A two-part inquiry on how ancient philosophy and medicine come up against pollution and modernization in China.
Image taken by Flickr user Global Panorama
By Mary Wang
Part two of a two-part series.
Reading the newspaper in China sometimes makes me laugh because I think I am reading satire. A river in Kunming turned into milk after waste water leaked into its stream; the Huangpu river in Shanghai carried the carcasses of 16,000 dead pigs in its current; in Chinese kitchens, pork dubbed ‘Avatar meat’ glowed in the dark after the lights were turned off, while much of the food in Chinese restaurants was found to be cooked with sewer oil that was never supposed to see the light of day. Considering the tight rein of China’s censorship, for every story that makes it to the newspaper, it means that hundreds others go untold.
Yet, repressed dissatisfactions often find their way into jokes and puns, risk-free ways to vent restricted terms and outlawed criticism under the guise of a giggle. One common joke consists of a list of reasons why Bin Laden would never have been able to attack the country:
• Bin Laden tried to bomb a bus, but there were so many people that he didn’t manage to squeeze through the door.
• Bin Laden then tried to bomb Guangzhou, a large city known for its thieves, but as soon as he arrived, his bag with the bomb in it was stolen.
• He then tried to recruit child terrorists but they had drunk poisoned milk powder and were hospitalized for kidney stones.
• He finally successfully bombed a mine, causing many deaths, but he waited for years and still no news channel reported the incident.
• In the end, he decided to crash a plane into a skyscraper, but the pilot couldn’t see the building through the smog and missed his target.
It doesn’t require much imagination to describe the situation as apocalyptic, and indeed, much of what I saw on my last visit reminded me of the first few scenes from Interstellar. In the near future, where severe drought and crop blights threaten human survival, the whole earth has been turned to farmland to salvage whatever is still left. As sandstorms rage over the continent, we see farmers constantly sweeping their homes from dust, an impossible fight as the dust invades the house by wringing in from every little crack. But my family in China isn’t living in science fiction. It’s just living. And after having spent a day or two there, I started to realize that people are living as if the apocalypse has already passed, accepting that there is nothing they can do to get back what they lost. They lower their heads, put on masks, and carry on living. Anyone I would ask about the pollution would reply along the lines of, “Because we have too many people in China”, or a simple sigh followed by, “… China.”
Even though much has changed in the past few decades in Western views of medicine, there is still a firm belief that medicine is a science that can control nature.
Sitting inside for most of the day, I pondered the effect of pollution on the generations of my family who live there, who aren’t able to fly away from it like I can. It isn’t just the air that’s dirty, the water is toxic too: although Jinan is a city that is famed for its natural springs, and one of the anecdotes my father likes to recall is how, when he was growing up, he could just dig a hole in the ground and drink the water, nowadays, even purified water is treated with caution, and most people who can afford it have an office-style water dispenser at home. And it isn’t just the water, the earth is contaminated—a reflection of the severe levels of heavy-metal pollution in Chinese soil—, and the foods on supermarket shelves are tampered with more often than not. I wasn’t much worried about my grandparents: they had already lived most of their lives in a clean, unpolluted country. Instead, I was worried about my seven-year-old cousin, who, together with his parents, lived with my grandparents. I wondered what it’s been like for him, to grow up in a world where he can’t play outside, or even go outside without wearing a mouth mask. Or what it’s like to only be able to drink the milk powder his aunt brought back from Europe because the Chinese one might be poisoned. Or to live in a country with natural resources so polluted that owning a vegetable patch is a powerful status symbol. I suspect that the pollution in which my family lives is much more pervasive than what windows can shut out, a dust that has wrung itself into every crack of daily life.
The lineage of pollution in China is linked to China’s changing understanding of the body. It is difficult to isolate thinking about Chinese society without thinking of its medicine—Chinese medicine has been practiced in China for the past 3,000 years, and is institutionalized in such a way that it is provided for in hospitals and taught in universities. Fundamental concepts in Chinese medicine are linked and shaped by Taoist and Confucian beliefs, and its way of viewing the body as interconnected with nature adheres to the Confucian ideal of harmony of parts within a larger whole. Chinese medicine is often labeled ‘natural’ in the West, and even though it’s hard to consider any complex medical system as ‘natural’, what best qualifies Chinese medicine for this label isn’t just the use of herbal treatments, but also its understanding that the human body is one with the nature that surrounds it. In this case, the body cannot be healthy if nature is out of balance, and diagnosing the troubles of the world can start by assessing the ills of the body. Western medicine, on the other hand, takes a rationalist, compartmentalized view of the body. Chemical components and technological machinery is used to treat specific parts of the body, and even though much has changed in the past few decades in Western views of medicine, there is still a firm belief that medicine is a science that can control nature.
I visited the department of Chinese medicine at Qilu hospital (affiliated with Shandong University) in the hopes of better understanding the impact of pollution. The hospital is the best in the region, yet, at the same time, it is also messy, loud and smelly. The penetrating smell of dirt, ammonia and bleach wafted out as I walked into the hospital lobby. Sick people slouched down in the plastic canteen chairs that lined the corridors, and those who didn’t fit squatted on the floor instead. It was hard to make myself understood without raising my voice, as the enormous hall echoed the sound of people shouting and advertisements playing on TV screens along with health-related programs, and the groups of people sitting on the floor waiting didn’t provide enough acoustic insulation for the stone floors and concrete walls. The assistant who led me to the office of the department’s head, Doctor Liu, said of her experience of visiting American hospitals in the summer, “Compared to here, American hospitals looked like hotel lobbies.”
Doctor Liu’s office was small and crammed; a room the size of a big bathroom in which most of the floor space was occupied by furniture. He had been at this institution for a long time, moving up from student to practicing doctor to the head of the Chinese medicine department in the hospital and university. When I asked him why his office was so small, he explained that the department had shrunk, and that some of their rooms had been taken over by the Ear, Nose and Throat department. My dad, who had once worked at the same hospital, told me later that the fastest growing department in the hospital was actually pediatrics, because, as the pollution worsened, more and more children were now born prematurely or with defects.
The Doctor acknowledged that if nature was out of balance, the body must be out of balance too, but he also made sure to add that the body also has the ability to adapt. “Lose a kidney, and the person can still live. Cut away three-quarters of a liver, and the person can still live. We have lived in this pollution for a while now, and we can still live.”
Yet, he noted a rise of certain diseases, even in his own department. More often than before, he saw people coming in with lung cancer, stomach cancer, or tumors. “Often, people only come to see the Chinese doctor when they’ve tried everything else already.”
Signs leading to his office said ‘Department of Traditional Chinese Medicine and Western Medicine’. I found it odd because, if I wanted Western medicine, surely I could go to any other department in this hospital that was not here?
Most Chinese hospitals have their own Chinese medicine department, and patients can choose for themselves which department to visit. But now, according to Doctor Liu, most of the Chinese medicine in China is combined with Western medicine, even in specialist universities. Doctor Liu’s career reflects this shifting current. Despite his early interest in Chinese medicine, the Doctor chose Western medicine in undergrad because he was good at math, chemistry and physics. Yet, his interest in Chinese medicine didn’t fade, and he found himself in the university’s library reading classic textbooks of Chinese medicine. So he pursued a graduate degree that combined Chinese and Western medicine, and specialized wholly in Chinese medicine during his doctoral years.
It is customary in China for Western medical education to contain some classes on Chinese medicine, and the other way around. However, the taught material of Chinese medicine was too elementary for the Western medicine doctors to have any useful understanding of the practice, and over the past several years, the number of teaching hours has already been decreased from eighty to thirty. As a result, it isn’t exactly a priority for students, who, according to Doctor Liu, usually just cram the material the day before an exam.
According to the Confucian ethos, doctors were supposed to treat everyone, no matter what, and in the past, Chinese doctors primarily survived through donations of wealthier patients.
The invasion of Chinese medicine by Western influences has been a cause for growing concern for the Doctor and his colleagues. There isn’t a clear definition of what it means to combine Chinese and Western medicine, and many question whether this fusion can endure. The status of Chinese medicine has been threatened by the Western discipline before. In the late 19th century, as Jesuit missionaries built hospitals in China, Western medicine became more popular while Chinese medicine was increasingly put away as an archaic superstition. After a period of disappearance, the Communist government reinstated Chinese medicine in the 1950’s as part of their nationalistic project. The Communists invented Chinese medicine in its modern form, now dubbed ‘TCM’ (Traditional Chinese Medicine), in their pursuit of creating a truly Chinese science. To ease its fusion with Western medicine, spiritual elements were silenced and the discipline was reformed into one that was more strictly physical. At the same time, schools and clinics were built across the country to support the new discipline, while the relative cheapness and effectiveness of Chinese medicine, which needed less resources and materials than its Western counterpart, encouraged the government to send ‘barefoot doctors’ to the countryside to provide widespread healthcare.
But as capitalism took over in the 1970’s, Chinese medicine’s position changed again. “The development of Western medicine is faster, there is more government support, but mostly, it just makes more money,” explained the Doctor. “The financial gain is too strong, and the technological development too fast. To survive, Chinese doctors have to lean into Western medicine.”
Contrary to many Western countries, the salaries of doctors in China are relatively low, in both Western and Chinese medicine, so most Western doctors supplement their income with anything from bonuses for achieving performance quotas to receiving bribes from patients to ensure preferential treatment. The same economic reforms that opened up China to capitalism also pushed out the country’s national health care system, and as public funding declined, hospitals started to act like unregulated private enterprises, despite still being formally owned by the state. In a small bid to ensure medical access for all, the government limited the salaries of doctors, which led to the unfortunate result of hospitals and doctors now relying on the use of expensive lab tests and medical equipment, mostly prescribed by Western doctors, to make money. Chinese medicine, on the other hand, doesn’t need anything else but the doctor’s senses and experience to come to a diagnosis, and it can achieve, for many non-urgent diseases, the same effects as Western medicine without complicated machinery or expensive medication. Even though national health insurance was reintroduced in 2008, these dynamics were already ingrained in the system, leading to an immense wage gap between Western and Chinese doctors. Or in other words, Chinese medicine has become a bit too cheap, too effective.
The other side of the problem is that there simply aren’t that many good Chinese doctors anymore.
“We used to say that we only accepted the best students to manage the lives of others. When I studied, the admitted students were the best of their schools. Now, only the second-best students study medicine. The best ones, they go into finance. And then, it is only the ones that aren’t good enough to study Western medicine who continue studying Chinese medicine.” According to Doctor Liu, the real practitioner of Chinese medicine isn’t even supposed to ask for money for treating patients.
According to the Confucian ethos, doctors were supposed to treat everyone, no matter what, and in the past, Chinese doctors primarily survived through donations of wealthier patients.
“But nowadays, if it doesn’t make good money, good students won’t pursue it,” said Doctor Liu.
“But what can you do?” he continued.
“What can you do?” I asked in reply.
“We have to accept the development of Western medicine. The question is really how to create doctors that can harmonize the East and the West.”
“So how do you do that?”
“Well, some Chinese doctors have started to prescribe aspirin as a fever-reducer, for example.”
The hospital felt like a place that was rushing to catch up with a new reality. Most organizations in China live in a reality in which quotas and performance plans seep through from the top layer onto the next office cube onto the next one, and this is especially true for hospitals. Doctors are often overworked, and pressured to perform according to monthly quotas. On the day of my visit, next to Doctor Liu’s office was a line of about fifteen people waiting to see a senior Chinese doctor, who methodically took their pulses and checked their tongues as if leafing through yesterday’s newspaper. The whole set-up felt more like the ER to me than the Chinese medicine department, where doctors were only dealing with the medical emergencies that were coming at them in the immediate present.
The room next to this doctor was dedicated to the reformulation of Chinese herbal medicine. Where, usually, a mix of herbs and roots would be brewed into a soup, here, the Doctor showed me their experiments in processing the herbs into new forms. Crushed herbs were shaped into convenient little tablets, or presented as sachets of powder, and there was something that looked like a pack of soy sauce that came with take-out sushi. He was most proud of what looked like a star-shaped chocolate, in which herbal medicine was literally sugar-coated. “We have to find new ways to make people take their medicine,” he said. “No one has time to brew the soups anymore.”
Not every generation in my family views the changes in their lived environment in the same way. My grandpa became an orphan when he was ten, started working in the mines at fourteen, joined the army at seventeen, and is from the dirt-poor peasant class that Mao Zedong lifted out of poverty. During that period, food and daily items weren’t bought but rationed by the government. Stamps for anything from bread to soap were handed out to each family, and being able to get your hands on food stamps for eggs was a luxury most families could only enjoy on a monthly basis. And so my grandpa has never been so content, now that he’s able to eat meat and eggs every day. The guarantee of food on the table every day is already such a challenge to his imagination that he doesn’t dare plan beyond the next mealtime. He can’t wrap his head around the idea that the beautiful food in the supermarkets could be poisonous. He is so particular about his food that he routinely retrieves from the garbage the expired food my aunt throws away.
“The only expiration date I know,” he says, “is that on a food stamp.”
My cousin was born in 2008, a year in which only one percent of the country’s urban population still lived in cities with an acceptable standard of air quality. When I asked him whether he knows what pollution is, all he could answer was “the level of 2.5 micrometer particulate matter measured at the monitoring station”. He sometimes speaks in a way that sounds unnatural for a child, as if he is literally copying and pasting a sentence from an adult conversation. I’ve always suspected that it’s because he isn’t around children much outside class. Like everyone from his generation, he’s an only child, and like the other local children, he isn’t allowed to play and run around outside because the streets are too filthy and dangerous. He has never known the cornfields that covered my grandparents’ neighborhood a few decades ago or what a fresh breeze feels like. For him, the level particulate matter is a condition so self-evident that it has become abstract.
From its origins, the cosmology of Chinese medicine served more as a way to present a grand, unified theory of the world rather than as a workable guide that could be strictly applied in pragmatic situations.
Neither the oldest nor the youngest seem to notice the pollution much—the oldest ones have seen too much to care, while the youngest have never seen anything else. Instead, it is the adults who are failing to adapt. They’re constantly checking the Air Quality Index on their phones or discussing the latest model of air purifier, because they’re the ones who can see how different the upbringing of their offspring is from their own. At the same time, my aunt and uncle are too busy working, running anything from a bun shop to a children’s daycare, and like many other middle-class Chinese, can only afford to live day by day.
The embracing of change in Chinese medicine is as old as the tradition itself. From its origins, the cosmology of Chinese medicine served more as a way to present a grand, unified theory of the world rather than as a workable guide that could be strictly applied in pragmatic situations. As a result, what was written in theory wasn’t always what doctors practiced.
Currently, the Doctor and many of his peers are working on a new theory in Chinese medicine called 血浊 (xue zhuo) that is gathering a lot of steam from the profession and the government. The theory, which literally translates into ‘blood turbidity’, believes that by tracing minute changes in a body’s condition, often before they are even visible, Chinese doctors can catch diseases before they have materialized. Most of this theory has been developed following the emergence of contemporary diseases that haven’t been dealt with as much in Chinese medicine before, like diabetes, in which case the doctors would look out for a dry mouth, weight gain, and high blood sugar. As Doctor Liu put it, “Blood is seen as naturally clear, but when pollutants enter and change the metabolic processes of the body, the blood will turn cloudy and turbid.”
In this process, both traditional methods of diagnosing as well as early-stage laboratory testing are used. But despite the influence of Western medicine, Doctor Liu, whose department has won several national awards for its work in this field, still holds on to a core value of Chinese medicine: Chinese medicine aims to prevent disease, while Western medicine aims to cure it.
“Tumors don’t occur suddenly,” the Doctor explained. “In Chinese medicine, we try to see the root of the disease as soon as the patient is only slightly unwell. Perhaps, if the right medicine is prescribed, the cancer won’t come anymore.”
In 2015, Youyou Tu, a Chinese scientist who has studied both Western and Chinese medicine, won the Nobel Prize for her development of a malaria cure based on ingredients in Chinese herbal medicine. Even though the drug in question, artemisinin, has been in common use in parts of Africa for years, it wasn’t until recently that Tu’s identity was revealed. Tu developed the medicine within a secret program set up by Mao Zedong to reduce the instances of malaria amongst troops fighting the US in Vietnam. “This Nobel Prize win proves that East and West can be combined,” said Doctor Liu.
The government has now picked up on the research on blood turbidity, and has started to increase its funding for Chinese medicine in general, setting up many new specialist Chinese medicine clinics across the country. Doctor Liu believes this government funding will be essential. “Our country’s health system can’t just rely on Western Medicine. There are too many people, too many farmers, and the system cannot take care of all of them.”
He predicted that Chinese medicine will be a welcome relief in the future. Hinting at the return of Mao’s ‘barefoot doctors’, Doctor Liu believes that Chinese medicine will be able to provide cheap and efficient healthcare for the country’s still growing rural population, as that is the population most likely to be overlooked.
At the dinner table, during my visit, each member of my family was doing something else. My grandparents were focused on eating their dinner. My grandpa still has the habit of finishing his food as quickly as possible. “You never know who might steal your next bite,” he says.
My cousin ate in front of the television, the viewing machine that has taken the place of the window, not that you can see anything through the window anyway. His parents never try to take him away from the TV, because they know there isn’t anywhere else for him to play.
My uncle was talking to no one in particular about some other scandal he had read about in the newspaper.
The windows were closed to shut out the dust, though the dense fog outside made it seem as if there were no windows at all. Whether they were adapting or not, for now, the generations of my family were living by staying huddled inside together.
Mary Wang is a Chinese-Dutch writer who recently received her MFA in non-fiction from Columbia University. Her pseudonym is Dr. Wang, with which she investigates the spread of Chinese medicine across the world as a bemused medical layman. The project’s findings will be distilled in bookform, and some of the fingers are currently set in a podcast called ‘Ask Dr Wang’, which can be found on www.radiusstation.org/askdrwang.