By Richard Just, MD
China is nothing like I imagined! The evolution of healthcare mirrors major events in Chinese history. Traditional Chinese Medicine (TCM) dates back 5,000 years when the first documentation appears. What is currently called TCM goes back 3,000 years, and was essentially passed from one generation to the next. Another factor that resulted in fragmentation of medical practices was that China was a feudal society whose states were constantly at war with each other. The emergence of the Qin state resulted in a single state system with a single script and standardized weights and measures. But their reign was so oppressive it lasted only 15 years, overthrown by the Han Dynasty in 210 BC. During this time fragments of the Great Wall were fused into one continuous structure, and the underground mausoleum of the terra-cotta warriors was constructed near modern day Xi’an which was China’s capitol at that time.
In my mind, China was still a monolithic society under a Communist regime and TCM was available to the masses while western medicine was for the ruling class. Well that’s not exactly the case. Prior to 1949, there had been a widening chasm between those who had access to healthcare and most everyone else who didn’t. When the Party came to power, most workers were employed by the government and had access to healthcare. All through the Cold War era, the only major leader who never left his country was Mao. He was mainly concerned with unification of the country and building a strong infrastructure. Many lesser officials did interface with the West, and when they returned with different ideas, the Cultural Revolution (1966-1976) ensued.
We all know that intellectuals, including doctors, suffered. But Mao realized he needed some physicians to treat the population. He also realized that TCM needed to be standardized so it could be disseminated to as many doctors as possible. In this process, much of the practice of TCM was changed in China, but it continued as it had been practiced for 3,000 years in Japan. In 1980, with the end of the Cultural Revolution, two policies were instituted that have resulted in major changes in society:
- One child per family rule: There are certain exceptions to this rule. But, in general, if a family has more than one child they are fined, heavily. And, if the practice continues, a sterilization procedure results.
- Opening up China to western ideas and businesses: One of the first businesses allowed into China was health insurance. Hard to believe but true. What has resulted is a system resembling ours. Government employees and officials have government insurance, which is essentially free. They have access to everything necessary for their care, and it is funded by taxing the entire population. Non-governmental employees buy private health insurance which generally covers 70% of costs, leaving 30% out-of-pocket. These policies consume a good chunk of income, and are renewed for 25 years after which all costs are covered by Social Security and the government. Again these funds derive from taxes. Parents pay for healthcare of their children, and rural farmers who can’t afford insurance are eligible for something like Medicaid/MediCal with “bare-bones” coverage. This latter situation is also not free. Obviously, most young people prefer a government job. These are hard to come by unless you know someone, and contribute to his “Red Pack.” This is the local phrase for payola or bribe.
Does this sound familiar? I found no one who felt the system was fair. But I didn’t speak with a government official.
Meanwhile, my wife and I had a personal experience with TCM. Prior to our trip, Dee Dee fractured two metatarsals in her left foot. This was healing when we left. But, I’ve dubbed China as the country of stairs. Lots of walking and climbing. This time both feet and ankles were extremely painful and swollen when we boarded the Yangtze River cruise. Fortunately, there was a doctor on board who saw her the next day. Her treatment consisted of acupuncture, acupressure, placement of antifungal patches on the tops of her feet and cupping. Not what I learned in training. It was recommended that she soak her feet and legs up to mid-calf level each night in very warm to hot water for 20-30 minutes. The whole process lasted one hour and cost 550 yuan, equating to roughly 90 USD. She was much improved by the following morning. That afternoon, Dee Dee had a second treatment. Both treatments were very painful, especially when the needles were inserted. It turns out Chinese needles have a much larger bore than those used in the U.S.
We listened to a lecture on TCM given by the same doctor. TCM involves not only acupuncture, acupressure and cupping, but also herbal medicine, Qigong, and Tai chi. He discussed the use of TCM modalities in treatment of migraine and other headaches, motion sickness and back pain. Every morning, the same Dr. John Lee gave Tai chi lessons on board, which we both attended. The only excursion Dee Dee has missed was to the temples at Fengdu which involved over 500 stairs and inclined walkways.
Now for the big question: “Is there any role for TCM in the treatment of cancer?” He said that TCM is of little benefit in treating or preventing cancer, but may have some benefit as an adjunct to surgery or other conventional treatments. More on this when we reach Shanghai.