaintherapeutic theprimary probexample, the conditoward it will a lem.15 resolving Resolving go longway the main for mostenuresispatients tion altogether. Similarly, of the urinarybladder is excitation-inhibition contradiction nerves, and the main aspect is insufficient excitation. that to promote can thenbe used therapeutically Acupuncture are notso simassessments But often suchclinical mainaspect.16 it fortenyears, enuresis suffering ple. In thecase of a teenager of the bladderwas excitation-inhibition was foundthatnervous "Withthe cerebralcortexlong renot the main contradiction. the nervecenter(of the brain) in a stateof inhibition, maining the bladder the lost controlover and, consequently, urinary cortexand the Tree action' of thecerebral 'inertia' pathological of the urinary bladder were far more serious. . . ."17 ofthebladderwas innervation fornervous therapy Acupuncture inhibition of cerebral contradiction the until ineffective primary was resolved(in thiscase, also through therapy). acupuncture a can of contradiction a The principal shift, creating aspect In unstablediabetes,for example, need for changed therapy. blood sugar is consideredthe primary excessive aspect of the and the therapyis directed blood sugar-insulin contradiction, exwhenthe diabetesis stabilized, toward itscontrol. However, the of main the is to cessive insulin aspect leading hypoglycemia of is adjustedto allowa smallamount and therapy contradiction, the of conditions Such changing sugarspillageintothe urine.18 necessitatof the the nature affect relationship, part-whole part of disease continued assessment processes. ing can contradictions made on thebasisof internal Assessment care. For in patient and Orientalmedicine help applyWestern on cases are first judged fortheireffect example,appendicitis is severe, thegeneralhealthof thebody.If theeffect appendec15 Ren Chuan-pao, "Combined Traditional Chinese and Western Medicine Sclerosing MedicalJournal,3 (2), p. 137. Therapy in Internal Hemorrhoids,"Chinese 16 Chang Chin-fu,"Applying MaterialistDialectics in Directingthe New Acupuncture I'liao Shih-chien Te Che-hsueh Treatment,"in Yung Mao-chu-hsi T'ung-shuai Ssu-hsiang Vol. I, Mao's Chairman (Put MedicalPracticeUnderCommand Thinking), Philosophical of
January, 1971; translated in Survey of China Mainland Press, Supplement 17 Wang Chung, op.cit., p. 26. 18 China's Medicine, July 1969, p. 398. 297, p. 11.

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tomycan be performed. If it is not, then a subdivision of the Westerndiagnosis by traditionalcriteriaof yuchih (early), yunreh (feverforming),and tureh (toxic fever)stages can be done. This leads to various combined Western-Eastern pharmacologie Thus, the subdivisionof diagnosticcriteriaby assesstherapies.19 in the contextof the overall conditionof ing local contradictions the body promotes a more unified understandingof and treatment for various diseases. In short,"The human body itselfis a unifiedwhole of opposites in contradiction."20
and Instability Stability

focusin China is equiarea of theoretical Anotherimportant in the human and librium body. As previously disequilibrium mentioned,traditionalmedicinein the past put centralemphasis since it was on balance, but the understandingwas unscientific internal stabilwhich based on a metaphysical equated cosmology A the state. and of with of the major body exigencies gods ity occurred in the 19th centurywith for materialism breakthrough Bernard's physiologic analysis of homeostasis. This work has been greatlyextended in thiscenturywithresearch into mechablood pressure,acidnismsfor the maintenanceof temperature, mechanisms. blood sugar, and stress-coping ityand alkalinity, criticizeBernard for a one-sided, Modern Chinese theorists undialecticalview towardequilibrium."Althoughhe pointed out in the internal environment... in the importance of stability theoreticalgeneralization Bernard purely emphasized that evin isolationfromthe endless motionof was for stability erything the organic body."21 Equilibrium is now considered a real and necessary and phenomenon,but one whichis alwaystemporary physiologic and disequilibrium,on the other partial. Struggle, instability,
19 PathologyLaboratory and Group, Provincial People's Hospital, Honan, "Combined Traditional Chinese and Western Medicine in Acute Appendicitis,"ChineseMedical Nan Kai Journal,3 (3), p. 266. See also Institute for Acute Abdominal Diseases, of Acute "Treatment Medical and (Kweichow), College (Tiensin) Tsunyi Hospital Abdominal Disease by Combined Chinese and Western Medicine," ChineseMedical Journal,4 (1), January, 1978, p. 11. 20 Wang Chi-sheng,op.cit.,p. 226. 21 Chin Wei, op.cit.,p. 107.

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hand, are permanent.For example, the excitationand inhibition of nerves,the contraction and expansion of muscles,the propuland stimulasion and resistanceof blood flow,and the inhibition tion of hormone secretion all have moments of stabilityin greater unstable processes. This theoreticaldebate is important "One-sided activities. for it has a bearing on practicaltreatment leads to therapeuticideas of stresson equilibrium and stability negativeequilibriumand passive defense,ideas whichemphasize Such dependent and passive roles for patients quiet and rest."22 are considered consistent with capitalist social organization, and patients where power relationsbetween health practitioners and social controlare necessaryideological componentsof a class society. The Chinese hold that in the unity of the two opposites, motionand equilibrium,motion is more fundamentalto the development and maintenance of the human body than equilibrium. "A strong fightingwill, revolutionaryoptimism, active work and study,regular physicallabor, and active sports training"23are thus essential to maintain or recover health and are oftenmore importantthan medicine. "The four main causes of illness among high level cadre are too much attentionto food, clothes,housing, and means of transportation."24 Theory of this kind promotes the use of practices like Tai Chi and Chinese nutritional therapyalong withmodern curativecare. thelowerone. An exampleof nervous can control The higher system in himself thisoccurswhena soldiermobilizes strength superhuman fora and does not feel the pain of injuriesin battlewhen he fights believes.25 cause in whichhe fervently man'sbodygoes Whenacupunctural is appliedforsurgery, anesthesia movement a seriesof changes thatgiveriseto thecomplicated through of opposites.Acupunctureis an active formof anesthesia,not a at theacupuncture of thepain. If we inject a localanesthetic deadening needs will not work. anesthesia Acupuncture pointsite,acupuncture to resist to innervate thebody'sability stimulation pain.26
22 Ibid., p. 108. 23 Ibid. Publi24 Mao Tse-tung,"Talk on Health Services,"January24, 1964; translatedinJoint cations Research Service,61269-2. 25 Jen K'ang-t'ung,op.cit., p. 62. 26 Ibid., p. 68.

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the(already factors anesthesia, existent) positive acupunctural Through arearoused toa full thehuman ofpainwithin thesense toresist body to wagestruggle initiative of the patient extent and the subjective full thus thehuman into is disease body play, enabling brought against initiative forsurgery.27 state tobe in a positive affording New surgicaltechniquesrequiringactive patientinvolvement have been developedas a resultof thisview.They includethe of ocularmovement evaluation strabotomy, during eatingduring and the moveto observevisceral abdominal function, surgery of to observe effect anesthesia whileundergeneral oflimbs ment tissuerepairfollowing majortrauma. These approachesalso change the role of healthworkers. less as stand in relationto patients First,healthprofessionals them as comradesin who "unitewith expertsthan as workers for health."28 theirstruggle Second, the renewedimportance of healthmainteand regulation to activization, education, given done closerto thattraditionally theworkofdoctors nancebrings more a health work as can Nursesand doctors closely bynurses. healthfuncof supportive rvaluation teamby the theoretical tions. thestruggle with idea.During is a wrong "Nurses only givemedicine" one More medicine side. is for health thepatient just important giving well view: an all-round istopromote being, improvphysical promoting their owninner to stimulating attention and paying spirits, ingtheir forces.29 healing be intervention a majormedical treatment In practical might For to reversean unbalancedmotion-equilibrium relationship. example: Allhavesympis calledneurasthenia. which is prevalent One disease of full I take view: thefollowing andinsomnia. ofheadache toms being normal is a at and at (of phenomenon energy daytime sleepy night isthat with neurasthenia The trouble andequilibrium). motion patients when it in thedaytime couldnotbe stimulated nervous their activity when itshould atnight not be inhibited andcould be stimulated should
27 Wang Chi-sheng,op.cit.,p. 226. 28 Wang Chih-yuanin Hsinhua(New ChinaNewsAgency) , January 11, 1975; translatedin 92. No. Mainland China 5778, Press, p. Survey of 29 Kirin Medical College, Hu Li ChihShih(Understanding People's Health Press, Nursing), 1976, p. 10.

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asbe inhibited. . . . Stimulation are twocontradictory and inhibition theremustbe one aspect a contradiction, pects.Since theyconstitute thatplaysthe leadingrole.But whichaspect?We restforthe sake of forthesakeof resting. butwe do notwork Hence,stimulation working we is concerned, treatment playstheleadingroleand,so faras medical of But manybookson treatment shouldlay emphasison stimulation. the tonic and sleeping recommend neurasthenia drugsfortranquilizing of treatment are aimed at inhibinerves.In a word,all the methods tion.30 In this case, daytime stimulationby acupuncture and physical therapyresolved the conditionin eightypercentof fivehundred patients. in a disease process would be Less extreme an intervention to support one aspect of the relation in order to strengthenit alone. Herbal drugs, for example, are used to promote blood circulationin stasis disease,31immunologiefunctionin infectious As and peristalsisin cases of gastric distention.33 conditions,32 on the their action named are traditional by many prescriptions body, this frameworkhelps to associate Eastern and Western pharmacologie treatment. Even during illness, motion is considered more important than equilibrium.Because of this,several new clinical treatment have been techniquesthatdepend on active patientparticipation is a fractures vertebral for dorsolumbar Treatment developed. either for calls treatment hyperexgood case in point. Western or lyingflatin tension,mechanical reduction,and case fixation, occurs. "As theyboth bed, untildeformed healing of the fracture effects stressexternal factorswhile neglectingpatient initiative, In the new not are [of these methods] satisfactory."34 usually
30 Kuo Shu-su, "Apply MaterialistDialectics in Conquering Common Diseases," origiPao, June 28, 1969. Revised and republished in nally published in Chieh-fang-chun PekingReview,September 3, 1969, p. 12. 31 Research Department,Shansi Medical College, "Ectopie PregnancyTreated NonsurMedical gicallyWith Combined Traditional Chinese and WesternMedicine," Chinese Journal,3 (1), 1977, p. 13. 32 Hmatologie Section of Hsi Yuan Hospital, Peking, "Preliminary Report on Treatment of Chronic Aplastic Anemia withCombined Traditional Chinese and Western ibid. 33 "Combined Traditional Chinese and Western Medicine in Acute Appendicitis," 34 Orthopedic Department,Tienstin Medical College, "A New Approach to Treatment 3 MedicalJournal, of Compression Fracturesof the Dorsolumbar Vertebrae,"Chinese (2), p. 111.
Therapy," Chinese Medical Journal, 3 (1), p. 37.

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method,a special pillow is placed under the back, which arches the spine in extension,using the back extensor muscles and related ligamentsthroughvarious exercises to decompress and apvia a "muscular splint." proximatethe laminae fractures "Of course, if we completelynegate the aspect of relative withinthe human body,we may become equilibriumand stability one-sided in that we would neglect the essential protectionand To recare, the needed rest, and the necessaryregulations."35 storeneuromuscularcontrolto a patientsuffering urinaryincontinence,acupuncture stimulationwas used. "Strong stimulation can of course excite nervesthathave been suppressed for a long is too strongor too frequent,the time. But when the stimulation opposite will occur. Stimulationwill be transformedinto suppression, hence the relapse of urinary control. I therefore stopped insertingany needle for a few days, and gave other Here again, we can see supplementaryforms of treatment."36 that the focus on motion and equilibrium in the resolution of contradictionsassociates medical and nursing diagnoses more closely.
External Forces on Health and Disease Correct handling of the relationshipbetween internalcauses and external causes was an importantproblem raised on the integrationof medicine withWesterntreatment. traditional Many comrades spoke of had placed on the role of the one-sided emphasis Westernpractitioners externalcauses. This could easilylead to the commissionof mechanical mistakes.On the other hand, traditional and metaphysical materialistic doctors advocated "supporting the upright and driving off the evil," but in the case of physicallyweak patients ... the curing effectwas slow to show.37 A mechanical view of disease posits causation in either external (i.e., germ theory) or internal (i.e., the theory of biochemical proclivity to alcohol) factors alone. Dialectics on the other
35 Chin Wei, op.cit.,p. 108. 36 Wang Po, "Wisdom Comes From Practice," (Red Flag), No. 4, April 1, 1972. Hung-ch'i Reprintedin Survey of China Mainland Magazines,No. 728. 37 Health Section of the Rear Service Departmentof Canton People's LiberationArmy, RevoTraditional Medicine withWesternTreatmentis a Big Penetrating "Integrating , February23, 1970; translatedin Surveyof China Mainland lution,"Nan-fang Jih-pao Press,Supplement 275, p. 3.

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hand involves the two. It suggests that external factors are catalystsof change, while the nature of change is defined by becomes operainternalconditions.Medicine,an externalfactor, tiveonly throughinfluencing already existentinternalcontradictions. Thus, "in an illness,the internalforcesare more decisive than medicine."38Similarly,"Acupuncture is obviously nothing more than an external cause, for the [primary]internalcause is the strugglebetween resistance to pain and the sense of pain withinthe human body"39and "we not only bring into full play we the role of medical personnel, but what is moreimportant, "40 . . . disease to combat mobilizethe broad massesthemselves (my more on conceived as health is depending emphasis). Restoring social and less on professional conditions. A case in point is cancer theories.Chinese criticizethe dominance of the theoryof cellular causation of cancers.41 In its place, Chinese research bodies upon the stressesthe interactionof toxins and infectious While the life of cellular precise nature of processes. integrity these interactionsis by no means clear, the Chinese have refrainedfromone-sided research on viral and cellular pathology, which has tended to characterize the partialistresearch in the West. Instead, the main effortshave gone into mass surveys, public education, improvementsin sanitation,and the elimination of environmentalpollutants.All these are external factors; they are factorsapplied not in order to mechanicallydestroya disease but to support positive aspects and negate negative asrelated to the disease. Even pects in the internal contradictions so, caused likeanysocial to be externally In the past,cancerwas thought cause. disease.This in factis onlyone side. The otheris the internal who but not induced certain cancer is foods, everyone by Esophageal eats themgets esophagealcancer.Tongue cancer is more common tooth,but not all among people who sticktheirtonguein a rotten the And even when who cancer. do this they getit,in some get people It is due to a complex itdoesn't.Whyis this? it spreadswhilein others
38 M. Macciocchi,op.cit.,p. 266. 39 Wang Chi-sheng,op.cit.,p. 227. 40 Huang Shu-tse,Speech at the World Health Assembly, May 7, 1973, printedin Peking Review,May 25, 1973, No. 22, p. 5. 41 Yang Yu-tien, "Completely Matchless,"Red Guard Bulletin, Peking No. 11, June 6, 1967, p. 4, in Survey of China Mainland Press,Supplement No. 198.

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DNAandRNA.Allthese ofenzymes, interaction factors, inflammatory factors are at play.42 internal and other no longerthought of in the Venerealdiseasesare likewise modelof thegermtheory. are mechanical Instead,socialfactors in both its control. It wideand was considered spread primary and educationwhichmade effective spread social mobilization of collective "This was theconcept treatment immunity possible. thanmedithatcan be ... evenmoreeffective or massimmunity "People are taughthow to fight cally induced immunity."43 born of immunity, againstdisease,so thatthereis a collective of which whole diseases a range continually against knowledge, crop up in the restof the world."44 individual curative thanthe passive, Rather approachto intheChinesepromote an fectants by the germtheory, suggested active group attack."We have a different concept of public educate."45 insteadof sterilize, healthin thissociety: to focus on social It is consideredundialectical, however, ... be must equipped with in a one-sided factors way."Surgeons absolute of asepsis.. . . However, a strict asepsisdoes not concept criticism on thorough we shouldcarry existin reality. Therefore, level public of primary of thosewho depart fromthe realities "thewrongidea of In such publichealthwork, healthwork."46 so disease prevention drugs alone mustbe overcome, through with health work mass thatthe policyof integrating prevention of healthwork This reorientation implemented."47 maybe fully has oftenbeen said to make the conceptof the hospitalless relevant. is Evenin curative care,theidea that"drugsare everything"
42 He Chung-hsi, Jen Ti Lo Ai Chung(The Human Bodyand Cancer),Tsujan Pien Cheng Fa Tsa Chih(Dialectics),Vol. 3, No. 1, 1976, p. 89. 43 Ma Hai-teh,"With Mao Tse-tung'sThought as the Compass forAction in the Control of Venereal Diseases in China," China'sMedicine(1), October, 1966, p. 52. 44 Ma Hai-teh,WilfredBurchettand Rewi Alley in China: The Quality ofLife (Baltimore, Maryland, 1972), p. 245. 45 Ma Hai-teh, quoted in personal interviews, November, 1976. Shou-shuTu-chief(StandardSurgical 46 Shanghai Medical InstituteNo. 2, Ch-ang-yung Translated by U.S. Department HEW (Washington, D. C, Illustrated). Techniques, 1973), p. 1. 47 RevolutionaryCommittee of Shanghai First Medical College, "Medical Education Must Be Transformedon the Basis of Mao Tse-tung Thought," Chinas Medicine, No. 3, March, 1968, p. 161.

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criticized. factor butnotthedecian important "Drugsconstitute sivefactor in curingdiseases.""If the drug is suitedto thedisease and is applied in properamount,the mentalstateof the can be whether itseffect the drugwilldetermine taking patient the and the disease "both Therefore, [patient's] fully displayed." are takencare of."48 thought Otherexternal maybe appliedas an adjunctto or therapies antibiotics. for replacement kill doesnot andmoxibustion directly pathogens. therapy Acupuncture and infections cure certain to the it then does Why possess power and In acute diseases? bacillary dysentery acupuncture inflammatory and relieve rectal moxibustion diarrhea, spasms mitigate may therapy andthepresence increase andat thesametime leucocytic phagocytosis The levelof theinfection of antibodies thatmaycontrol favorably. . . ,49 likewise. in blood increases the hydrocortisone diseasecauand external of internal of concepts A wedding sation leads to a reassessmentof the potential for health. of society we thinkthatwiththe improvement "Theoretically, venereal socialdiseasessuchas tuberculosis, disease,and leprosy and thelikeare willbe eliminated. diseases, cancer, Degenerative is made that Thus a projection also in part social conditions." "whatyou call diseasesof old age, and we call diseasesof capisuch environmental willbe overcome talism"50 changes through work of of pollution, as the reduction processes, reorganization and the lesseningof stress.These externalchanges will help of thebodyin properorderand, it contradictions keep internal controlled is thought, can onlyoccurin a socialist by the society workers. definialso leads to a different The focuson contradictions medicine viewof Western-based tionof health.The mechanical the simpleabsenceof tendsto definehealthas a staticentity: the other hand, is difon The dialectical view, pathology. than absolute definition, conditional rather ferentiated its by
48 No. 159 P.L.A. Hospital, "What Is Decisive Is Man Armed With Mao Tse-tung Pao, October 30, 1970; translatedin Survey Thought,"Cheih-fang-chung ofChinaMainland Press,Supplement 297, p. 36. 49 Shanghai Research Institute of Acupuncture and Moxibustion, Handbook of and Moxibustion Acupuncture Therapy (Hong Kong; 1971), p. 249; translatedby Hans Agren. 50 Ma Hai-teh, quoted in personal interviews, November, 1976.

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which processof struggle constantly dependsupon thedynamic therelain the most includes This, body. importantly, occurring and motion in the tionof a partto the entire body,equilibrium of and the relation internal and as a external whole, organism factors.
Conclusion

of the British MedicalAssociaT. F. Fox, former president in 1960 that "the Chinese are engaged tion,wrote prophetically in perhaps the largest social experiment of all time and as we understand it,could be a local casualty."51 Medicine, in China'smedicine. is occurring shift A majorparadigmatic and modof traditional Eastern as thecombination Whatstarted medical medicine has rewritten ernWestern history, changedthe definition of health, a new of healthworkers, relations promoted in thehealthsystem. It has and changedtherole of thehospital different curative new treatment techniques, promoted brought formeda new conceptualmodel for and preventive strategies, All thisis docuand raised new researchquestions. diagnosis, mented and clear. of assiststhe achievement the new framework Politically, of threeChinesesocial goals. These are the closerassociation and modern and traditional nursesand doctors, practitioners, thatsocial It is the with thought generally public. professionals if the down be broken must these between country groups gaps classdifferences eliminate is to reduceand eventually altogether. can responsibly be severalcomments Withregardto health, of the variousgroups menmade. First,the social association in tionedabove createsa basis for more and betterteamwork healthof any thenational This wouldimprove medicalpractice. and would witha shortageof professional personnel, country which to several is heir suchas China a country assist particularly medicalsystems. different on the innatevalue of traditional Pro and con arguments thatsome usefulnew therapies it is clear medicalsystems aside, of Orientaland Western have emergedfromthe combination medicine.It has probablyalso provideda healthyskepticism
51 T. F. Fox, "Health Care in New China," American Journal ofPublicHealth,June, 1960, p. 35.

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in bothorigtoward thedross,theinefficient, and theiatrogenic inal systems. materialist can the dialectical philosBeyondtheseinsights, it medicine? American to offer Although is selanything ophy a greatdeal of dialecthereis already in such terms, dom stated thatthe value of It appears to thisobserver ticsin our theory. of scienviewis in theapplication thedialectical explicit making life. As the human work of in the tific improving theory practical in itsapproachto is morecomprehensive framework dialectical between connection it seemsto createa moredirect lifeactivity, This and medicalpractice. medical medical research, knowledge, which we most with are in chronic diseases is especially pertinent and elabconfirmation needs further burdened.This, however, oration by those directlyinvolved in the experiment:our Chinesecolleagues.
New YorkCity

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