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ARTICLE IN PRESS
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Social Science & Medicine 61 (2005) 1045–1058
www.elsevier.com/locate/socscimed
Decolonization and the movement for institutionalization ofChinese medicine in Hong Kong: a political process perspective
Stephen W.K. Chiu, Lisanne S.F. Ko, Rance P.L. Lee�
Department of Sociology, The Chinese University of Hong Kong, Shatin, Hong Kong
Available online 17 February 2005
Abstract
This paper focuses on the question of why the social and political acceptance of Chinese medicine has grown in the
former British colony of Hong Kong since the late 1980s. To supplement the conventional explanations for the
institutionalization of alternative medicines, we propose a political process perspective that highlights the effects of
political changes amidst the decolonization process in Hong Kong. During the late 1980s and early 1990s, the
weakening of the political position of the established elite, the opening up of political space for previously excluded
groups, and the competition for support among the new political elite, all stimulated the indigenous Chinese medicine
organizations to mobilize for the institutionalization of Chinese medicine. By the mid-1990s academics from leading
tertiary institutions began to take over the leadership of the movement and in doing so carried it to a higher level. In the
conclusion, we briefly consider the implications of this movement for the future development of alternative medicine in
Hong Kong and other societies.
r 2005 Elsevier Ltd. All rights reserved.
Keywords: Alternative medicine; Traditional medicine; Political process; Hong Kong
Introduction
Since the 19th century, biomedicine has developed
rapidly to replace indigenous medicines as the dominant
medical system in most parts of the world. In the last few
decades, however, indigenous medicines have been
making a comeback. A similar process of rising social
and political acceptance has also been observed in Hong
Kong. While biomedicine—or ‘‘western medicine’’ as it
is called in Hong Kong and other Chinese societies—has
long been the orthodoxy, Chinese medicine has gained
much official recognition, and Chinese medicine practi-
tioners have become more professionalized and socially
accepted since the late 1980s. Following Lee (2000a), we
call this a process of institutionalization. In this paper,
e front matter r 2005 Elsevier Ltd. All rights reserve
cscimed.2004.12.026
ing author.
ess: [email protected] (R.P.L. Lee).
we focus on the growing acceptance of Chinese medicine
by the social and political establishment as a central
feature of the process of institutionalization. Our
research question is: Why and how did this apparent
institutionalization happen? Borrowing insights from
theories of social movements, we shall focus on how the
interplay between the political process and the mobiliza-
tion by Chinese medicine organizations brought about
the institutionalization of Chinese medicine in the
mainstream medical system.
The marginalization and institutionalization of Chinese
medicine in colonial Hong Kong
While studies of indigenous or traditional medical
systems commonly observe that these systems coexist
d.
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–10581046
with modern medicine in most developing countries (see
Chi (1994), Leslie (1976), and Quah (1989, 2003), for
Asian cases; Good (1987), and Senah (1995), for the
African experiences), studies on European and North
American societies have reported a steady or rising level
of receptivity to alternative medicines (Eisenberg et al.,
1998; MacLennan, Wilson, & Taylor, 1996; Fulder,
1988). Governments have been relatively slow to
respond to this growing popularity of alternative
medicines but there has been some progress in incorpor-
ating them into the mainstream (Eisenberg et al., 1998;
Goldstein, 2000, 2002; Nahin & Straus, 2001).
Against this background of the widespread ascen-
dancy of alternative medicines in advanced societies, the
revival of Chinese medicine in Hong Kong becomes
more interesting. While Hong Kong has shared with
many developing countries the existence of medical
pluralism (Lee, 1980; Leslie, 1980), the institutionaliza-
tion of Chinese medicine has come at a very high level of
development. Does Hong Kong represent simply a local
manifestation of this global trend? Is the institutionali-
zation of Chinese medicine in Hong Kong a result of the
same set of factors as in other advanced societies? To
better understand the case of Hong Kong, we must first
review the history of the local medical system.
During the interwar period the colonial government
began to play a more active role by establishing the first
medical school in the local university and the first
teaching hospital (Lee, 2000b; Li, 1974; Choa, 2000).
Health- and medicine-related ordinances such as the
Medical Registration Ordinance, Pharmacy Ordinance,
Midwives Ordinance and Nursing Ordinance were also
enacted (Choa, 2000). These educational and legal
changes led to the creation of a formal medical system
based solely on biomedicine.
Post-War developments further reinforced the dom-
inance of biomedicine and the activities of its practi-
tioners. First, the Hong Kong Medical Council was set
up in 1957 as a statutory body by the Medical
Registration Ordinance (Federation of Medical Societies
of Hong Kong, 1989). Second, the Department of
Medical and Health Services was established in 1952 to
provide a full range of medical and health facilities for
the community at large (Li, 1974). Third, the govern-
ment assumed more responsibility for health service
provision from the 1960s, including the promulgation of
two comprehensive health plans in the 1960s and 1970s,
the establishment of several new hospitals, and the
founding of the second medical school in the territory in
the early 1980s (Gauld, 1998).
Compared with western medicine, Chinese medicine
was much more marginal in the overall medical system
even though there was a long history of its use and
practice in Hong Kong (Tse, 1998; Topley, 1975). As
Koo (1998) summarized the situation, ‘‘no registry of
Chinese doctors was established; no formally recognised
Chinese medical school was built; no control over the
quality of care or qualifications of practising doctors
was given to the profession; no Chinese medical services
were offered in any of the government hospitals and
clinics; and little research on Chinese medicine was
conducted’’ (p. 682). All issues and problems involving
the use of Chinese medicine came under the control and
responsibility of the Secretariat for Home (formerly
‘‘Chinese’’) Affairs (Topley, 1975). The colonial policy
of non-interference and non-support for Chinese med-
icine was justified on the ground that it was part of the
indigenous customs and should therefore best be left
alone (Lee, 1980).
The ‘‘revival’’ of Chinese medicine in late colonial
Hong Kong is marked by policy and institutional
changes (refer to Table 1 for a chronology of events).
Most importantly, Chinese medicine has been given a
much more prominent place in major policies for
medical development. In preparation for the return of
Hong Kong to Chinese sovereignty in 1997, the Basic
Law (mini-constitution) of the post-colonial Hong Kong
Special Administrative Region (HKSAR) was approved
in 1990. Its Article 138 stipulates: ‘‘The Government of
the Hong Kong Special Administrative Region shall, on
its own, formulate policies to develop western and
Chinese medicine and to improve medical and health
services. Community organizations and individuals may
provide various medical and health services in accor-
dance with law.’’ The Chief Executive’s Policy Addresses
in 1997 and 1998 mentioned Chinese medicine, the first
time that it figured prominently in local policy state-
ments. Moreover, the Health and Welfare Bureau
included Chinese medicine in its year 2000 consultation
document on local medical development (Health and
Welfare Bureau, 2000). The Hospital Authority then
promulgated in 2001 guidelines on clinical research on
Chinese medicine and indicated that it would support
the development of Chinese medicine services in public
hospitals (Hospital Authority, 2001). With respect to
economic policy-making, the Trade and Industry
Department announced its 10-year Plan for the devel-
opment of a Chinese medicine-based industry in 1999
(Trade and Industry Department, 1999). The Innovation
and Technology Commission was also established under
the Trade and Industry Department to support, among
other projects, those in the area of Chinese medicine-
related research and development.
Changes have also been observed in the policy-
making process. The Working Party on Chinese
Medicine and the Preparatory Committee on Chinese
Medicine, for example, were established in 1989 and
1995, respectively, to review the practice and use of
Chinese medicine in Hong Kong and to prepare the
groundwork for the coming statutory body for Chinese
medicine. In addition, political parties and politicians
have expressed their views about the development of
ARTICLE IN PRESS
Table 1
Milestones in the development of Chinese medicine in Hong Kong
Date Event
Between November 1988
and January 1989
Deletion and re-instatement of an article about Chinese medicine in the Basic Law
February 1989 Poisoning incident due to the misuse of toxic podophyllum emodi, thought to be non-toxic gentiana
scabra (Lung Dam Cho), triggering subsequent regulatory actions
August 1989 Working Party on Chinese Medicine (WPCM) is formed by the government, the first public review of
Chinese medicine in Hong Kong
Autumn 1991 School of Professional and Continuing Education, The University of Hong Kong provide courses for
Chinese medicine practitioners
April 1995 The Preparatory Committee on Chinese Medicine (PCCM) is appointed by the Secretary for Health
and Welfare to formulate regulatory plans on Chinese medicine
October 1997 The Chief Executive of the newly established Hong Kong Special Administrative Region announces in
his first policy address the government’s commitment to developing Chinese medicine
November–December
1997
Consultative Document in the Development of Chinese medicine in the HKSAR was published
September 1998 Hong Kong Baptist University recruits the first batch of full-time undergraduate students for Chinese
medicine programme
July 1999 Chinese Medicine Ordinance is finally passed by the LegCo
September 1999 On the recommendation of PCCM, the Chinese Medicine Council is made responsible for
implementing regulatory measures for Chinese medicine
September 1999 The School of Chinese Medicine established at The Chinese University of Hong Kong in 1998 begins
admitting students
November 2002 The list of the first batch of 2384 registered Chinese medicine practitioners under the Chinese Medicine
Ordinance is confirmed
May 2003 Chinese medicine traders are invited to submit their application for licenses
Source: Archival materials and news reports.
S.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–1058 1047
Chinese medicine from time to time. The topic of
Chinese medicine has been raised as an agenda item in
more than 20 Legislative Council (LegCo) meetings
during the past decade.
Various social institutions have been transformed to
accommodate the development of Chinese medicine. In
the education sphere, new academic programs and
research centers focusing on Chinese medicine have
been initiated in local universities. Three out of the eight
local universities currently offer full-time bachelor
degree programs in Chinese medicine. More than half
of the local universities have set up related research
centers as well. Changes are also under way in the legal
system. In accordance with the stipulation of the
Chinese Medicine Ordinance in 1999, the legal and
institutional framework for regulating the practice, use,
trade and manufacture of Chinese medicine were
finalized. The first batch of registered Chinese medical
practitioners was confirmed in 2002 and the registration
assessment for eligible Chinese medical practitioners was
completed in early 2003. Chinese medicine traders were
also invited to submit their application for licenses later
that year. There are changes within the government
structures too. The founding of the Chinese Medicine
Council in 1999 under the Chinese Medicine Ordinance
is also part of the institutional changes for the further
development of Chinese medicine in Hong Kong.
Furthermore, a Chinese Medicine Section was set up
in the Government Laboratory in 1998. A new division,
the Chinese Medicine Division and a new post of
Assistant Director of Health (Traditional Chinese
Medicine) were also created in the Department of
Health in the same year. We can conclude that although
by no means challenging the dominance of bio-
medicine, Chinese medicine has received a rising level
of political support and public acceptance and experi-
enced increasing institutionalization as a form of
alternative therapies.
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–10581048
Explaining the institutional revival of alternative
medicines
Goldstein (2000) has described the several dimensions
of the growing acceptance of alternative medicines in the
United States. The most obvious dimension is certainly
growing utilization in the society. The second one is at
the ideological level, including the acceptance of the
term ‘‘alternative medicine’’ by conventional practi-
tioners and the recognition of the right and freedom of
individuals to choose different forms of healing prac-
tices. A third aspect is the ‘‘political acceptance’’ or
recognition ‘‘by the government and other quasi-official
bodies through laws, licensure, and regulations’’ (p.
289). This political process is important because it
‘‘frequently lead[s] to even greater levels of general
acceptability for CAM [complementary and alternative
medicine] because of how they are interpreted by the
public, or because of legal requirements that demand a
certain degree of societal acceptance of legally sanc-
tioned activities’’ (p. 289). In this paper, we focus on this
last dimension although we will also touch upon the
issue of its utilization and cultural conceptions.
The literature on alternative medicines and their
revival is voluminous, but the focus in most cases is
not on the causes of the revival but more on describing
the revival and the implications for the contours of the
medical system (for examples see Goldstein, 2000, 2002;
Lock, 1990; Sheehan & Brenton, 2002). In the limited
number of studies concerned with explaining the current
resurgence of alternative medicines, four distinct analy-
tical perspectives can be identified: cultural legacies,
functional and practical need, structural power relations
between various parties, and an alternative postmodern
ideology.
In the cultural legacies perspective, how people handle
their health problems is basically conditioned by their
own cultural contexts. Efforts to maintain health and to
cure illness are supposed to resonate with certain
cultural premises and vary substantially from one
cultural/ethnic group to another (Chen, 1981; Chi,
1994; Leslie, 1976; Nyamwaya, 1987). Li (1998), for
example, observes that among Chinese, the utilization of
a plurality of treatments from both Chinese and western
medicine is consistent with the cultural legacy of
harmony and equilibrium in the natural world. The
weakened position of traditional medicine in Taiwan is
said to be related to the decline of Confucianism as a
dominant societal ideology (Chi, 1994). A similar
argument has also been developed to account for the
rise of alternative therapies in the advanced societies.
Rising migration flows to these societies result in the
formation of ethnic communities. New migrants to these
communities are claimed to bring their cultural customs,
including preference for using alternative medicines,
from their country of origin (Kaptchuk & Eisenberg,
2001). In the case of Hong Kong, for example, the inflow
of new migrants from Mainland China might have
stimulated the social acceptance of Chinese medicine, as
migration has indeed accelerated since the 1990s.
The second type of argument is that the revival is
based on pragmatism and functional necessity. As long
as indigenous medicine provides people with pragmatic
solutions to health problems, it is almost guaranteed to
survive and accepted by the social and political main-
stream. Quah (1989) calls this the ‘‘triumph of practi-
cality.’’ Receptivity to alternative medicines will grow if
the dominant medical tradition no longer meets the
needs of people. Studies therefore have reported how
people have become more aware of the limitations of
biomedicine, dissatisfied with it and find alternative and
indigenous medicines an attractive option (Fulder, 1986;
Kaptchuk & Eisenberg, 2001; Lee, 1980).
The third type of argument is that the revival of
alternative medicines is a result of new consumer choices
spurred by a new ideology or set of beliefs. In other
words, the resurgence is viewed as a product of ‘‘cultural
revolt’’ (Goldner, 1998; Lupton, 1997). The new
ideology on health emphasizes, among other things, a
holistic understanding of health and illness and indivi-
dual choices and responsibility for health care decisions
(Goldstein, 2000; Kelner & Wellman, 1997). This new
ideology can be traced to the post-materialist or post-
modern values found in many advanced societies and
the transformations of the lay public from passive
patients into knowledgeable consumers of health care
services (Cant & Sharma, 1999; Inglehart, 1990).
A common feature of these approaches to Chinese
medicine is that they are more ready to answer the
question about utilization than institutionalization per
se. The structural arguments attempted to address this
issue more directly and were initially proposed to
account for the hierarchical relations between biomedi-
cine and indigenous medicines in many non-West
countries. The argument is that biomedicine was made
to be structurally superior to indigenous medicines
primarily as a manifestation of the political–economic–-
cultural hegemony through colonization and professio-
nalization (Elling, 1981; Saks, 2001; Unschuld, 1975).
Cho (2000) analyzes the relationship between the
traditional and biomedicine professions from a structur-
al perspective that emphasizes the institutional bases of
interest and power conflicts. Lee (1982) also argues that
this hierarchical health pluralism could be understood in
terms of the concepts of ‘‘functional strength’’ and
‘‘structural superiority’’. Western medicine enjoyed a
superior position through institutional means, while
Chinese medicine still prevailed because of its practical
value. This created an inconsistency between functional
strength and the structural inferiority of Chinese
medicines in Hong Kong that prompted pressures
towards greater harmonization of the two aspects. Lee
ARTICLE IN PRESS
Table 2
Percentages and rates of persons having consulted a medical practitioner by types of practitioners between 1982 and 2001a
Time points Type of practitionerb
Chinese medicine Western medicine
% c Rate d % c Rate d
1982, May–July — 7 — 77
1982, November–1983, January — 8 — 86
1983, July–September — 7 — 80
1989, January 6.7 9 93.3 122
1990, July 6.1 6 93.9 86
1992, August–September 6.3 7 93.7 97
1996, May–June 7.5 11 92.5 138
1999, September–November 19.9 28 86.5 122
2001, January–May 16.9 27 89.0 143
Sources: Census and Statistics Department (1983, p. 16, table 5), Census and Statistics Department (1992, p. 54, table D1c), Census and
Statistics Department (1996, p. 71, table 5.4d), Census and Statistics Department (2000, p. 41, table 4.3a), and Census and Statistics
Department (2002, p. 41, table 4.3a).aIn 1982 and 1983, the analysis was based on the consultations during the past 7 days before enumeration. In other years, it was
based on the past 14 days before enumeration.bIn 1982 and 1983, it is the type of the first three doctors consulted during the previous 7 days. In 1989, 1990, 1992 and 1996, it is the
type of the last three doctors consulted during the previous 14 days. In 1999 and 2001, the types of all the doctors consulted are
analyzed. Since it is unlikely that people will consult more than three different types of doctors during a 14-day period, the changes in
definition should not affect the comparability of the results.cThe percentages for the years 1999 and 2001 do not sum to 100 as a person might consult both types of doctors.dThe rate in all years is per 1000 persons in the respective enquiry periods.
S.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–1058 1049
(1982) further postulates that the structural disadvan-
tage of Chinese medicine in Hong Kong could be
mitigated as Chinese medicine underwent modernization
and professionalization.
1Some people consulted both Chinese medicine practitioners
and western medicine practitioners . In the 2001 survey, 5.8%
of all those who had consulted a doctor reported to have
consulted both types of doctors. Discounting this 5.8%, the rate
of consulting a Chinese medicine practitioner was 17.7 per
thousand persons, still substantially higher than the pre-1999
figures.
Towards a political process approach
Space limitation does not allow a detailed evaluation
of these arguments. Suffice to say is that while the
existing arguments usefully highlight certain facets of
the increasing popularity of Chinese medicine or
alternative medicine in general, they are at best
incomplete in accounting for the institutionalization
process. Our question here centres on the incorporation
of Chinese medicine into the institutional mainstream of
the society and the conferral of a legally and politically
sanctioned status. A key assumption in the existing
arguments is that increasing utilization would lead to
political acceptance. Yet this argument rests on two
problematic premises. First, it is doubtful whether
utilization had risen prior to the institutionalization.
As reported in Table 2, successive official surveys show
that the percentage of people consulting a Chinese
medicinal practitioner or using Chinese medicines and
herbs has remained largely constant in the two decades
prior to the late 1990s. Between 6% and 11% of the
population had consulted with a herbalist, bonesetter,
and acupuncturist or used Chinese herbs or medicines
from 1982 to 1996. These findings are confirmed by
many other territory-wide surveys (see the review in Lee,
2000b). Only since 1999 and after the apparent
momentum for institutionalization, has the utilization
rate (per 1000 persons) increased significantly.1
Second, the linkage between utilization and institu-
tionalization is never direct, for it is mediated by a
political process. For a government to change its policy
there has to be a political motivation. This study
therefore proposes to incorporate the insights of the
existing approaches into a political process model,
drawn from social movement studies, since we believe
this model can offer a dynamic account of the political
acceptance and institutional revival of Chinese medicine
in Hong Kong. In this paper, we treat the political
acceptance of Chinese medicine as the result of a social
ARTICLE IN PRESS
2Our analysis is broadly consistent with her observations but
our political process approach puts more emphasis on the
mobilization for collective action among stakeholders and their
interaction with the state. Furthermore, we also have a broader
view on the relevant stakeholders to include academics at the
higher education institutions.3See Ko (2002, Appendix 2) for the profiles of the informants.
S.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–10581050
movement waged by Chinese medicine practitioners and
other stakeholders over the 1990s.
Already a voluminous literature has been generated
from this perspective (cf. Klandermans, 2001; McAdam,
1999; McAdam, McCarthy, & Zald, 1996; Jenkins &
Klandermans, 1995), but the most important concept in
the political process approach is the ‘‘political opportu-
nity structures:’’ ‘‘consistent—but not necessarily formal
or permanent—dimensions of the political environment
that provide incentives for collective action by affecting
people’s expectations for success or failure’’ (Tarrow,
1998, p. 74). Jenkins and Klandermans (1995, p. 4),
among others, suggest that the organization of the state,
the system of political representation, and the cohesion
and alignments among political elites are important
components of the political opportunities structure that
shape the emergence and development movements.
Provided that the political structures are vulnerable,
action protest initiated and formed under a common
perceived threat by those indigenous organizations
(usually the aggravated groups) may produce an impact.
Applications of the approach to the study of social
movements in the context of decolonization and
democratization in Hong Kong can be found in Lui
and Chiu (2000).
Several important insights follow from this model.
The first is that the social movement to achieve the
institutionalization of Chinese medicine is largely con-
ditioned by the broader political context. The mutable
political opportunity structures act as triggers for all
collective actions. Second, a social movement exempli-
fies a continuous dynamism. How insurgent groups
make use of major political transformations, change
their structural power relationships with other social
groups, and advance their interests are the basis of these
dynamics. During this process, several factors are of
importance to sustaining a social movement. Organiza-
tions are needed, for example, to initiate the first
collective action, while more robust organizations are
in a better position to mobilize resources and mount
more actions to maintain a movement. Moreover, the
role played by various social groups in the develop-
ment of a movement is not fixed but mutable. A transfer
of leadership roles from one group to another with
greater organizational strength is also possible. The
various stakeholders have also forged shifting alliances
among each other. In this case, the political process
model also directed our attention to the increasing
support by the established elite for the movement
to institutionalize Chinese medicine, just as Jenkins
and Eckert (1986) discuss the effect of ‘‘elite patronage’’
on the rise of a black social movement in the United
States. Finally, the political process model is also
appropriate for the study of the constitution of the
medical system because as Mechanic and Rochefort
(1996) point out, ‘‘politics and government deserve
special consideration as variables influencing the orga-
nization of national medical care system.’’ Similarly, Ho
(2002) highlights changes in the agenda-setting process
in regulating Chinese medicine as a result of democra-
tization and decolonization.2 By highlighting the inter-
actions among various societal actors and the state, the
political process approach recognizes that in all modern
societies the state is instrumental in providing or
regulating medical services. In a sense we are not writing
off the existing explanations to the revival of alternative
medicines but seeking to set them against the context of
broader changes in political opportunities and the
process of collective mobilization by the various
stakeholders.
Like most other researchers of social movements, we
have used qualitative methods in our data collection and
analysis. For this project, we collected over 1500 news
reports on the development of Chinese medicine in
Hong Kong since the 1970s and consulted a large
number of publications by Chinese medicine organiza-
tions gathered from organizations, individuals and local
libraries. To obtain in-depth information on the Chinese
medicine movement, we conducted 17 intensive inter-
views (averaging 2 h in length) of key informants who
were involved in the movement, including Chinese
medicine practitioners, biomedical doctors and univer-
sity professors involved in the promotion of Chinese
medicine.3
Decolonization and the changing political opportunity
structure in Hong Kong
The British government pursued the agenda of
political reform and a ‘‘graceful’’ retreat. Since the late
1980s, on the other hand, the Chinese government had
made it clear that the existing colonial political structure
would be preserved to a certain extent and full
democracy would not be achieved overnight after the
handover. The China government proposed the concept
of ‘‘one country, two systems’’ with the idea of making
Hong Kong a Special Administrative Region under the
sovereignty of China with limited democracy to counter
the colonial government’s attempt to create a political
fait accompli. It is in this situation of transitions and
constant flux that actors supporting the promotion of
Chinese medicine found the political opportunities to
propel it to the medical mainstream.
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–1058 1051
The changing political opportunity structures for Chinese
medicine
In spite of the limited democratization, however,
decolonization opened up opportunities for political
access for those previously excluded from the established
structures. New political structures had to be designed
and new political elites had to be recruited. Pro-China
elite groups previously excluded from the colonial polity
were thus co-opted into the new establishment. Some
individuals belonging to the traditional elites—the rich
and formerly pro-British—were also co-opted into the
pro-China camp (Lam, 1996). They were to serve as the
countervailing force to the liberal political forces created
by the colonial government through the three-tiered
administrative structure of the District Boards, Urban
Council/Regional Council, and Legislative Council
(LegCo).
Because of this political fluidity, openings were
created for Chinese medicine organizations to make
their voices heard for four reasons. First of all, the
superior positions of the established elite groups were
threatened and their power base began to shrink.
Moreover, ‘‘participation in formal institutional politics
had given rise to divisions among the loosely connected
active groups’’ (Lui & Chiu, 2000, p. 11). The Tianan-
men incident in Beijing in 1989 further exacerbated the
cleavages, leading to the consolidation of the schism
between pro-democracy and pro-China conservative
forces. The divided political elites then engaged in a
long power struggle as they jostled for political influence
in the transitional period and after (Lam, 1996).
Second, McAdam (1982, p. 43) notes that when
groups previously excluded from the political process
are given access to political structures, they might gain
‘‘a net increase in the political leverage’’ during the
structural changes. Local Chinese medicine societies, for
example, were for the first time given a chance to
participate in an institutional structure during this
political transition, notably on the Basic Law Con-
sultative Committee that was to draft the mini-constitu-
tion for Hong Kong. This conferral of status was
unimaginable under the British colonial rule. Apart
from the Basic Law Consultative Committee, Chinese
medicine societies had their own representatives in the
400-member Selection Committee to select members of
the Provisional Legislative Council as well as the 800-
member Election Committee to elect the Chief Executive
of the future SAR. They also participated in those
statutory bodies responsible for designing the regulatory
systems for Chinese medicine.
Third, Chinese medicine societies found many new
influential allies. By combining their claims with the
language of ‘‘national heritage’’, ‘‘cultural reunification’’
and ‘‘patriotism’’, the Chinese medicine societies had
secured an effective platform to gain the general public’s
support since these resonated with popular discourses in
the transitional period. The report of the Working Party
on Chinese Medicine certainly echoed this sentiment.
The report began by referring almost obligatorily to the
position of Chinese medicine in Chinese history and
culture: ‘‘Traditional Chinese medicine has a history of
over 5000 years, with written records dating back some
2000 years. It is an integral part of Chinese culture. The
use of traditional Chinese medicine has developed
through centuries of clinical experiences into a medical
system with theoretical basis and different treatment
modalitiesy . The development of traditional Chinese
medicine has been particularly significant in the past few
centuries’’ (1994, p. 4). A Legislative Council member’s
speech also reflected the same sentiment: ‘‘ytraditional
Chinese medicine is an important part of the rich
Chinese culture. If we are able to utilize such valuable
resources properly, the health of the people of Hong
Kong will be better protected’’ (Hong Kong Legislative
Council, 1995, p. 1620). As the political elites struggled
for power and influence in the transitional period, they
eagerly grasped any opportunities to demonstrate their
patriotic and nationalistic credentials.
Even members of the mainstream western medicine
establishment ceased to stand in the way of the advance-
ment of Chinese medicine for the fear of appearing to be
political incorrect. Furthermore, the two most prominent
physicians in the LegCo had been enthusiastically giving
concrete and strategic support to Chinese medicine. For
example, between 1989 and 1999, one of these physicians
gave speeches or raised questions in relation to Chinese
medicine on 11 occasions in LegCo meetings.
Fourth, Chinese medicine societies, having been an
excluded group in the past, had experienced a ‘‘benign
neglect’’ at the hands of both the then colonial
government and the Chinese government. They were
given much freedom to mobilize support for Chinese
medicine. Moreover, Chinese medicine is an officially
recognized medical tradition in mainland China and has
been accorded a status equal to that of western medicine
(Croizier, 1976; Quah & Li, 1989; Rosenthal, 1981).
Although there is no evidence that the China govern-
ment mandated Hong Kong to adopt the same policy,
this had directly influenced the views of Hong Kong
politicians towards Chinese medicine. Local politicians
generally believed Chinese medicine was no longer a
politically sensitive issue but rather had become a
‘‘politically correct’’ topic. In this respect, the attitude
and strategies adopted by these two governments
created a favorable condition for Chinese medicine
societies to mobilize support.
Mobilization by Chinese medicine societies
Against these backdrops, Chinese medicine societies
responded vigorously to two challenges in the transitional
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–10581052
period: the drafting of the Basic Law in 1988 and the
Lung Dam Cho incident in 1989. Both events were
initially viewed by the Chinese medicine societies as
potential threats to their status, thus triggering off
mobilization for collective actions to defend themselves
in the face of the perceived common threat.
In the first case, the Chinese medicine societies were
caught by surprise when they found out that a provision
concerning the development of Chinese medicine had
been deleted from the first draft of the Basic Law. They
held joint meetings among themselves, appealed to other
Chinese medicine practitioners for support, formed a
committee and petitioned the Basic Law Consultative
Committee to reinstate the clause. Nine Chinese
medicine organizations and 308 individuals signed the
petition (Sin-Hua Herbalists’ and Herb Dealers’ Promo-
tion Society, 1996, p. 30; Tam, 1994, p. 24).
In the second incident, two people became seriously ill
after mistakenly taken the toxic podophyllum emodi
which was thought to be non-toxic gentiana scabra
(Lung Dam Cho). In response to the incident the
government set up the Working Party on Chinese
Medicine to review the use and practice of Chinese
medicine. At first Chinese medicine societies adopted a
stance of diplomatic non-cooperation when receiving a
request from the Working Party to supply information
on the herbal medicine trade. Then they gradually
gathered their forces and became more vocal, especially
after their success in the Basic Law drafting process. In
1990, representatives from Chinese medicine profession
were co-opted into the Working Party. Chinese medicine
societies gave press interviews, and wrote to the Work-
ing Party and local newspapers to express their opinions.
They now recognized that whether they liked it or not,
the Preparatory Committee on Chinese Medicine would
develop a framework for the regulation of Chinese
medicine in the near future. If they did not make use of
the chance to voice their opinions in the design of the
rules for the statutory body, they would have to follow
in the future whatever was laid down for them. A
Chinese medicine practitioner recounts vividly the
change in attitude among his colleagues:
[It was] just like watching something on fire across
the rivery . In the past, though it was still burning, I
felt safe standing on the opposite side. But now, the
fire is spreading almost up to my housey . So they
[Chinese medicine practitioners] were very angry
about it. They strongly urged their chairmen to fight
against ity. (Interview).
They began to make broader claims. For instance, in
response to the report of the Preparatory Committee on
Chinese Medicine issued in 1997, some Chinese medicine
societies urged the government to include Chinese
medicine in local public health services (Hong Kong
Daily News, 1997) and the school curriculum (Wen Wei
Po, 1997). Some made more specific requests, such as for
lenient requirements for registration of Chinese medicine
practitioners (Hong Kong Economic Journal, 1997), and
for inclusion of Chinese medicine practitioners into a
new LegCo functional constituency (Sing Tao Daily,
1997). The openings in the political opportunity
structure therefore offered new space for Chinese
medicine societies to mobilize their constituencies in
order to advance their interests.
All these set the stage for subsequent collective actions
of Chinese medicine societies and individual Chinese
medicine practitioners in the 1990s. Many individual
Chinese medicine practitioners and societies responded
actively and positively to government measures on
Chinese medicine. They frequently formed formal and
informal coalitions among themselves. Some Chinese
medicine practitioners turned to individualistic strategies
and sought to obtain an official qualification in Chinese
medical training from the universities. Still, the most
remarkable change was the rapid growth of organizing
activities by Chinese medicine societies. Drawing from
information in Tse (1998), the Working Party on
Chinese Medicine (1992) and publications of various
Chinese medical societies, an average of one new
Chinese medicine society was founded per year between
the mid-1980s and the mid-1990s. The number climbed
to a total of 16 between 1995 and 1999. In 2000–2001,
the number further surged to 32. Attempts were made to
overcome this organizational proliferation through
amalgamation within the profession. The founding of
the Association of Practitioners of Chinese Medicine
General Chamber Hong Kong Limited through an
alliance of five existing societies in 1990 is one example.
Elite support and positive societal responses
Mobilization by indigenous organizations had pro-
vided the initial impetus for the institutionalization and
revival of Chinese medicine in Hong Kong. Yet these
organizations lacked the capabilities to continue mobi-
lization efforts over a longer period of time. Their loose
organizational structures were one of their serious
handicaps. Moreover, they suffered from a chronic lack
of resources such as charismatic leaders, committed
membership, adequate finance, structured solidarity
incentives and communication networks, all essential
for any large-scale mobilization. Internal cleavages also
surfaced time and again in an endless circle. Although
the historical ideological division between pro-China
and pro-Taiwan Chinese medicine societies had appar-
ently been fading away, a new basis for schism gradually
emerged around mid-1990s between Chinese medicine
practitioners who had undergone formal training and
those who entered their practice via self-learning or
apprenticeship (learnt from their parents or masters).
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–1058 1053
Under these circumstances, any collective action would
likely be ephemeral and relatively ineffective. By the
mid-1990s, however, the Chinese medicine movement
looked set to enter a new phase in which new and more
resources actors becoming more important in its
development.
One thing the incipient Chinese medicine movement
managed to achieve in the early 1990s was to frame the
whole movement successfully as a nationalist movement
by arguing that the structural inferiority of Chinese
medicine was a disgraceful product of colonialism.
References were often made in Chinese medicine
publications and press conferences to support by Main-
land Chinese officials. Chinese medicine thus emerged as
a desirable political currency in the transition to Chinese
sovereignty. As a result, new players joined the move-
ment when they perceived opportunities to advance their
own interest from the process of mobilization in favor of
Chinese medicine.
Among interested parties, politicians were most
sensitive to the shifting political context and structures.
They would support any position that could increase
their political assets. Since Chinese medicine had
achieved, respectively, as a signifier of cultural reunifica-
tion, how could these politicians resist the temptation to
jump on the bandwagon of Chinese medicine? The
signaling effect of the Basic Law is paramount in this
connection. After the inclusion of Chinese medicine in
the Basic Law in the early 1990s, LegCo members,
members from the District Boards and the two
municipal councils, local advisors of China, political
parties and the like all lavished their support for Chinese
medicine in speeches at council meetings, in newspaper
interviews and at public forums. As a Legislative
Councilor remarked in a 1995 speech:
The Basic Law has stipulated [for the recognition of
Chinese medicine]y . It is for this reason that the
government should not take a negative and dismis-
sive attitude towards the development of Chinese
medicine in Hong Kong (Hong Kong Legislative
Council, 1995, p. 1612).
The mass media were similarly enthusiastic. Through
extensive discussion in both newspaper editorials and
public forums, they helped shape public discourses on
Chinese medicine development. At least 13 newspaper
editorials were devoted to the topic of Chinese medicine
between 1997 and 2000, nine of them in 1999 alone. The
upshot was that the mass media contributed to the
creation of a climate of public opinion that was
conducive to the development of Chinese medicine.
It was not until the participation of business
enterprises, however, that the fascination with the
commercial potential of Chinese medicine and the idea
of an ‘‘international centre of Chinese medicine’’
become widespread. During the economic downturn of
the late 1990s, those firms sitting on piles of cash from
other businesses like real estate and manufacturing
generally believed that Chinese medicine could become
the ‘next big thing’—comparable to the Internet boom.
They began to collaborate actively with local universities
and mainland Chinese medicine institutes on research
and clinics. New companies focusing on Chinese
medicine and other bio-technological ventures were also
formed. For a while after 1997, new bio-tech firms,
including those devoted to Chinese medicine, enjoyed
the same status as Internet start-ups in the marketplace.
Even the Government jumped on this bandwagon
during the late 1990s. It found the nationalistic overtone
of Chinese medicine appealing and was eager to exploit
the commercial potential of Chinese medicine in order to
revive the economy after the Asian Financial Crisis. In
his first policy address in 1997 (at a time when the full
impact of the Crisis was not yet apparent), the Chief
Executive stated,
For the protection of public health, we aim to
introduce a bill in the next legislative session to
establish a statutory framework to recognise the
professional status of Chinese medicine practitioners;
to assess their professional qualifications; to monitor
their standards of practice; and, to regulate the use,
manufacture and sale of Chinese mediciney . I
strongly believe that Hong Kong has the potential
to develop over time into an international centre for
the manufacture and trading for Chinese medicine,
for research, information and training in the use of
Chinese medicine, and for the promotion of this
approach to medical care (Tung, 1997).
Since this statement was included under the section on
‘‘a compassionate and caring society’’. It was supposed
to be a health care issue, but the Chief Executive also
stressed the economic value of Chinese medicine to
Hong Kong. China responded positively to this strategic
move. The most popular topic in the pro-China press, in
this period concerned how China could help Hong Kong
develop into an international centre of Chinese medicine
(Ta Kung Pao, 1999a, b). Others relevant themes
discussed in the Chinese press included how to make
Chinese medicine a scientific subject and the future co-
ordination between Chinese medicine and western
medicine (Wen Wei Po, 1999a; Ta Kung Pao, 1999b).
After the reunification, cooperation and exchanges
between the Mainland Chinese medicine establishment
(universities and hospitals) and that in Hong Kong
became legitimate and hence much more frequent. The
much higher level of development and institutionaliza-
tion of Chinese medicine on the Mainland also helped
endow local Chinese medicine bodies with a gloss of
respectability.
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–10581054
Once Chinese medicine was perceived as a commodity
that could be marketed internationally, interest in it was
no longer confined to individual Chinese medicine
practitioners and societies. Questions such as how to
incorporate scientific methods into the study of Chinese
medicine and how to commercialize Chinese medicine
began to preoccupy academic researchers and business
enterprises. A coalition among universities, enterprises
and the government gradually emerged, with university
professors taking on the leading role in sustaining the
movement for the development of Chinese medicine.
Among elite groups that lent their support to Chinese
medicine, academics and tertiary institutions were most
important to the second phase of the movement. It was
especially after a series of Chinese medicine poisoning
incidents occurring between the late 1980s and the early
1990s that they began to play an active role as Chinese
medicine experts in statutory advisory bodies for
Chinese medicine. New political opportunities enabled
these actors to gain access to more information about
the policy processes and enhance their leverage in
political bargaining. Through the exchanges and inter-
actions in these bodies, Chinese medicine practitioners
and academics certainly developed greater rapport and a
common understanding on the future development of
Chinese medicine. Individual professors in privileged
institutional positions could then advise their universi-
ties to modify their strategies accordingly so as to exploit
the opportunities that were emerging from the Chinese
medicine movement.
Apart from the above-mentioned political opportu-
nities, local universities were comparatively well pre-
pared for the mobilization (see Lee, 1980). They had
supported studies relating to Chinese medicine dating
back to the 1970s, but it was not until the early 1990s
that these universities embarked on major organiza-
tional initiatives. Rigorous formal structures and
schools devoted to the teaching and researching of
Chinese medicine were founded in three local univer-
sities in the latter half of the 1990s. The smooth transfer
of power from Chinese medicine societies to universities
made the movement sustainable. On the one hand, more
universities began to realize it would serve their own
institutional interests to become involved in Chinese
medicine education and related research. If universities
were successful in upgrading Chinese medicine and
turning it into a ‘‘normal’’ discipline, they would then be
in a stronger position to receive resources from various
parties, including government and private enterprises.
When discourses about Chinese medicine shifted from
cultural reunification to professionalization and its
potential as a new engine of economic growth, local
universities were more than willing to play an active role
in the transformation and turn themselves into training
bodies for Chinese medicine professionals. On the other
hand, Chinese medicine societies were well aware of
their own limitations. They were thus inclined to solicit
support and resources from outside bodies from the very
beginning. They knew that credentialism was a major
element of professionalization and that only universities
could grant them recognized qualifications. More
individual Chinese medicine practitioners had enrolled
in courses offered by universities. The almost fatalistic
attitude in the profession at that time towards this shift
of leadership can be gleamed from the following
comment of a Chinese medicine practitioner:
Universities have to do something in this regard
(training of practitioners)y . In the final analysis,
universities are the most resourceful agenciesy .
They did nothing to advance Chinese medicine
education from the 1950s to the end of the
1980sy . But after the implementation of govern-
ment registration, all the candidates for registration
have to be university graduatesy . In other words,
there will be no place for all those privately owned
training institutesy . But there is no alternativeythe
standards of practising Chinese medicine practi-
tioners have to be raisedy . Many other similar
Chinese medicine training institutes have to be
eliminatedy(Interview).
In short, Chinese medicine societies gradually surren-
dered their leading role to local universities in exchange
for a higher status for Chinese medicine and upward
mobility for its practitioners.
Academics at the Chinese University of Hong Kong,
Hong Kong Baptist University and Hong Kong Uni-
versity, all leading universities in the colony, had in fact
attempted since the 1990s to mobilize for the institutio-
nalization of Chinese medicine research and education
through the establishment of Chinese medicine schools
and programs in their universities. Progress was slow at
first but by the latter half of the 1990s, university
professors finally succeeded in taking advantage of the
structural opportunities to achieve their goals. For
instance, universities continued to expand their Chinese
medicine courses in continuing education programs and
to develop formal schools of Chinese medicine and
related research institutes. Most of the courses proved to
be popular among practitioners and the general public
(Hong Kong Baptist University, 1999; Wen Wei Po,
1999b). They also began to operate their own clinics
both for student placements and as a public service.
Moreover, they continuously leveraged support from
their mainland Chinese counterparts in course designs,
teaching and so on. Joint ventures between local and
mainland Chinese medicine institutions became much
more commonplace.
Although arriving relatively late on the scene in the
late 1990s, private enterprises also began to capitalize
more on the appeal of Chinese medicine. They included
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–1058 1055
a few prominent property developers and some Chinese
medicines manufacturers. Their participation was gen-
erally believed to be a response to the continuing
promotions made by the HKSAR Government. It was
undeniable that the Chief Executive’s policy addresses in
both 1997 and 1998 and subsequent policy changes had
given these enterprises much hope. These enterprises
were made to believe that, with the support of the
government, Chinese medicine could be developed into a
flourishing industry. This gave Hong Kong a glimpse of
hope in the economic downturn following the Asian
Financial Crisis. Businessmen recommended strengthen-
ing connection and co-operation with China, conducting
research on some potent Chinese drugs, developing
Chinese medicines into healthy products, and so on.
They also supported local universities and mainland
Chinese medicine institutes in doing research on Chinese
medicines (Hong Kong Economic Daily, 1996), and they
opened Chinese medicine clinics either by themselves
(Ming Pao, 1999) or in co-operation with local
universities (Hong Kong Economic Daily, 1999). In
short, by the turn of the new century the entire society
was heated up by the discourse of ‘‘international centre
of Chinese medicine’’ because of the arrival of private
enterprises. Besides, their financial support to local
universities had given the latter a great boost. Only then
could the universities implement adequate organiza-
tional structures to replace Chinese medicine societies in
sustaining the development of Chinese medicine.
Discussion and conclusion
The growing acceptance of alternative medicine has
been widely observed in all the advanced societies. Our
paper has sought to contribute to the understanding of
this phenomenon by paying particular attention to the
changing political process and opportunities it created
for concerned actors to promote the institutionalization
of alternative medicine. As Tilly (1978) has argued, a
period of political transition often produces a realign-
ment of power and interests among different groups and
creates in the process a ‘‘power vacuum’’. It is in this
period of political fluidity that groups previously
excluded from institutionalized access to power begin
to challenge their exclusion. The power of the estab-
lished elite groups is threatened or begins to diminish.
The maintenance of their power becomes even more
precarious if these elite groups are divided among
themselves. In contrast, the political leverage of the
excluded groups (the indigenous groups in particular)
grows—provided they can gain increased political access
and attract influential allies and if the state’s capacity to
repress them declines. A movement may therefore be
generated if these groups are able to capitalize on the
available structural opportunities. If however these
indigenous groups are not endowed with sufficient
organizational capacity to sustain and advance mobili-
zation, support from outside these groups becomes
essential for the viability of the movement. The recent
social and political resurgence of the Chinese medicine
movement in Hong Kong well exemplifies how these
political processes affect a social movement. Our
political process approach also allows us to identify
the crucial turning point in the development of Chinese
medicine: that is, why following a long period of
dormancy, the indigenous Chinese medicine organiza-
tions sprung into action in the 1990s and why the
societal response to the mobilization for Chinese
medicine development had become much more favor-
able towards the end of the 1990s than previously.
Existing models explain the re-emergence of indigen-
ous medicines by using concepts of cultural inertia, a
cultural revolt or relative power of interest groups. Our
approach complements these lines of thought by looking
at the interactions of different sets of cultural values and
the political context. For Asian societies still undergoing
the long process of modernization however, it has been
argued that modernization is likely to weaken the hold
of traditional medicine (Chi, 1994; Lee, 1982). The Hong
Kong case suggests that under favorable conditions,
traditional medicine has made use of modernization and
its ideological manifestation of nationalism as the
overarching frame for breaking into the medical main-
stream (Croizier, 1976). More pertinently, in Mainland
China, Chinese medicine has been pushed by the
Communist revolution to the mainstream medical
system because the Communists can use traditional
medicine to symbolize the continuity of Chinese culture
to counter Western bourgeoisie science and technology
(Croizer, 1976). In other words, cultural values and
ideologies are important but their impact is also
conditional on the broader political context and whether
they are ‘‘mobilized’’ by the stakeholders to achieve a
particular objective.
As for the power argument, a clear relationship
between the structural positions of different interest
groups and the changing political opportunities is
evident. Under relatively favorable conditions, stake-
holders will mobilize for collective actions and seek to
shape political outcomes. In particular, Hong Kong’s
decolonization spurred the alliances between Chinese
medicine practitioners and a number of established elites
such as university professors, biomedical practitioners
and politicians. The power resources available to specific
groups are of course related to the broader political
system and process. In most developing societies,
colonial rule is the critical political context shaping the
structural position of traditional medicine vis-a-vis
biomedicine. There is a substantial literature on tradi-
tional medicine in colonial societies which attributes the
marginalization of the former by the social and political
ARTICLE IN PRESSS.W.K. Chiu et al. / Social Science & Medicine 61 (2005) 1045–10581056
influence of biomedical practitioners. Less attention,
however, has been put on the decolonization era when
the subordination of traditional medicine became
unsustainable and traditional medicine was revived
and then institutionalized (e.g., Flint (2001) on South
Africa).
Our study complements these studies by examining
the case of colonial Hong Kong in which a coalition of
traditional healers and other stakeholders put pressure
on the government to recognize and regulate Chinese
medicine. The case of India also suggests that decolo-
nization often created impetus for practitioners of
traditional Ayurvedic and Unani medicines to lobby
for more recognition and support by the postcolonial
government (Leslie, 1976). Nevertheless, the Indian case
also suggests that we should not take the post-colonial
revival for granted because after independence, the new
government had not put much effort into the institutio-
nalization and promotion of traditional medicine (Bane-
rji, 1981). Decolonization may create the political
opportunities for the social and political revival of
traditional medicine, but the outcome is never prede-
termined. Romero-Daza (2002), for example, highlights
a variety of postcolonial experiences in incorporating
traditional medicine into primary health care. The
World Health Organization (2001) also offered evidence
for the open-ended nature of the institutionalization of
traditional medicine in developing societies. Our analysis
here points to the importance of the mobilization by
stakeholders and the coalition of interests that pushed
Chinese medicine towards the mainstream. The emer-
gence of supporters from among the elites was also
critical for the relatively successful institutionalization.
Perhaps more comparative research on the development
of traditional medicines in postcolonial societies would
help toward a understanding of the dynamics of the
institutionalization of traditional medicine in the devel-
oping world.
Acknowledgements
Authors’ names are arranged alphabetically to in-
dicate equal contribution. We are grateful for the
support of a small grant from the Department of
Sociology, The Chinese University of Hong Kong. This
is part of an on-going project on the development of
traditional medicine in Hong Kong.
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