Perceptions and uses of Chinese medicine among the chinese in Hong Kong

RANCE P. L. LEE

P E R C E P T I O N S A N D U S E S OF C H I N E S E M E D I C I N E

A M O N G T H E C H I N E S E IN H O N G K O N G

ABSTRACT. The present paper was based on both qualitative observations and quantitative survey data. Major findings are as follows: (1) The sacred or magical-religious tradition of Chinese medicine is accepted by a relatively small portion (roughly one-fifth) of the ordinary Chinese people in urban Hong Kong, and is relatively more popular among women or less educated people. (2) Both the classical-professional and the local-empirical traditions of secular medicine are resorted to by many Chinese people (over one half) either for treating diseases or for strengthening their constitution. The acceptance of secular Chinese medicine does not vary significantly among different sex, age, education, or income groups. It should be noted that secular Chinese medicine is often used in addition to or in combination with modern Western medicine. (3) It appears that most people are more confident in the Chinese medical tradition than in Chinese-style practitioners in Hong Kong, and that people's confidence in secular Chinese medicine has been increasing in recent years. (4) There are reasons for the confidence in secular Chinese medicine. Chinese medicine is generally perceived to be better than or as good as Western, scientific medicine in some ways, such as for tonic care, for fewer side effects, for curing the cause (not symptoms) of diseases, and for treating certain diseases. Therefore, to ordinary Chinese people, Chinese and Western medicine may perform either equivalent or complementary functions. (5) As regards the process of seeking medical care, most people seem to follow the pattern of moving from self-medication, using Chinese and/or Western home remedies, to Western-style doctors, to Chinese-style practitioners, and finally to a Western medical hospital. Policy and theoretical implications of these f'mdings are discussed.

Traditional medical beliefs and practices can be broadly classified into 'secular'

and 'sacred' traditions. The preeminent type of secular medicine in most Chinese

societies is the classical-professional tradition of Chinese medicine. It emerged

about 800 B.C. in the China mainland, and became the official system of medi-

cal care in imperial China (for details, see Needlaam and Lu 1969). Its theoret-

ical foundations and its detailed classification of diseases and medicaments

have been well documented in scholarly literature, such as The Classic o f Inter- nal Medicine (Nei-ching), Treatise on Cold Disorders (Shang-han lun), The Pulse Classic (Mo-ching), and General Compendium o f Materia Media (Pen-ts'ao kang- mu).

This classifical-professional tradition is based on Chinese Cosmological ideol-

ogies, of which the primary ones are the balance between yin (representing the

dark, moist, feminine) and yang (representing the bright, dry, masculine) forces

of the universe, the interplay among five elements (metal, wood, water, fire, and

earth), and the great interdependence between the Macrocosm and the Micro-

cosm. 1 As contemporary scholars (cf., Croizier 1968; Needham and Lu 1969;

Palos 1971; and Porkert 1974) in many parts of the world have recognized, the

Culture, Medicine and Psychiatry 4 (1980) 345-375. 0165-005X/80]0044-0345 $03.10. Copyright © 1980 by D. Reidel Publishing Co., Dordrecht, Holland, and Boston, U.S.A.

346 RANCE P. L. LEE

classical-professional tradition of Chinese medicine is not scientific in the strict sense, but its formulation is based on naturalistic and rationalistic principles. It has been practiced by professional practitioners who have undergone pro- longed training. Because of its scholarly tradition and its recognition by the

imperial state~ it has become the 'great tradition' of Chinese medicine dominat- ing many 'little traditions' (both secular and sacred) in various parts of China. 2

The little traditions of secular medicine refer to the medical concepts and behavior commonly shared by the people in a given locality. They are usually a set of loosely organized, relatively simple, and empirically-based ideas about the causes, prevention, and treatment of diseases. The remedies are often applied by the people themselves, not by professional healers. As China has been one of the largest countries in both land area and population size, local differences in disease patterns and therapeutic resources coupled with the underdevelopment of communication technology may have contributed to the great variety of local- empirical remedies. Most of these local-empirical folk beliefs and remedies have not been systematically identified and recorded in the scholarly literature. 3

The sacred or magical-religious tradition of Chinese medicine is a syncretic product of various religious or philosophical traditions, particularly Buddhism,

Taoism and Confucianism. It is based on the belief in supernatural determina- tion of illness and on the application of magical or religious rituals to the treatment of diseases. As this second folk type of healing practice has not constituted the mainstream of orthodox Chinese medicine, it frequently is conceived as a 'little tradition'.

For many years, classical-professional Chinese medicine has coexisted along with both local-empirical and magical-religious remedies in China and in other Chinese communities. It should be noted, however, that despite variations in healing procedures, the various traditions of Chinese medicine are unified by the Chinese worldview (Croizier 1973:5; and Topley 1975:257) and for many Chinese they are not mutually exclusive. The purpose of this paper is to examine the ways in which the various forms of Chinese medicine are accepted by the Chinese in Hong Kong. I will also compare the acceptance of Chinese medicine with that of Western, scientific medicine. In order to properly understand the

role of traditional Chinese medicine, I will briefly outline at the outset the social and political context of Hong Kong.

HONG KONG: AN INDUSTRIAL CITY UNDER BRITISH RULE

Hong Kong is situated at the southeastern coast of the China mainland, and was part of China before its foundation as a British Colony in 1842. At present, it has nearly five million residents in a total land area of approximately 1052 square kilometres. More than 98% of the population are Chinese in origin.

PERCEPTIONS AND USES OF CHINESE MEDICINE 347

Hong Kong is a highly urbanized society; about 90% of its population is concentrated in urban areas. Within the last three decades, it has also become one of the preeminient commercial and industrial centers in Asia (Lin, Lee, and Simonis 1979). An overwhelming majority (about 98%) of its workforce (roughly 2 millions) are engaged in services or manufacturing industries. The G.N.P. per capita increased from HK $ 1212 in 1950 to HK $13826 (about US $ 2904) in 1978, which was third only to Japan (US $ 8324) and Singapore (US $ 3205) in the entire Far East region. Moreover, Hong Kong is probably the third city in the world next only to London and New York in terms of the number of foreign banking and quasi-banking institutions.

With respect to its health status, Hong Kong has caught up with many developed countries. Nowadays people die mostly of the degenerative diseases rather than infectious diseases (Colbourne 1976). The life expectation at birth is now 70 for men and 77 for women.

The medical care systems in Hong Kong are pluralistic, comprising a variety of medical traditions. Western, scientific medicine, however, has become the predominant approach in this realm of pluralistic health care. At the end of 1976, there were 3742 Western-style doctors, 4 the doctor-population ratio being 1 to 1190. There were also 27 government hospitals and 11 private hospitals. These Western-style hospitals provided a total of 18706 beds; the bed-population ratio was approximately 4.3 per thousand. The government had established 51 outpatient clinics and 23 polyclinics and specialist clinics, whereas in the private sector there were a total 414 Western-style medical clinics registered under the Medical Clinics Ordinance.

The government has played a crucial role in the medical development of Hong Kong. Its total expenditure on health and medicine was HK $ 14.6 millions in 1949/50; it increased to HK $ 666 millions in 1976/77, about 10% of the government's total expenditure (for details, see Ho 1979: 72-76). The government's policy is to provide low-cost, rather than free, medical care to the eco- nomicaUy disadvantaged population. It has, however, also been a policy of the government to regulate and support Western, scientific medicine rather than other forms of medical practice (see Lee 1975a, 1975b; and Topley 1975, 1976). The Medical Council of Hong Kong registers Western-style doctors only, and the Medical Registration Ordinance primarily affects Western, scientific medical practice. Moreover, the government does not provide Chinese medical care, nor do the university medical faculties teach Chinese medicine.

As I have argued in some detail elsewhere (Lee 1975a, b), because of support from government and universities, the profession of Western medicine has pre- empted other forms of medical care in Hong Kong. It has an officially approved monopoly of the right to define and deal with health and illness in the community. The pre-eminence of modern Western medicine, however, has not

348 RANCE P. L. LEE

driven out the traditional forms of medical care. Chinese medicine, both secular and sacred, survives in the Chinese community of Hong Kong today. In this connection, it should be pointed out that since the foundation of Hong Kong as a British Colony in the middle of the 19th century, the Chinese have been given

the assurance that they could continue to live according to their own customs and usages. As a result, Chinese medicine still has a place in the Colony. The questions are: Do the Chinese resort to their indigenous remedies? Why do they

do so?

THE SACRED TRADITION IN CHINESE MEDICINE

Despite Western influence and the rapid growth of modern science and technology, traditional Chinese religious practices continue to thrive in the Chinese community of Hong Kong. A great variety of Chinese deities are being wor- shipped. There are at least 600 Buddhist and Taoist temples in Hong Kong, which are often crowded at festivals (Hong Kong Government 1979:188-189) . Nearly every village has its own ancestral hall and many households in both rural and urban areas have their own ancestral shrines. Countless shops (including police stations) have a god-shelf. The arts of geomancy (fung-shui) s and fortune- telling are still popular. 6 The question of concern to us is: Do people resort to

magical-religious healing? Yap (1967), a psychiatrist trained in the West, has observed that there is the

belief among Chinese people in Hong Kong, particularly the poorly educated, that mental illness (especially hysterical disorder) is due to possession by evil spirits or malevolent foxes. The patient's family may go to a Chinese temple to pray and obtain amulets. Since the demons are thought of asyam (yin) in nature, religious rituals involving fire, ye~ng (yang) are sometimes used to cure the disorder.

Potter (1974: 219-224) undertook an anthropological study of shamanism in a Cantonese community (Ping Shan) in rural Hong Kong from 1961 to 1963. He found three spirit-mediums, who are locally known as mann m a e p h o x . 7 A major duty of these mediums is to call on a spirit to cure illnesses. At the request of a sick person or a concerned relative, the medium acts as a healer by going into a trance, calling down her familiar spirits, and searching for the ghost who has stolen the sick people's soul. She also outlines the steps necessary to achieve a cure, such as the kinds of food and the amount of paper money required to ransom the ailing person's soul. Normally, the medium ends the session by scat- tering rice around to feed her tutelary spirits, and giving her callers rice to take home to the patient. If the illness is very serious, the medium may arrange for a ceremony at the patient's home.

Topley (1970: 429-434) , an anthropologist, conducted in-depth interviews


with 20 Chinese mothers in urban Hong Kong in 1969. ' Injury by fright ' (hadk- ts'an) was repor ted by many informants as a common problem among children,

part icularly in the first 100 days after birth. A major preventive measure is to

have children wear jade bangles or silver chains with jade pendants, as it is

believed that jade is harmony-inducing and can thus help 'settle fear' . When a

child is found to be suffering from relatively mild injury by fright, Chinese

medicines are often used. But in serious cases, the soul is assumed to have left

the body - due to demon interference - and t reatment requires magical-religious

means such as having children nominal ly adopted by a deity, or resorting to

Taoist priests. Different kinds o f rituals and incantations may also be tried, such

as 'calling out against fear ' (hadm-king) or 'cutt ing off the Little Man'.

Myers (1974) carried out anthropological f ieldwork in a Chinese spirit-

medium temple, called 'Taih Wong Yeh Miu', in an urban district (Kwun Tong)

in Hong Kong. In the temple, the trance session of the spiri t-medium (ki-tong) is the central focus o f almost every religious activity, s According to Myers

(1974: 3 7 - 3 8 ) , the peti t ions presented by worshippers fell into four categories;

they were requests for (1) the curing o f disease, (2) security in the future, (3)

advice to solve problems, and (4) information on the possibili ty of acquiring

wealth. Of these four categories, the request for the curing o f disease was most

common. To confirm Myers ' observations, I observed 29 worshippers (28 women and

1 man) on an evening in January 1975. 9 Seventy-six per cent of them requested

a cure for themselves or close relatives. The healing procedures they experienced

are described by Myers (1974: 38) as follows:

While conversing with the M-tong, the petitioner is expected to give as many details about the illness as possible. On several occasions the medium has been seen holding the wrist of the sick person apparently attempting to read the pulse. The response to the request for a cure may take one of four possible forms: (1) The giving of herbs for the use of the sick person. (2) The giving of an amulet - drawn with red ink on yellow paper - to be boiled in water and then cooled and drunk by the sick person. (3) A combination of both of the above, i.e., herbs and an amulet. (4) Herbs mixed with pieces of a burnt incense stick that was chewed by the M-tong while still burning. This remedy is rather rare and may be given with or without an amulet. (5) The M-tong may judge that the illness is the doing of an evil spirit and that exorcism is in order; in this instance, he will take a mouthful of sacred water and spit it into the face of the afflicted person to drive out the spectre.

It is worth noting that herbs are often used in combinat ion with religious rituals.

This fact suggests that secular and sacred medicine are not mutually exclusive in Chinese culture.

The studies described above show that magical-religious cures are used by

both rural and urban residents of Hong Kong. But how many people do so? I

have found no statistics about the prevalence o f magical-religious healing in

rural areas. It is my hunch that rural people are more l ikely to resort to sacred

350 RANCE P. L. LEE

remedies than are urban people. Nevertheless, in the case of Hong Kong it is worthwhile to focus on the urban sector, as an overwhelming majority of the

population are residents of urban areas. In the summer of 1972, I undertook a Kwun Tong Health Attitudes &

Behaviour Survey. A proportionate stratified (according to housing types and subdistricts) random sample of 702 household heads was selected for study from the community of Kwun Tong, and the data were collected through personal interviews with a structured questionnaire. It should be explained that Kwun Tong is one of the largest industrial-residential districts (about 5 square miles) in urban Hong Kong. At the time of the survey, it had nearly a half million people, most of whom were living in public housing estates and belonged to middle- or lower-income groups. The people under study were thus mainly ordinary citizens in Hong Kong; 1° they were not elites nor members of high

society. Findings of the survey were as follows: Most respondents (81.1%) reported

that they or their family members had never visited a Chinese temple for curing diseases, 16.8% reported 'occasionally visited', and 2.1% reported 'often visited'. Regarding their beliefs and attitudes, (1) 22.5% of the respondents believed that the worship of deities or ancestors could help cure diseases; (2) 21.5% believed in the effects offung-shui (geomancy) on the health and illness of a family; and (3) 30.2% agreed that wearing a jade ornament would help 'settle fear' and prevent 'injury by fright'. The survey results suggest that most urban dwellers do not trust nor use magical-religious remedies. Roughly one-fifth of ordinary people in urban Hong Kong may subscribe to some aspects of sacred Chinese medicine. This finding contrasts with Kleinman's (1980) observations of extensive popular resort to sacred folk healers in Taipei. The difference may reflect distinctive cultural practices and social situation in two very different Chinese communities or result in part from the different research methods employed: surveys versus ethnography.

In an attempt to determine the distribution of magical-religious beliefs among different subgroups of the Chinese population, I found that the above-mentioned sacred medical beliefs were clearly associated with the sex or educational levels (no schooling, primary education, and secondary education or more) of the respondents under study. In general, women were more likely than men to believe in the medical effects of such religious worship (gamma = 0.30), fung- shui (gamma = 0.25), and jade ornament (gamma = 0.31). The less educated respondents were more likely to believe in religious worship (gamma = -0 .37) , fung-shui (gamma = -0.29) , and jade ornament (gamma = -0.32). All these relationships are statistically significant at the 0.001 level (chi-square test). In this connection, it should be remembered that Topley's (1970) informants were all women and that an overwhelming majority of the worshippers in the temple studied by Myers (1974) were also female. Moreover, in both studies most


were poorly educated. My survey findings, together with the anthropological observations of Topley and Myers, thus indicate that magical-religious medicine is popular mainly among women or less educated people in Hong Kong.

THE SECULAR TRADITION IN CHINESE MEDICINE

Secular Chinese medicine refers to both the classical-professional and the local- empirical traditions. In both traditions, herbs, animal parts, and mineral resources

are often used as medicinal material. Anyone walking around the streets in Hong Kong will be impressed by the

countless shops and stalls selling Chinese medicinal material. In many of these shops, one is likely to fred a practitioner of secular Chinese medicine. There are numerous Chinese newspapers and magazines in Hong Kong; nearly everyone of them has Chinese medicinal advertisements and also special columns discussing the nature and use of secular Chinese medicine.

An important indicator of the prevalence of secular Chinese medicine in Hong Kong is the great number of Chinese-style practitioners of various kinds. In Hong Kong, there are three major types of Chinese-style practitioners: (1) general practitioners of Chinese medicine, treating all kinds of illnesses mainly by prescribing herbs and other medicinal materials; (2) acupuncturists, specializing in the treatment of illnesses by inserting needles into certain points of the body; and (3) bone-setters, specializing in the treatment of fractures, dislocations, sprains and strains, n According to a survey conducted by the Hong Kong Medical Association in cooperation with the government's Census and Statistics Department in 1969, there were then 4506 Chinese-style practitioners. Of these, about 63% were general practitioners, 5% acupuncturists, and 32% bone-setters. This figure was nearly twice that of Western-style doctors in that year. 12 In this connection, it should be mentioned that the great number of Chinese-style practitioners is mainly due to the government's policy of minimal interference with local customs and usages. In Hong Kong, anyone can claim to be a Chinese- style practitioner, and what is required is a payment of HK $150 for commercial registration. As a result, there are numerous Chinese-style practitioners with varying qualifications.

Nevertheless, unless there was a demand in the community, practitioners of Chinese medicine could hardly survive. In September 1966, Choa (1967a) asked his general-ward patients in a government hospital (Queen Mary) if they had consulted a traditional practitioner at any time in connexion with their current illness. He found that nearly half (41%) of the patients (100 male, 50 female) interviewed had attended practitioners of traditional medicine either at the outset of illness (19%) or after they had taken Western medicine without im- provement (22%). Choa's findings should be qualified as the study focused on

352 RANCE P. L. LEE

the patients then seeking help from Western, scientific medicine, rather than ordinary people in the larger community. Nonetheless, his study clearly indicates the acceptance of classical-professional Chinese medicine in Hong Kong. Later in this paper, I shall return to this issue and report my own findings from several sample surveys in the community.

In addition to classical-professional Chinese medicine, the people in Hong Kong also have their own local-empirical ways of dealing with health and illness. In this connection, it should pointed out that the Cantonese form the largest community in Hong Kong 13 and thus that the local-empirical tradition of Chinese medicine in Hong Kong may be essentially a Cantonese form (Topley 1975: 242-243).

The Cantonese community has a number of local-empirical remedies. It is a common practice for families to keep at home certain kinds of popular Chinese patent medicines for possible self-medication, such as Tiger Balm, White Flower Oil, and Po-chai Pills. Plants and animal parts may also be used for self-medication or for health-enhancing, such as using ginger juice for treating a baby's sweating at night, drinking water-cress juice to stop the vomiting of blood, taking flesh- water goby soup after wounds or surgery, treating nose-bleeding by eating rice cooked with banana, eating snake skin for curing skin diseases, dissipating sputum by drinking the shau-mei green tea boiled with American ginseng (see Chung 1972).

Several scholars (Choa 1967b; Topley 1970; Anderson & Anderson 1975; and Anderson 1978)have underscored the fact that in the Cantonese community an important set of local-empirical ideas about disease causation and treatment is food or diet therapy. It is concerned with the relationship of food and diet to one's health and illness. As Choa (1967b:54) once remarked, "the Cantonese people appear to pay far more attention to t h i s . . , than do people from other parts of China." I have observed that many local newspapers have special columns dealing with food therapy, and many Chinese bookstores display a number of popular books on this topic. 14

Topley (1970: 425-429) has described a concrete example of the use of food therapy on the basis of her interviews with 20 Chinese women (19 were Cantonese) in urban Hong Kong. Measles is considered by many of these mothers as 'something that has to come out'; it functions to correct an imbalance of 'hot' and 'cold' and also cleanses the system of poison inside the child's body. Dietary observances play a major part in the treatment of measles. Abstinence from 'hot' or 'poisonous' foods such as goose, duck, carp, and pheasant is required. On the other hand, a vegetarian diet is generally recognized as 'cool' and is thus rec- ommended. A breast-feeding mother should also observe the dietary rules.

The Chinese conception of food and health is certainly more complicated than what Topley's study has shown. Many Chinese (particularly the Cantonese)


generally believe that people are broadly divided into two polar types according to their physical constitution: 'cold' (or excess of coolness)and 'hot ' (or excess of heat). Likewise, foods are classified into three basic types: (1) 'cold' food, if it has cooling effects on the constitution; (2) 'neutral' food, if it has neither cooling nor heating effects; and (3) 'hot ' food, if it has heating effects, is In order to obtain a balance or harmony of 'cold' and 'hot ' aspects in one's constitution, a person with a 'hot ' constitution should avoid 'hot ' foods and should take 'cold' foods, whereas a person with 'cold' constitution should take 'hot '

foods rather than 'cold' foods. It is generally expected that a 'cold' person overconsuming 'cold' foods would feel giddy, lose appetite, suffer from stomach upset and diarrhea, and become tired. On the other hand, a 'hot ' person taking too much 'hot ' foods would feel 'hot ' all over his body, and would have a sore-

throat, and even swelling of the gums; the nose of this person may also bleed. Many Chinese people, particularly the Cantonese, therefore usually examine

their own constitution in terms of 'hot ' and 'cold' concepts and then take proper foods in their daily meals. Normally one learns one's constitution by

experimenting with different kinds of foods and observing the results. It should be mentioned that many Chinese people also classify foods in terms

of their 'dry' or 'wet' effects on the constitution. However, it appears that the 'dry'- 'wet ' classification is not as pre-eminent as the 'hot '- 'cold' distinction, and its use by ordinary people (though not professional practitioners of Chinese medicine) is often mixed up with the 'hot '- 'cold' dimension. In addition, many people also use such labels as 'tonic', 'poisonous', 'purifying', and 'bulky' to codify the effects of foods on one's constitution. 16

The above discussions show that the Chinese folklore concerning food and diet is not only a way of preventing illness, but is also a way of treating illness. As Chinese say, "To cure a disease, one should depend on medicine for 30% and on taking proper rest and proper foods for 70%." When one is sick, dietary modification is usually required. For instance, a person who suffers from diseases due to the excess of heat should take 'cold' foods so as to correct the imbalance; a person having diseases due to the excess of coolness should consume 'hot ' foods; a person suffering from 'poison' should take those foods that can 'purify' it; and a person who feels weak should resort to ' tonic' foods.

The Chinese folklore surrounding food and health in the contexts of Hong Kong and other Chinese societies deserve detailed studies. Despite the good work of such scholars as Anderson and Anderson (1975) and Wu (1979), our knowledge of this folklore is still in a preliminary stage. How is a particular

food actually classified and consumed by different groups of Chinese people in different localities? To what extent are there consensual views among them? How is the local classification at variance with the classification in the scholarly literature (e.g., Pen-ts'ao kang-mu) of classical-professional Chinese medicine?

354 RANCE P. L. LEE

How do these beliefs affect the nutritional status of the people? How does folklore exist along with modern scientific conceptions of food? How is food therapy used in combination with magical-religious remedies or with prescriptions by professional practitioners? How does the folklore affect the interaction between patients and professional (particularly Western-style) practitioners? These are some of the questions that deserve further empirical research.

In the past several years, I have undertaken several sample surveys for the purpose of compiling some quantitative data to show the acceptance of the classical-professional and the local-empirical traditions of Chinese medicine by the Chinese population in Hong Kong. The following are relevant results from each of the surveys.

(A) Kwun Tong Life Quality Survey

A proportionate stratified (according to housing types and subdistricts) random sample of 1065 household heads in the district of Kwun Tong was interviewed with a structured questionnaire in the summer of 1971. It was found that 63:5% of the respondents had been treated by a Chinese-style practitioner in the past, and that 94.5% had consulted a Western-style doctor. It is noted that most respondents (66.4%) had consulted both Chinese-style and Western-style practitioners; among these respondents (N = 689), 9.5% consulted Chinese-style practitioners more often, 72.1% consulted Western-style doctors more often, and 18.4% about the same.

(B) Kwun Tong Health A ttitudes and Behaviour Survey

As reported previously, this survey was based on a random sample of 702 household heads in Kwun Tong in 1972. It was found that 36.2% had consulted a general practitioner of Chinese medicine in the past three years, 14.4% had consulted a bone-setter, 1.7% had consulted an acupuncturist, and 2.1% had consulted other traditional specialists. Moreover, among those respondents (N = 651) who sought professional help for illness during the past three years, 11.1% reported that they visited Chinese-style practitioners more often, 82.8% consulted Western-style doctors more often, and 6.5% about the same. This "use of Chinese-style relative to Western-style practitioners' was weakly associated with sex (gamma = 0.19), age (gamma = 0.10), educational level (gamma = -0.08), and income status (gamma = -0 .06) of the respondents) 7 It appears that the female, the older, the less educated, and the lower income people were somewhat more likely to consult Chinese-style relative to Western-style practitioners. However, the relationships were so weak that none of them was statistically significant at the 0.05 level (chi-square test).


The survey ialso indicates that 41.5% of the respondents had consulted both

Chinese-style and Western-style practitioners in the past three years, and that this combined use of medical traditions was not significantly (chi-square test, p > 0.05) related to sex (gamma = -0.15) , age (gamma = 0.01), education (gamma = 0.08), and income (gamma = -0 .02) of the respondents.

As mentioned, it is a common practice among Chinese families to keep certain medicines at home for possible self-medication. 18 The survey indicates that over four-fifths of the respondents kept at home some Western drugs for wounds; about three-fourths had Chinese medicinal liquor for bone-setting; about two- thirds kept some kinds of Chinese medicinal oils or ointments for relieving headache, dizziness, vomiting or skin trouble; about half of the respondents had either Chinese or Western medicines for curing colds and flu, and for treating diarrhea; and about one-fifth had a thermometer at home. Obviously, both Chinese and Western medicines play a part in home-remedies.

(C) Lam Tin Health Survey

A group of Chinese University students under my supervision conducted interviews with a random sample of 227 individuals, aged 18-70, in Lam Tin - a subdistrict (population: 52,060) of Kwun Tong - in the summer of 1976.

A part of the survey was to find out the local demands for Chinese medical care) 9 It was found that 40.8% of the respondents felt that the community

was in shortage of general practitioners of Chinese medicine, 53.5% indicated a shortage of Chinese-style bone-setters, and 81.9% felt a shortage of acupuncturists. Moreover, 96.5% felt that a government-subvented community health clinic should include not only Western-style doctors but also Chinese-style practitioners.

(D) Hong Kong-wide Utilitarianistic Familism Survey

Lau (1977) undertook this survey in urban Hong Kong in early 1977. A proportionate stratified (according to housing types and districts) random sample of 550 Chinese adults between the age of 20 to 59 was selected for the study from the entire urban sector in Hong Kong. At my request, Lau included a battery of questions related to medical care. Data were collected through personal interviews with a structured questionnaire. It was found that in the past three years, 51.5% of the respondents had consulted Chinese-style practitioners, while 91.1% had visited Western-style doctors. The use of Chinese-style practitioners was not significantly (chi-square test, p > 0.05) associated with sex (gamma = 0.06), age (gamma = 0.006). education (gamma = -0.003), or income status (gamma = 0.06) of the respondents. 2°

356 RANCE P. L. LEE

It is notable that among those (N = 506) who had consulted a medical practitioner in the past three years, 2.4% consulted Chinese-style practitioners only, 52.8% consulted both, and 44.9% consulted Western-style doctors only. As before, a majority of the respondents had consulted both Chinese-style and Western-style practitioners. Further analyses show that this variable (Chinese- style only is scored 2; both is scored 1; and Western-style only is scored 0)was not significantly (chi-square test, p > 0.05) related to sex (gamma = 0.02), age (gamma = 0.06), education (gamma = -0.04), or income (gamma = 0.05).

The respondents were asked to report their use of Chinese medicinal material. It was found that in the past three years 63.5% had used Chinese medicines to cure diseases, and that 55.3% had used Chinese medicines for tonic care (i.e., to strengthen or nourish their constitution). The use of Chinese medicinal material for disease treatment was not associated (chi-square test, p > 0.05) with sex (gamma = -0.03), age (gamma = 0.07), education (gamma = 0.03), or income (gamma = 0.08). The use of Chinese medicines for tonic care was not related (chi-square test, p > 0.05) to age (gamma = 0.03) or education (gamma = 0.06), and was slightly related (chi-square test, p < 0.05) to sex (gamma = 0.33) or

income (gamma = 0.19). Hence, with regard to the use of Chinese medicinal material to build up one's constitution, women were somewhat more likely to

engage in this health behavior than men while higher-income individuals were somewhat more likely than lower-income individuals. It could be that as I have argued in another paper (Lee 1976), Chinese women are more likely to feel weak than men. Moreover, as tonic Chinese medicines have generally become expensive items in recent years, higher-income individuals are better able to afford it.

As discussed previously, diet therapy is an important part of the Chinese (particularly the Cantonese) culture in Hong Kong. The survey results suggest that this folklore is indeed popular among different social groups in Hong Kong. Specifically, it was found that (1) 74.4% of respondents had attempted to take certain foods (e.g., pork bladder boiled with ginkgo and coicis semen) in their daffy meals for the purpose of eliminating the 'wet' and 'bulkly' defects in their own constitution; (2) 91.3% had consumed foods (e.g., wax gourd or leaf mustard soup) during the summer time in order to reduce or prevent the excess of 'heat' in their constitution; (3) 93.5% had taken foods (e.g., water cress or sun-dried Chinese white cabbage soup) during dry seasons for the purpose of purifying the liver and strengthening the lungs; (4) 64.9% had taken foods (e.g., long-boiled chicken or mutton) to combat the cold wind and to strengthen the constitution. Further analyses show that these patterns generally held across different sex, age, education, or income groups. In this connection, it should be mentioned that from the previously reported Kwun Tong Health Attitudes and Behaviour Survey, 82.9% of the respondents agreed that a sick person should


'modify his diet'. This belief was shared by people in different sex, age, education, and income groups. Moreover, extensive resort to dietary change and special foods both for health maintenance and self-care has been reported for other Chinese communities (cf. Kleinman 1980:179-202, for data on Taiwan).

(E) Chinese University Faculty Health Survey

A group of sociology students under my supervision undertook a study of the health behavior of the Chinese teaching staff at The Chinese University of Hong Kong in early 1979. A proportionate stratified (according to departments and ranks) random sample of 109 full-time teaching staff of Chinese origin were drawn from the faculties of arts, science, social sciences, and business adminis- tration. Data were collected by means of a self-administered questionnaire. It is obvious that the University teaching staff are a very selected group in Hong Kong; they are highly educated and most of them have received higher education in the West. It was found that about 10% of them consulted Chinese-style practitioners more often than (4%), or as often as (6%), Western-style doctors in recent years. Moreover, 42% of them indicated that they often used Chinese- style methods (e.g., consuming Chinese medicinal material, drinking Chinese tonic wine, or practicing Chinese boxing) to improve their health. Asked about the kinds of patent medicines they usually kept at home for possible self- medication, 13% reported that they had more Chinese than Western medicines, 52% kept as many Chinese as Western drugs, and 35% had more Western than Chinese medicines. Up to now the University's health center has provided only Western medical service; however, 48% of the Chinese teaching staff under study felt that the center should add a Chinese medical section, 38% had no opinions, and only 14% objected to the idea. Apparently, Chinese medical care is not rejected by the highly educated segment of Hong Kong society.

Let us sum up the findings of the above five surveys. These surveys consistently show that the Chinese in Hong Kong are more likely to resort to Western- style than Chinese-style practitioners. Nevertheless, it does not mean that Chinese medicine is not popular in Hong Kong. The surveys consistently demonstrate that a great number of the Chinese people (including university teaching staff) have resorted to the classical-professional and/or the local- empirical traditions of Chinese medicine. A point to be noted is that Chinese remedies are often used in addition to or in combination with Western, scientific medicine.

We should now raise the question: Why do people resort to Chinese medical care? In his study of 150 general-ward patients in a government hospital in Hong Kong, Choa (1967a) found that nearly a half of those taking traditional medicine gave 'faith in it' as their main reason. My own surveys also confirm that

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among the general population in the community, the use of Chinese medicine is mainly ascribed to the respondents' confidence in it. The findings are as follows:

In the Kwun Tong Health Attitudes and Behaviour Survey, respondents were asked to compare their confidence in Chinese-style versus Western-style practitioners in Hong Kong, and also their confidence in Chinese medical tradi-

tions versus Western medical science. Most respondents expressed more confidence in Western-style doctors (67.1%); nevertheless, nearly one-third of them were either more confident (6.1%) or equally confident (26.8%) in Chinese-style practitioners in Hong Kong. Moreover, most respondents preferred Western medical science, but over one-third of them were either more confident (10.1%) or equally confident (25.2%) in the Chinese medical tradition. Further analyses show that the use of Chinese-style versus Western-style practitioners was strongly related to the relative confidence in the two types of practitioners in Hong Kong (gamma = 0.81 ; chi-square test, p < 0.001) and was also significantly related to the relative confidence in the two medical traditions (gamma = 0.75; chi-square test, p < 0.001).

The Lam Tin Health Survey produced similar results. While most respondents (58.6%) were more confident in Western-style doctors in Hong Kong, 41.4% were either more confident (9.5%) or equally confident (31.9%) in Chinese-style practitioners. Moreover, about a half of the respondents (49.8%) were more confident in Western medical science, while another half were either more confident (9.9%) or equally confident (40.3%) in the Chinese medical tradition.

In the Hong Kong-wide Utilitarianistic Familism Survey, nearly half of the respondents (49.7%) were more confident in Western-style doctors, and slightly more than a half were either more confident (7.5%) or equally confident (42.8%)

in Chinese-style practitioners in Hong Kong. Further analyses show that this relative confidence in Chinese-style versus Western-style practitioners had a significant bearing upon the relative use of these two types of practitioners (gamma = 0.69; chi-square test, p < 0.001), and that this relationship held among different sex, age, education, or income groups. 21

From the above surveys, two points should be emphasized. First, the three surveys consistently indicate that people are more confident in Western than Chinese medicine, but it does not mean that they have no faith in the later. In fact, some of them are more confident in Chinese medicine and many of them are equally confident in both types of medical care. Second, both the survey in 1972 and the survey in 1976 indicated that people are more confident in the Chinese medical tradition than in Hong Kong's Chinese-style practitioners. This result probably stems from the lack of uniform control over Chinese medical practice in Hong Kong. Many people tend to believe that Chinese medicine may be as good as modern Western medical science, but unfortunately they


cannot be certain whether a practitioner of Chinese medicine in Hong Kong is qualified.

We have seen that many people in Hong Kong have faith in Chinese medicine and therefore resort to it. But what are the bases of their faith?

In the Kwun Tong Health Attitudes & Behaviour Survey, people tended to make differential evaluations of the different aspects of Chinese versus Western medical care. Most people (83.3%) perceived that Western medicine was more effective than Chinese medicine in the prevention of infectious diseases; only a small number of them felt that Chinese medicine was more effective (2.6%) or equally effective (6.1%). Regarding tonic care, most respondents believed that Chinese medicine was better than (70.2%), or as good as (18.2%), Western drugs. Concerning the treatment of diseases, only a few people perceived that Chinese medicine worked faster than (2.6%), or as fast as (6.1%), Western medicine. However, most people believed that Chinese remedies are less likely than (59.7%), or as likely as (35.5%), Western treatment to produce side-effects. Moreover,

more than a half of the respondents felt that Chinese medicine was either more effective than (23.2%), or as effective as (29.1%), Western medicine in curing the cause, rather than merely the symptoms, of a disease.

In the survey, respondents were also given a list of common diseases and were asked to make comparisons between the two medical traditions. Most people preferred Western to Chinese medicine for the treatment of most diseases, including tuberculosis (91.2% for Western versus 1.4% for Chinese), fever (90.5% versus 5.7%), heart diseases (84.9% versus 0.9%), stomach ache

(84.3% versus 3.4%), mental illness (84% versus 0.4%), skin diseases (83.6% versus 6.6%), throbbing and diarrhea (78.3% versus 13.4%), and whooping cough (76.9% versus 14%). For dysmenorrhea and anemia, most people believed in Western methods (65% and 55%, respectively), but a number believed that Chinese methods are better (17.6% and 29.1%, respectively) or equally good (17.4% and 15.9%, respectively). Opinions were evenly split with regard to measles (47.9% for Western, 47% for Chinese). On the other hand, Western medicine was thought of as less effective than Chinese medicine in dealing with rheumatism (24.2% versus 54.1%) and with sprains and fractures (8.2% versus 86.5%).

The Lam Tin Health Survey showed similar results. The respondents were asked to answer an open-ended question: "In what ways do you think Chinese medicine is better than Western medicine?" Many respondents (about 30%) mentioned the treatment of such diseases as rheumatism, sprains and fractures, bronchitis, and flu and colds. Some (about 10%) suggested that Chinese medicine is better for curing the cause (not symptoms) of diseases and that it has fewer side-effects. Asked "In what ways do you think Western medicine is better than Chinese medicine?", most people (about 60%) mentioned that for the treatment

360 RANCE P. L. LEE

of common diseases it works faster; some people (about 8%) felt that Western medicine is better because it is more scientific.

From the above two SUlveys, it is evident that many people in Hong Kong have faith in Chinese medicine because it is perceived to be better than, or as good as, Western medicine in particular ways, such as for tonic care, for fewer side-effects, for curing the cause rather than merely the symptoms of diseases, and for the treatment of certain diseases including measles, rheumatism, bronchitis, anemia, dysmenorrhea, and sprains and fractures. To the Chinese, therefore, the use of Chinese medicine alone or in combination with Western medicine for dealing with health and illness is both logical and pragmatic. In their minds, the two medical traditions are not mutually exclusive; instead, they perform equivalent or complementary functions.

THE PROCESS OF SEEKING HELP

So far, we have seen that the Chinese in Hong Kong tend to resort to a variety of medical traditions, particularly Western, scientific medicine, classical-professional Chinese medicine, and local-empirical remedies. Is there an order in the use of these different medical traditions?

The Kwun Tong Health A ttitudes and Behaviour Survey indicated that in the initial stage for common diseases, most respondents (57.9%) would self-medicate, 38.5% would resort to a Western-style doctor and only 3.6% would visit a Chinese-style practitioner. Self-medication often includes taking a rest, modifying food and diet pattern, and using relatively simple Chinese and/or Western medicinal material. By way of comparison, in a study of responses to actual illness episodes over a one-month period in 115 Taiwanese families in Taipei, Kleinman (1980: 183) found that 93% of illness episodes first received self or family care, and 73% received their only care in this setting.

I f the first moves do not work, most people (72.2%) would consult a Western- style doctor; only 11.7% would self-medicate and 11.5% would resort to a Chinese-style practitioner. It is noted that at this second stage, 4.6% would go to a Western medical hospital. 22

I f the second move is not effective, the proportion of respondents using a Western-style doctor would drop to 48.7% and the proportion using self- medication would drop to 1.8%. However, the proportion of people resorting to Chinese-style practitioners would increase to 20.1% and the proportion going to a hospital would rise to 29.3%.

It appears that the most typical process of seeking medical help is to move from self-medication, to Western-style doctors, to Chinese-style practitioners, and finally to a Western-style hospital. 23 Three qualifications should be made. Despite the lack of systematic data, it has been my observation that (1) self-


medication in the form of dietary modification usually continues throughout the entire process of seeking help and (2) magical-religious remedies are more likely to be resorted to towards the later stage of seeking help. (3) Prospective empirical studies of help seeking for actual illness episodes are needed to determine if these survey ffmdings of what individuals believe they would do comport with

how sick persons actually behave.

SUMMARY AND IMPLICATIONS

Hong Kong is a modern industrial society under British rule. An overwhelming majority of its population are Chinese in origin. Because of the support from government and universities, Western, scientific medicine has been the preeminent type of medical care in Hong Kong. Notwithstanding the predominance of Western medical science, many Chinese in Hong Kong are still dependent upon the sacred and particularly the secular traditions of Chinese medicine.

Magical-religious remedies in the context of Hong Kong include, for instance, the use of spirit-mediums (referred to as shamans in Taiwan and other Chinese communities) and Buddhist or Taoist priests; the worship of deities or ancestors and the propitiation of ghosts; the manipulation of fung-shui; and the wearing of jade ornaments and the use of magic charms. It seems, however, this sacred tradition is decreasing in significance. It is resorted to by relatively few people. The fact that it is more popular among women and less educated people suggests that the expansion of school education for both males and females in Hong Kong will result in a further decline of sacred medicine in the years ahead) 4 But as already mentioned, sacred folk healing appears to be flourishing in Taiwan in the face of very rapid modernization and urbanization (Kleinman 1980), and this seemingly paradoxical situation exists in other rapidly developing societies as well, so that the Hong Kong case needs to be understood in terms of its particular social context as sketched above.

The secular forms of Chinese medicine remain strong in the Chinese community of Hong Kong. The great number of Chinese herbal shops and Chinese- style practitioners of various kinds, and the countless advertisements and discussions appearing in local newspapers and popular magazines, reflect the popularity of secular Chinese medicine. Several sample surveys consistently demonstrated that both classical-professional (as represented by the Chinese- style practitioners of various kinds) and local-empirical (as represented by food therapy and home medicines for self-medication) types are resorted to by many ordinary Chinese people, and that this is the case among different sex, age, education, and income groups. It should be underscored that traditional remedies are often used in addition to modern Western medicine.

Based upon sample surveys, we can state with confidence that people are

362 RANCE P. L. LEE

relatively more confident in the Chinese medical tradition than in Hong Kong's Chinese-style practitioners. It might be due to the lack of uniform control over Chinese medical practice in Hong Kong. It appears that the biggest problem faced by secular Chinese medicine in Hong Kong is the lack of support from government. The government has neither controlled nor subvented any Chinese medical services. The lack of control makes people uncertain whether or not a Chinese-style practitioner is qualified. Moreover, the lack of government subvention coupled with the rising cost of Chinese medicinal material (due to the shortage of supply from China) has made it increasingly difficult for ordinary people, though not wealthy ones, to purchase traditional Chinese medicines.

Although the government does not support Chinese medicine, it does not eliminate it either. Because of its policy of minimum interference with local customs and usages, the government has been tolerant of traditional Chinese medical practices. Any person in Hong Kong can run a Chinese medicinal shop or practice Chinese medicine. To a large extent (with some limitations on wording), he is free to advertize and to popularize himself through mass media (this is not the case for Western-style doctors). Professional examinations and disciplinary action are not required by law. Nevertheless, it should be noted that the government's tolerance of Chinese medicine is not unconditional. The government claims that in order to safeguard public health, it is necessary to impose some measure of control. For example, any person practicing Chinese medicine is prohibited by law from using any name, title, addition or description which may induce the belief that he is qualified to practice according to modern scientific methods. The practice of Chinese medicine is also subject to certain technical constraints. The practice of surgery and the treatment of eye diseases are not allowed. The prescription and sale of Chinese herbs are not restricted, but if any patent medicine is found to contain any poisons, dangerous drugs or antibiotics, the proprietor will be prosecuted. Similarly, if any Chinese-style practitioner is found to use Western methods of treatment (e.g., injections, dangerous drugs or antibiotics, or X-ray) he will be charged under the provisions of the Medical Registration Ordinance, the Pharmacy & Poisons Ordinance, or the Antibiotics Ordinance.

Since control over Chinese medicine is minimal, malpractice and misues of Chinese remedies can hardly be avoided. As reported, there are many Chinese- style practitioners of various kinds in Hong Kong, but they appear to have varying qualifications. Some of them might have received substantial training through apprenticeship or in a Chinese medical training institution in mainland China, Taiwan or Hong Kong, but there are also 'quacks' who have few qualifications. With respect to local-empirical ideas and remedies, some of them may work effectively, but some may do more harm than good. In view of the fact that many Chinese people are still dependent on Chinese-style practitioners and


on Chinese medicinal material, perhaps the government should begin to question its long-time policy of minimum interference with local customs, and should either eliminate Chinese medicine or control it as much as it controls Western medical practice.

In order to exert uniform control over Chinese medical practice, a Medical Council for Chinese medicine should be established. However, I was once told by a reliable informant that the government would not consider it unless the practitioners of Chinese medicine organize themselves and make a petition together with a workable proposal to the government. Unfortunately, this is easier said than done. In recent years, there have been considerable discussions in the community on the possibility of organizing the Chinese-style practitioners and exercising uniform control over their education and practice, but so far no action has been taken by the practitioners. The reasons are obvious. First, many practitioners, particularly the less qualified ones, do not wish to subject themselves to professional examination and disciplinary procedures. Second, the different streams of thought in Chinese medicine and the numerous associations of Chinese-style practitioners in Hong Kong make it difficult even for well- qualified practitioners to decide who should be the 'examiners' or 'controllers'.

The classical-professional tradition of Chinese medicine is not a completely

unified system of thought. On the basis of distinctive components of Chinese cosmology (e.g. yin-yang, Five Elements, and Macrocosm-Microcosm interde- pendency) and different classical texts, scholars over the past several thousand years have grouped themselves into various schools of thought (for details, see Chinese Medical College of Peking 1973). In Hong Kong at present, there are 20 or more professional associations of Chinese-style practitioners. Some of the larger ones (e.g., the Association of Hong Kong & Kowloon Practitioners of Chinese Medicine, the Association of Kowloon Practitioners of Chinese Medi- cine, and the Association of Hong Kong Practitioners of Chinese Medicine) have as many as 1000 to 1500 members. Meanwhile, there are over 20 Chinese medical training institutes in Hong Kong, most of which offer a three-year curriculum at the 'undergraduate' level (admitting students who have completed secondary education and are over the age of 18) and some of which also offer a one-year 'postgraduate' course (for those who have completed the three-year training or have had at least five years of practical experience). 2s

Hence Chinese-style practitioners in Hung Kong have in some ways modified their social organization. They have established professional associations and have set up institutes for the training of practitioners (instead of relying solely on the traditional method of learning through apprenticeship). Unfortunately, these professional associations and training institutes lack uniform standards and disciplinary procedures. They issue certificates (which are often hung on the wall of the practitioner's office) to their members or graduates, but the lay

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public are generally not sure how good they are or which is more reliable. Unless

the government is willing to take the initiative, Chinese medicine in Hong Kong

will continue to lack uniform standards for training and practice. Consequently, current problems with malpractice and misuse of Chinese medicine will continue. As our survey data testify, people are relatively less confident in Hong Kong's Chinese-style practitioners than in the Chinese medical tradition itself.

To further modify the organization o f Chinese medical practice is important, but so is the advancement o f its technical content o f work. To upgrade the

technical quality of Chinese medicine, the use o f scientific methods may help

a great deal. According to recent reports (cf., Diamond 1972; and Kao 1974), medical workers in China have demonstrated that with the application of scien-

tific procedures, the efficacy of Chinese medicine or its combination with

Western skills can be greatly improved. However, Chinese-style practitioners in

Hong Kong seem to have done little in this direction. It may be due to their lack

o f scientific training. Nevertheless, in recent years an increasing number of

Western-style doctors and Western-trained scientists have become interested in

scientific studies of Chinese medicine. For example, a Chinese Medical Research Centre has been established by a reputable Western-style physician in Hong

Kong; and a research team comprising Western-style doctors and biochemists

have been testing the use of acupuncture for the treatment o f drug addiction.

Moreover, as Ogle (1979:2), a senior staff member in pharmacology at Hong

Kong University and an advocate of research on Chinese medicine, has recently

reported:

Academic staff members of the University of Hong Kong, mainly from the Preclinical Departments of the Medical Faculty, have been actively engaged in research on Chinese Traditional Medicine for many years. A review of the work carried out within the past 10 years, . . . reveals that . . . no less than 20 research papers have been published on the phamacological actions and other activities of various herbal medicines, and at least 11 articles on different aspects of acupuncture. Staff members from the Department of Chemis- try have published widely on the chemical analysis of plants; out of about 40 papers, more than 6 have been devoted to investigations on medicinal plants . . . . During the 10-year period reviewed, six postgraduates earned their higher degrees from research on such materials.

A significant event is the formation of the Chinese Medicinal Material Re- search Centre at the Chinese University o f Hong Kong in 1975. Its aim is to extract bioactive components from Chinese medicinal herbs by interdisciplinary research. At the present time, the Centre has 4 chemists, 3 biologists, 2 biochemists, 1 sociologist, 1 psychologist, and 1 library specialist. In addition to

building up a pharmacognostic file (currently totalling 12,000 entries), the Centre's staff has been studying anti-fertility herbs, herbs affecting hepatic func- tion, and anti-hypertensive herbs. Most likely, these various efforts will help

advance the technical aspect o f Chinese medicine.


The People's Republic of China has set a national policy of integrating Chinese and Western methods. In my own field-trips to several rural communes in south- ern China in the last three years (Lee 1978), I found that the national policy has been implemented down to the village level and is well received by rural dwellers. It is unlikely that the Hong Kong government will set up such a policy in the foreseeable future. There are, however, forces in the community pushing toward an integration of Chinese medicine with Western science. Probably the recent promotion of Chinese medicine in China has led Western-style doctors in Hong Kong to take more interest in knowing about, if not using, Chinese medicine. As mentioned, some of them have advocated, or taken part in, scientific studies of herbal medicine or acupuncture. Moreover, the Hong Kong Medical Association, which is the largest and the most active professional association of Western-style doctors in Hong Kong, has offered short-term training programs on the theory and use of acupuncture. Medical students have sponsored public exhibitions of Chinese medicinal herbs and techniques and have carried out simple investigations on popular herbal remedies (Ogle 1979: 2). In this connection, it should be reported that from interviews with 60 Western-style doctors in Kwun Tong in 1972 (Lee 1972: 45-46) , I found that 60% of them supported the integration of Chinese and Western medicine, 32% were undecided, and only 7% objected. Moreover, 56% felt that the community hospital (Western medicine) should include Chinese medical service, 35% were undecided, and only 9% objected.

Chinese-style practitioners are even more enthusiastic than Western-style doctors about this subject. In local newspapers and magazines, one can f'md a number of articles written by Chinese-style practitioners, asserting that Chinese and Western methods have their own strengths and weaknesses and that the two approaches should be integrated so as to complement each other. I interviewed 105 Chinese-style practitioners in Kwun Tong in 1972 (Lee 1972: 45--46), finding that 81% of them believed in the integration of Chinese and Western medicine, 15% were undecided, and only 4% objected. As regards the incorpora- tion of Chinese medical service into the community hospital, 85% were positive, 14% were undecided, and only 2% objected. Thus, most of the Western-style and particularly the Chinese-style practitioners under study seem to be favorably disposed towards the integration of Chinese and Western medical traditions.

The lay public also favor this integration. In the Lam Tin Health Survey, (1) 46.9% of the respondents felt that for the diagnosis and treatment of most diseases, the joint effort of both Chinese- and Western-style practitioners would do better than either type alone; (2) 95.3% felt that Western-style doctors in Hong Kong should learn traditional Chinese medicine; (3) 95.2% felt that Chinese-style practitioners in Hong Kong should learn Western methods; (4) 96.2% wished that universities in Hong Kong would provide medical students with both Chinese and Western medical training.

366 RANCE P. L. LEE

To sum up, Hong Kong does not have a national policy for supporting Chinese medicine or its integration with modern medical science. However, the people themselves resort to both systems of medicine, and 'integrate' the two approaches in one way or another. Furthermore, many practitioners of both systems seem receptive to each other. In recent years, increasing numbers of Western-style doctors and Western-trained scientists have shown their willingness to learn from the indigenous Chinese medical tradition. Chinese-style practitioners are even more enthusiastic than their counterparts about the possibility of integrating Chinese and Western medicine.

Before ending this paper, I would like to suggest some wider implications of the findings from the various studies I have reviewed. The interplay between traditional and modern elements in a modernizing society constitutes a fascinat- ing topic for social science studies. In the realm of health and illness, there have been numerous studies on the role of traditional medicine and its relationship with modern Western science in Asia and many other parts of the world (for some examples, see Landy 1977). Pertinent work in Asia includes medical anthropology and international health studies in different parts of India by Marriott (1955), Gould (1957, 1965), Leslie (1969, 1976b), Madan (1969), Bhatia et al. (1975), Beals (1976), and Taylor (1976); research on traditional Burmese medicine by Spiro (1975); the study of lay choices among modern and traditional forms of care in Northwestern Thailand by Kunstadter (1975); and investigation of the uses of traditional versus modern medicine in a rural Malay community by Chen (1969). The changing role of traditional Chinese medicine under the impact of Western medicine has been empirically investigated in several Chinese settings, as in studies by Hsu (1955) in a Chinese rural town prior to the Chinese Communist revolution; by Sidel and Sidel (1973), New and New (1977), and Lee (1978) in the People's Republic of China; by Fann (1965), Holbrook (1974), Ahern (1975a, 1975b), Gale (1975), Kleinman (1975, 1980), Martin (1975), Tseng (1975), and Unschuld (1976) in rural or urban areas of Taiwan; by Gwee et al. (1969) and Quah (1977) in Singapore; and by Chen (1975) and Dunn (1975) in Malaysia.

The societies in which these studies took place vary greatly in terms of national health policies, cultural norms, political structures, and levels of socio- economic development. The present paper adds to this general body of literature by examining the role of traditional Chinese medicine in relation to modern Western medicine in the context of Hong Kong, which is a highly industrialized and urbanized Chinese society under Western (British) rule for nearly one and a half centuries. Our studies in Hong Kong, together with the various studies I have cited for other parts of Asia, appear to show a general pattern.

It can be concluded that traditional medicine of various kinds persists, notwithstanding the introduction of Western scientific medicine. It is the coexistence


of both traditional and modern forms of medical care, rather than the displace- ment of one by another, that has been the typical pattern in different societies. The term 'coexistence' should perhaps be qualified; it is hierarchical rather than equalitarian. Partly because of the legitimation by political (government) and academic (university) authorities, Western scientific medicine has succeeded in subordinating traditional forms of remedies. On the other hand, the government's permissiveness toward traditional remedies may lead to an 'anomic' state within the traditional medical circles, and the universities' lack of concern may make it difficult for traditional medicine to maintain and upgrade its technical quality. Without positive support from political and academic authorities, traditional medicine can hardly modernize its social-organizational and technical contents of work and will thus continue to play a subordinate role in the realm of health and illness.

Despite the pre-eminence of Western medical science, however, many ordinary people retain trust in and resort to various forms of traditional remedies in

one way or another. Traditional and modem cures are often thought of as per- forming equivalent or complementary functions; they are not mutually exclusive

nor contradictory. It is the 'recipients', rather than the 'givers', who often rightly or wrongly integrate modern medicine with various forms of traditional remedies.

Apart from this general pattern, one important point of the present studies in Hong Kong needs to be highlighted. As we have seen, many people in Hong Kong resort to both traditional and modern medicine. What is most striking is that this is the case among people of very different social and economic (sex, age, education, income) groups. It is important to discern why this medical behavior is so pervasive in Chinese society?

To account for resort to both modern and traditional remedies, the present paper emphasizes the importance of identifying people's perceptions and evaluations of the salient attributes of clinical care (see WHO 1974). In the Chinese society of Hong Kong, speed of recovery from illness, prevalence and severity of side-effects, effectiveness in preventing infectious diseases, ability to strengthen one's constitution, and treatment of cause rather than merely symptoms of diseases are generally thought of as some of the salient attributes of medical care. Sample surveys show that Chinese medicine is generally perceived to be better than, or as good as, Western medicine in some ways, such as for tonic care, for fewer side-effects from treatment, for curing the cause of diseases, and for treating some diseases (e.g., measles, rheumatism, bronchitis, sprains and fractures). On the other hand, Western medicine is generally regarded as better for the treatment of most diseases, for faster recovery from illness, and for the prevention of infectious diseases. Because of these differential evaluations of their perceived attributes, people tend to consider it 'rational' to accept both Chinese and Western remedies. To them, the two medical traditions are not

368 R A N C E P. L. LEE

m u t u a l l y exclusive; in s t ead , t h e y p e r f o r m equ iva len t or c o m p l e m e n t a r y f u n c t i o n s

in the rea lm o f h e a l t h a n d illness. In th i s c o n n e c t i o n , i t shou ld also be m e n t i o n e d

t h a t d e e p - r o o t e d in Chinese cu l tu re are t w o general prac t ica l pr inc ip les o f every-

day life: (1) every a p p r o a c h is b o u n d to have i ts o w n s t r eng ths and weaknesses ,

and (2) a p e r s o n s h o u l d a d o p t t he s t r eng ths o f one a p p r o a c h to c o m p l e m e n t

t he weaknesses o f a n o t h e r app roach . Peop le ' s a t t i t udes t o w a r d t r ad i t i ona l a n d

m o d e r n med ic ine are, in e f fec t , a r e f l ec t ion o f these two core pr inc ip les in

Chinese c u l t u r e .

The Chinese University of Hong Kong

A C K N O W L E D G E M E N T

This is a revised version of the paper presented at the Anthropological and Sociological Studies of Asian Medicine Section (organized by Anthony Forge) of the International Conference on Traditional Asian Medicine, Australian National University, Canberra, 2 to 8 September 1979, under the auspices of the World Health Organization. The author wishes to thank the comments from Michael Bond and Arthur Kleinman. A substantial portion of the data in this paper were drawn from surveys funded by Harvard-Yenching Institute and the Hong Kong Government, under the auspices of the Social Research Centre of The Chinese University of Hong Kong.

NOTES

1. For more discussion on the theoretical formulations and healing procedures of classical Chinese medicine, see Palos (1971) or Porkert (1974).

2. Classical-professional Chinese medicine has also been recognized (Leslie 1976a: 1 -12) as one of the three great medical traditions in Asia, the other two being the Ayurvedic in South Asia and the Arabic-Greek (Yunani) in West Asia and other Muslim areas.

3. In recent years, medical workers in the People's Republic of China have made attempts to search out and record the wide variety of local-empirical remedies. Peasants in various localities have been encouraged to submit their indigenous cures or family secrets. Reportedly, the barefoot doctors have been playing a major role in this matter. A recent volume edited by Wu (1975) is a product of these efforts. A Chinese-style practitioner (Chung 1972) in Hong Kong has compiled a list of empirical remedies developed by the Cantonese.

4. Of these, 3,127 were registered in the Medical Council of Hong Kong, 210 were pro- visionally registered (i.e., new graduates from medical school, working as interns for one-year), 116 were unregistrable doctors being engaged in university teaching or government services, and 289 were unregistrable doctors practicing in charity clinics exempted from registration. For more discussion about these different types of Western- style doctors, see Topley (1976: 244-245) . In addition to these 'legal' doctors, there were also a thousand or so practitioners who illegally practiced Western medicine in Hong Kong. Most of these illegal practitioners were trained in China and then immigrated to Hong Kong.

5. All Cantonese terms in this paper are Romanized in the system of Meyer and Wempe (1947). However, when terms appear in quoted citations from the literature, they appear in the author's original Romanization.


6. Fung-shui (Cantonese) literally means 'wind and water'. It is concerned with the proper balance or harmony of dements in natural surroundings, and is perceived as a way of explaining and manipulating the fortunes and misfortunes of those who are living in a given setting (see Freedman 1968). As regards the art of fortune-telling, it uses various methods (e.g., face-reading, palm-reading, analysis of one's time of birth, feeling of bones, and analysis of one's name) to foretell the destiny of a person's life (see Tseung

1967). 7. Mann mae phox literally means 'ask-rice old lady'. They act as intermediaries between

the villagers and the supernatural worlds of heaven and hell. 8. At the time of the study, the temple had four spirit-mediums. 9. Of the 29 worshippers under observation, 5 were aged 27-39, 10 aged 40-49, and 12

aged 50-69. I wish to thank Mr. Davy Leung for his assistance in collecting the data. 10. For more details about Kwun Tong and its people, see Chan (1973); and Lee (1973).

As King (1973) has shown, Kwun Tong is by no means a self-contained community; its social, political and economic life is to a large extent connected with, and thus in many ways similar to, Hong Kong society as a whole.

11. In addition to these three major types, there are also specialists in sex-related illnesses, in pediatrics and gynecology, in ear-nose-throat diseases, in hemorrhoids, and in skin diseases, etc.

12. The immigration of people (some of whom have had medical training) from the Chinese mainland since 1969 has further swollen the number of Chinese-style practitioners in Hong Kong.

13. According to the 1971 Census, 88.2% of the people in Hong Kong were Cantonese- speaking. Of these, a great majority were born in Hong Kong or immigrants from Kwangtung Province in China.

14. Chung (1978), for example, has described a total of 299 kinds of food and their effects - in terms of Chinese medical conceptions - on health and illness.

15. Many kinds of poultry and wild animals are regarded as 'hot ' foods. It is also generally believed that fried oily foods and spicy foods are 'hot'. Other examples are crab, shrimp, turtle, carp, coffee, lichees, durians, brandy, and Korean ginseng. 'Cold' foods include many kinds of green vegetables (e.g., lettuce, water-cress, leaf mustard, angled luffa, bitter melon, small green bean, and spinach) and fruits (e.g., banana, water melon, water chestnut, and pear). Other examples of 'cold' food are beer, whisky, green teas, bean curd, American ginseng, and chrysanthemum tea. Rice, potatoes, and many kinds of Chinese red teas are generally regarded as neutral. Some people (particularly Chinese-style practitioners) classify foods into five categories in terms of the magnitude of cooling or heating effects: cold, cool, neutral, warm and hot.

16. F o r example, mango and Mandarian orange are 'wet'; lichees and coffee are 'dry'; snake and Korean ginseng are 'tonic'; goose and uncastrated cock are 'poisonous'; pig's blood and chrysanthemum could help 'purify' the blood or eliminate poisons; and glutinous rice and chestnut are 'bulky'. For further discussion of these various concepts, see Anderson 1978.

17. The variable 'use of Chinese-style relative to Western-style practitioners' is scored as follows: Chinese-style only (scored 2), both (scored 1), and Western-style only (scored 0). The variable of sex is transformed into a dummy variable: male (scored 0) and female (scored 1). The variable of age consists of three categories: under 35 (scored 0), 35-49 (scored 1), and 50 or above (scored 2). The educational levels are: no schooling (scored 0), primary education (scored 1), and secondary school or more (scored 2). Income status refers to the total household income per month. Since at the time of the study most residents in the community belonged to the middle- or lower-income groups, the variable of income status is divided into two categories: under HK $ 800 (scored 0) and HK $ 800 or above (scored 1). It should be reported that according to the 1971 Census, the medium household income per month (as of January 1971) in all

3 7 0 R A N C E P. L. LEE

of Hong Kong was HK $ 700.8. In my survey, I used a somewhat higher figure (HK $ 800) as the dividing point, because the survey was undertaken in the summer of 1972, not in January 1971. To some extent, therefore, I took inflation into consideration.

18. According to Topley's (1976: 259) observation, there are normally four kinds of items: (1) traditional drugs, e.g., 'Protect Infant Pills', crushed pearl powder, and medicines for diarrhea and vomiting, for boils or other skin complaints; (2) modem traditional medications, including oils and ointments for skin trouble, stomachache, headache, and toothache; (3) modern Western medicine, including penicillin ointment, iodine and other preparations for wounds, aspirin, and cold cures; and (4) traditional substances packaged to look like modern medicine, of which many are panaceas.

19. According to our survey in 1971, there were 16 Chinese-style practitioners of various kinds in the Lain Tin community (see Lee and Chin 1972: 8).

20. Except for the variable of income, other variables in this study are formulated in the same way as those in the Kwun Tong Health Att i tudes and Behaviour Survey (see footnote #16). Income status also refers to the total income of household per month, but the variable is divided into HK $ 1500 or less (scored 0) and HK $1501 or more (scored 1). The reason for the change of the income categories is to take into consideration recent inflation.

21. The gamma values are 0.69 among women, and 0.70 among men; 0.67 among young- age, 0.73 among middle-age, and 0.67 among old-age; 0.74 among low-education, 0.68 among middle-education, and 0.68 among high-education; 0.62 among low-income and 0.73 among high-income groups. All relationships are statistically significant at the 0.001 level (chi-square test).

22. There is no Chinese medicine hospital in Hong Kong. There are such hospitals in the People's Republic of China and in Talwan.

23. This pattern has also been confirmed by cross-tabulation tables showing the 'internal shifts' between the three stages of seeking help.

24. Hong Kong has undergone rapid expansion of education in recent years. From 1964 to 1974, for example, the number of pupils in primary schools increased from 596,971 to 721,517; the number in secondary schools increased from 177,680 to 344,171; and the enrolment of full-time students in post-secondary institutions increased from 6915 to 15,834, while that of part-time students increased from 11,917 to 30,607 (see Census & Statistics Department, Hong Kong, 1975 :60 -61 ) .

25. Choa (1967a) had the impression that most practitioners of Chinese medicine nowadays are products of these training institutes. From one of these institutes (Ching Wah Chinese Medical Institute, founded in 1953) I once visited, I learned that up to 1972 it had produced a total of 435 graduates.

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Perceptions and uses of Chinese medicine among the chinese in Hong Kong