Abolition, reinvention, and institutionalization

Why inherited medicine came within one vote of being abolished.

After the Opium Wars, missionary hospitals and Western-style faculties grow in the treaty ports, and foreign medicine becomes associated with the laboratory, surgery, and public health. Many Republican reformers read inherited medicine as a residue of the past holding modernization back, as had happened in Japan. In 1929 that reading reaches the health committee and a phase-out plan is approved; the sector’s organized reaction stops it.

The abolitionists were not ignorant, and the defenders were not a single bloc. Yu Yan knew well the classics he attacked; Yun Tieqiao answered with a sophisticated argument about the status of the concepts. And between them lay a third path, Zhang Xichun’s convergence current, which tried combinations without declaring a winner. Reducing the episode to science against superstition erases exactly what makes it interesting.

• The treaty ports concentrate Western hospitals and medical schools.
• The Japanese precedent of conditional licensing weighs on the Chinese debate.
• 1929: a phase-out plan approved in committee and blocked by protest.
• The convergence current offered a third, non-binary position.

Zhong xi yi hui tong 中西医汇通 “Convergence of Chinese and Western medicine”. A late-nineteenth and early-twentieth-century current that sought to articulate both systems without subordinating one to the other.

Integration, academies, single textbooks, and barefoot doctors.

From 1949 the People’s Republic adopts a policy of integrating both medicines, driven by a shortage of health personnel and by the intent to use domestic resources. In 1956 the first higher academies of Chinese medicine are founded in Beijing, Shanghai, Guangzhou, and Chengdu, and unified national textbooks appear with them. Shortly afterwards the barefoot doctor campaign brings basic care to the rural communes through short trainings mixing procedures from both systems.

Those textbooks had to make one syllabus out of what had been rival lineages for centuries. To do so they selected, simplified, and left out practices that were hard to fit, from ritual healing to regional variants of moxibustion. The parallel with the Song editorial campaign is direct, and so is its moral: when a state edits, examines, and dispenses, it decides which part of a tradition survives in print.

• A policy of integration from 1949, in a context of too few doctors.
• 1956: academies in Beijing, Shanghai, Guangzhou, and Chengdu.
• Unified textbooks make a formerly plural tradition teachable.
• Barefoot doctors (c. 1965–1985) extend basic rural coverage.

Chijiao yisheng 赤脚医生 “Barefoot doctors”. Village health workers with short training, active mainly from the 1960s to the early 1980s, who combined resources from both medicines in rural care.

The twentieth-century construction thesis and the arguments against it.

Historians such as Paul Unschuld, Volker Scheid, and Kim Taylor have documented that the phrase “Traditional Chinese Medicine”, with its ordered doctrinal body and stable vocabulary, is largely a twentieth-century product. Before it there were lineages, schools in disagreement, religious practices, regional variants, and an enormous contradictory literature. Institutional standardization turned that plurality into a system presentable on the same plane as biomedicine, and in doing so it also changed it.

The thesis has legitimate counterweights. The texts are real and old, the continuity of formulas and procedures is verifiable in earlier sources, and every living tradition is reformulated without ceasing to be a tradition: Roman law and Hippocratic medicine did not arrive intact either. Saying TCM is a twentieth-century construction does not mean it was invented from nothing; it means its present systematic form has a date, authors, and identifiable motives.

• Before 1950 practice was plural, local, and doctrinally at odds with itself.
• Standardization fixes a shared vocabulary and a shared syllabus.
• Textual and practical continuity with earlier periods is real and checkable.
• “Construction” describes the systematic form; it does not deny the age of the sources.

Zhongyi 中医 “Chinese medicine”. The term spreads precisely when a name is needed to distinguish it from Western medicine; before that, no contrast was required.

What each case actually demonstrated, and what it left undemonstrated.

The artemisinin case is precise. A line in the fourth-century Zhouhou Beiji Fang suggested to Tu Youyou that heat was destroying the active principle of qinghao; the team changed the extraction method, isolated the compound in 1972, and it was tested by modern pharmacological procedures. What was validated is a molecule isolated from a plant pointed to by an old text. The classical theory surrounding that plant played no part in the demonstration and was not confirmed by it.

Acupuncture took another road. After Reston’s 1971 dispatch, so-called acupuncture anaesthesia spread, heavily promoted in that period; later reviews showed it was applied to highly selected patients and with supplementary analgesics, and its real scope was far smaller than publicized. Subsequent research has focused mainly on symptoms such as certain pains and nausea, with contested results and one persistent difficulty: telling the effect of the procedure apart from that of the sham control.

• The clue was textual; the demonstration was modern and pharmacological.
• A drug derived from a plant does not validate the theoretical framework around it.
• Acupuncture anaesthesia was promoted well beyond what practice supported.
• Clinical research has addressed specific symptoms; it does not establish cures for diseases.

Qinghao 青蒿 The Chinese name of the plant from which artemisinin was isolated. The exact correspondence between the old name and the species used today is a matter of botanical debate.

Heritage, market, regulation, and evidence, kept apart.

Four different conversations about Chinese medicine run at once today, and they are habitually mixed. The heritage conversation treats texts and practices as cultural inheritance. Health policy decides what is funded and who may practise, and varies widely between countries. The economic one moves a global market in products. And the scientific one asks whether a specific procedure does anything measurable. An argument that holds in one of them does not automatically hold in the others.

Two facts help calibrate. First: WHO published an international point nomenclature and, in 2008, a locating standard, and in 2019 ICD-11 took in a traditional medicine chapter; WHO itself clarifies that this codifies terms for statistical purposes and does not endorse efficacy. Second: there are documented problems of quality and substitution, such as the kidney damage associated with aristolochic acid, which led to plants being withdrawn from pharmacopoeias, and the use of protected species, now excluded from the Chinese pharmacopoeia.

• Heritage, regulation, market, and evidence are separate debates.
• WHO standardization concerns nomenclature, not efficacy.
• ICD-11 chapter 26 codifies terms for statistical purposes.
• There are documented risks of quality, substitution, and interactions.

ICD-11, chapter 26 A supplementary chapter of the International Classification of Diseases adopted in 2019, collecting traditional medicine terms so they can be recorded statistically. It expresses no judgement on efficacy.