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RESPIRATORY RESEARCH
\

in the

PEOPLE’S REPUBLIC OF CHINA

by

Frederick 5113210, M.D., PhD.
Professor of Physiology
State University of New York
Downstate Medical Center
Brooklyn, New York

A publication of the

Geographic Health Studies
JOHN E. FOGARTY INTERNATIONAL CENTER
for Advanced Study in the Health Sciences

US. Department of Health, Education, and Welfare
Public Health Service
National Institutes of Health

DHEW Publication No. (NIH) 75-770

 

For sale by the Superintendent of Documents
US. Government Printing Ofﬁce, Washington, DC. 20402
Price $1.75 Stock Number 017-053—00037—0

SOVIET HEALTH STUDIES '\
1.

\OOOQO\UI-hwl\)

10.
ll.
12.
13.
14.

Other Publications of the Geographic Health

    
 

FOR .
ADVANCED STUDY IN THE HEALTH ‘

93.5
Anatomy of East-West Cooperation. U.S.-U.S.S.R. Public Health Exch
1958-1967 "r w:
. The Soviet Five-Year Plan for Public Health, 1971-19751
. Fundamental Principles of Health Legislation of the U.S.S.R.T
. Soviet Medical Research Priorities for the Seventies
. The Soviet Feldsher as a Physician’s Assistant
. Medical Care in the USSR.
. Nutrition Research in the U.S.S.R., 1961-1970
. Machine Diagnosis and Information Retrieval in Medicine in the U.S.S.R.T
. Soviet Medicine: A Bibliography of Bibliographies
Chronic Effects of Mercury on OrganismsT
Soviet Biomedical Institutions: A Directory
Soviet Personalities in Biomedicine
Soviet Research in Pharmacology and Toxicology
A Bibliography of Soviet Sources on Medicine and Public Health in the U.S.S.R.

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’CHINA HEALTH STUDIES

1

OOPGQO‘UIA

g; 1. Medicine and Public Health in the People’s Republic of China

. Topics of Study Interest in Medicine and Public Health in the People’s Republic of
China: Report of a Planning Meeting

. A Bibliography of Chinese Sources on Medicine and Public Health in the People’s
Republic of China: 1960-1970

. Anticancer Agents Recently Developed in the People’s Republic of China ~ A Review

. Prevention and Treatment of Common Eye DiseaseS]L

. Standard Surgical Techniques, Illustrated'l'

. Neurology — Psychiatry'l'

China Medicine As We Saw It

. Chinese Herbal Medicine

. Acupuncture Anesthesia in the People’s Republic of China, 1973

SWEDISH HEALTH STUDIES

1.

National and Regional Health Planning in Sweden

TTranslations of Soviet and of Chinese documents, produced in very limited quantities

only.

 

CONTENTS R C
732
K36
Preface ........................ PUBL . . vii

Foreword . . . . .' ................... ix

Page

Acknowledgments ............................. xi

Chapter I. Introduction: A Historical Background for the Understanding
of Medicine in China Today .......................

Reference ............................... 8

Chapter 11. Institutional Medicine in the People’s Republic of China:

Visits to Hospitals and Research Institutions .............. 11
Progress After 1949 ......... 7 ................. 11
The Kwangtung Province People’s Hospital .............. 13
Loh Kang Commune .......................... 14
Capital Hospital, Peking ........................ 16
The Shanghai Physiological Institute .................. 16
Institute of Materia Medica in Peking and in Shanghai ......... 17
The Second Medical College in Shanghai ................ 18
Summary ................................ 1 8
References ............................... 27

Chapter III. Development of Physiological Concepts in China ....... 29
The Early Development of Anatomy .................. 29
The Early Discovery of Circulation ................... 30
The Early Practice of Surgery ..................... 30
Ancient Chinese Physiological Theories ................ 31
The Energy Theory (the Theory of Ch’i) ................ 32
The Organ Theory (the Theory of Tsang-Hsiang) ............ 34
The Meridian Theory (the Chinglo Theory) .............. 34
The Yin-Yang and Five-Element Doctrines ............... 37
Other Aspects of China’s Medical Heritage ............... 38
Summary ................................ 39
References .............................. 40

Chapter IV. Respiratory Research in China Prior to 1949 ......... 43
The Transitional Period of Physiology in China ............ 44
Summary and Conclusions ....................... 45
References ............................... 47

iii

0108'"

Chapter V. Respiratory Research in Contemporary China ......... 51

Research in Pulmonary, Anatomical, and Functional Geometrics . . . 51
Research in the Kinematics of the Lung System ............ 53
Research in Lung Dynamics ...................... 56
Research in Gas Exchange and Gas Diffusion in the Pulmonary System 56
Research in the Regulation of Ventilation ............... 56
Pulmonary Function Testing Research ................. 59
Instrumentation in Respiratory Research ............... 61
Smoking and Air Pollution Studies ................... 65
Research in Altitude and Hyperbaric Physiology ............ 65
The Historical Development of Altitude Physiology in China . . . . 66
Hyperbaric Physiology ....................... 70
Summary and Conclusions ..................... I . . 70
References ............................... 71
Chapter VI. Clinical Respiratory Research ................ 77
Chinese Priorities in Respiratory Disease Research ........... 77
Health Stations and Mobile Unit Concepts ..... _. ......... 77
Clinical Reports on Respiratory Diseases ................ 77
Advancements in Respiratory Drugs .................. 79
Summary and Conclusions ....................... 82
References ............. ‘ .................. 83
Chapter VII. Acupuncture and Respiratory Research ........... 87
A Short Historical Account of Acupuncture .............. 87
Acupuncture and Respiratory Diseases ................. 88
Acupuncture Anesthesia and Respiration ............... 90
Summary and Conclusion ................. —. ..... 92
References ............................... 93
Chapter VIII. Publication of Physiological Journals in China ....... 97
Summary and Conclusions ....................... 106
References ............................... 108

iv

Chapter IX. Medical Education and the Training of Physiologists ..... 109

Summary and Conclusions ....................... 114
References ................. , ............. 1 15
Chapter X. Conclusion and Future Prospects ............... 117
References ............................... 121

Appendix 1. Respiratory Drugs Made in the People’s Republic of China . 123

 

PREFACE

The worldwide eradication of disease is a declared major goal of United States
health efforts, and aid to all nations toward the elimination of hunger and sickness is
an aim that has been ofﬁcially enunciated on several occasions.

Much progress in these directions has and is being made, and the John E. Fogarty
International Center for Advanced Study in the Health Sciences is playing a part in
this progress.

Established as part of the National Institutes of Health in July 1968, and named in
memory of the late Congressman John E. Fogarty of Rhode Island, the Center is an
organization envisioned by Mr. Fogarty and called for in his address to the Third
National Conference on World Health in September 1963, as “a great international
center for research in biology and medicine dedicated to international cooperation and
collaboration in the interests of the health of mankind.”

With Senator Lister Hill of Alabama, Congressman Fogarty charted the growth of
the National Institutes of Health and the nation’s medical research and education for
nearly two decades as Chairman of the House of Representatives’ Appropriations
Subcommittee on the Departments of Labor, and Health, Education, and Welfare.

The many-faceted operations of the Fogarty Center have grown and flourished in
collaboration with other American, foreign national and international bodies, and by
means of bilateral agreements with the governments of several countries including
France, Italy, Japan, and the U.S.S.R. The Center also has the effective and continuing
cooperation of the World Health Organization and the Pan American Health Organiza-
tion, and engages in less formal exchanges involving scientists and physicians from the
United States and abroad. Similarly, toward the production of new and valuable
medical ﬁndings, it shares its resources with other elements of the National Institutes
of Health and with the US Public Health Service.

In addition to serving as the communications pulse for scientiﬁc information
emanating from abroad, the Center provides American and overseas scientists oppor-
tunities to deal with complex problems of vital concern in mankind’s well-being.
These opportunities and services are inherent in the Center’s International Education
Program, in its International Fellowship Program and the Visiting Program for Foreign
Scientists. Also being implemented is the Center’s International Research Exchange
Program that enables American health professionals to study abroad.

Many and varied health-related topics have been investigated by the Center’s
Scholars-in-Residence Program, by a continuing program of conferences and seminars,
and by its ﬁve-year-old Geographic Health Studies Program. This latter enterprise, a
series of studies designed to obtain and disseminate comparative knowledge of the
health-care systems of other countries, is this publication’s raison d’etre.

vii

Inquiries about this and other publications of the Geographic Health Studies
Program, which are listed elsewhere in this book, should be directed to Dr. Joseph
R. Quinn, Geographic Health Studies Program, Fogarty International Center,
Bethesda, Maryland 20014.

Milo D. Leavitt, Jr., MD.
Director
Fogarty International Center

FOREWORD

The current state of our knowledge of pulmonary medicine reﬂects the con-
tributions of scientists and physicians working in many countries in all parts of
the world. Knowledge of physiology is universal, hence its fabric requires contin-
uous interchange of ideas among scientists of different backgrounds. The ﬂow of
information from the People’s Republic of China has been interrupted for many
years, but it is now evident that we have much to learn from Chinese pulmonary
medicine. Indeed many pulmonary diseases are related to local ecology, and it is
well known that some aspects of physiologic function may differ among ethnic
groups. Thus, it is essential that occidental scientists have the opportunity to
share observations with their Chinese counterparts in physiology and medicine.

For the American scientist interested in the biology of the respiratory system
in health and disease, it is most fortunate that Dr. Kao, an eminent respiratory
physiologist, has undertaken to study the contributions of Chinese research in
the field of respiration. His monograph reviews many facets that are of great
interest, although it is obvious that some limitations prevented an in-depth study
of the topics encompassed in his report.

Nonetheless, this book represents a giant step toward learning about pul-
monary medicine and research in the People’s Republic of China. For this, Dr.
Kao is to be congratulated.

Claude Lenfant, MD.
Director, Division of Lung Diseases
National Heart and Lung Institute

 

ACKNOWLEDGMENTS

The author wishes to acknowledge the generous assistance of many institu-
tions and people who have made this monograph possible. The staff of the
Chinese Embassy" 1n Ottawa, Canada, and of the Permanent Mission of the
People’s Republic of China to the United Nations deserve special mention for
their efforts 1n obtaining visas to China. The Responsible People of the
Chinese Medical Association in Peking and of its many branches in the cities that
the delegation with which I traveled visited and the Responsible People of the
International Travel Service and Overseas Travel Service in China were most
gracious, arranging for our itinerary and providing for the necessary assistance in
our visit. I owe my special thanks to the Responsible People of the communes,
hospitals, schools, factories, Youth Palace, nurseries, museums, and other institu-
tions that we visited, and to the many workers, scientists, professors, and physi-
cians with whom we talked. They provided information that greatly enriched
our visit.

The staff members of the Medical Research Library at the Downstate Medical
Center of Brooklyn, N.Y., of the Yale University Medical Library, New Haven,
Conn., and of the National Library of Medicine of the National Institutes of
Health, Bethesda, Md., were most helpful searching for literature related to this
monograph.

I wish to express my special gratitude to my laboratory staff: Ms. Inga Piazza,
who spent many laborious hours working over and typing the manuscript, and
Ms. Sarah Mei, Instructor of Physiology, who did original literature research,
made graphs, and proofread the entire manuscript. Needless to say, no responsi-
bility for errors of any sort, including the statistical quotations, statements, etc.,
rests with these individuals.

I wish to express the’ warmest sentiments to my family—to my wife Edith,
who stood steadfastly behind my ventures in this historic time of international
relations, and to my son John, who accompanied me to China and who spent
endless time improving the style and language of the monograph.

Finally, my thanks are due to the Fogarty International Center, National
Institutes of Health, Bethesda, Md., for its publication of this monograph, as
well as its support of my travel to the People’s Republic of China.

lOrganizations including communes are governed by a committee, the head of which is
the Fu Tze Jen or the Responsible Person.

All the sciences of ancient times and the Middle Ages had their very distinct
ethnic characteristics, whether European, Arabic, Indian or Chinese, and it is
only modern science which has subsumed these ethnic entities into a universal
mathematised culture. But while all the physical and some of the simpler
biological sciences of China and Europe have long fused into one, this has not
yet happened with the medical systems of the two civilisations. As we shall later
see, there is much in Chinese medicine which cannot yet be explained in modern
terms, but that means neither that it is valueless, nor that it lacks profound inter-
est.

Joseph Needham

Medicine and Chinese Culture

In: Clerks and Craftsmen in
China and the West

Cambridge University Press, 1970

xii

Chapter I

INTRODUCTION:
A HISTORICAL BACKGROUND FOR THE UNDERSTANDING
OF MEDICINE IN CHINA TODAY

The purpose of this report is to present my observations as a respiratory physi-
ologist and as editor of the American Journal of Chinese Medicine of medical
facilities toured extensively during two recent trips to the People’s Republic of
China. Although this report is concerned primarily with the nature and develop-
ment of respiratory physiology in China, such a specialized presentation is insep-
arable from the larger discussion of the social and cultural background of Chinese
medical practices. It is for this reason that I ﬁrst present some general comments
about medicine in both ancient and modern China to establish a background
against which the discussion of respiration will hopefully become more vivid.
Second, I present information on various representative medical institutions in
China—research work in respiration and/in respiratory diseases is inseparable
from the unique institutional style of investigation and clinical studies in contem-
porary Chinese society. Finally, a detailed account of the history and present
status of respiratory physiology in China is presented, with particular reference
to research, clinical studies, public health programs, educational work, and
scientiﬁc publication.

The year 1971 marked a time in which the relationship between China and
the United States began to thaw after a 22-year hiatus. The Ping-Pong diplomacy
of April 1971 was quickly followed up by diplomats and journalists when
President Richard Nixon made an unexpected announcement on July 15, 1971,
concerning Dr. Henry Kissinger’s China visit and the President’s planned visit
(1.1). Medical professionals also visited China soon afterward, and their reports
have made a deﬁnite impact on the health-care concepts of American society, an
impact which is only now being digested and put into perspective (1 .2-1 .6).

In 1972,I spent 3 weeks in China. Scientiﬁc and scholarly interest prompted
me to initiate the organization of an American medical delegation to visit China
in 1973, which was composed of 13 individuals. Our team toured medical insti-
tutions throughout China for 40 days at the invitation of the Chinese Medical
Association and was sponsored by the American Journal of Chinese Medicine.

Our delegation was the ﬁrst group of American-Chinese medical scholars to
visit China. It included a pharmacologist, internist, cancer specialist, neurophysi-
ologist, neurosurgeon, nurse, anesthesiologist, specialist in rehabilitation medi-
cine, physiologist, and a medical student. We traveled almost 6,000 miles and

1

visited nine cities while in China. This visit exposed to us a country with a new
social and medical system. I was profoundly affected by the scope of this exper-
iment in social engineering, which, historically speaking, has been one of the
main features of Chinese culture. Chinese medicine is an example of that experi-
ment and has had a duration in China of more than 2 millennia.

The transformation of medicine and the medical delivery system in modern
China has been one of the most astonishing achievements of the new social struc-
ture. Medicine is not only a physician with a pill or a syringe, not only an insti-
tution, not only a system; it is all of these and more. It is a social order unto
itself that affects all aspects of the human being.

To understand new China, it is absolutely necessary to look into the past for
comparison. This cannot be accomplished easily by an observer who casually
lands in China and stays for a short time. It is necessary to have a valid perspec-
tive for comparison that embraces an intimate understanding of China prior to
1949. Among recent travelers to China from this country were some born
in China who came to the United States after receiving special education
(1.7-1.23). Such individuals are uniquely equipped to make judgments concem-
ing the scientiﬁc progesss of present-day China. I came to the United States
after graduating from medical school in China, and for the past 25 years, I have
lived mostly in the United States. When I visited China in 1972 and in 1973, I
was like a person suddenly thrust into an entirely new environment while my
mind and experiences were still prograrned with events of the old, thus making
possible a unique type of internal comparison between the past and the present.

The contrast between the two Chinas—that is, the country before and after
l949—perhaps may be illustrated by some of my own experiences. In 1943,
while passing through the famine region in Honan, I observed that the bark of
the trees had been stripped to the level of a man’s height and consumed by
human beings who were too weak to reach any higher. Emaciated and jaundiced
children walked about with thin legs, protuberant bellies, sunken eyes, and pro-
truding cheek bones. It has been estimated that 1,800 famines have occurred in
China and that the one in Honan in 1943 took over 3 million lives alone. China
was not a sleeping giant, but rather a sick and incapacitated‘one. She was a giant
in terms of large territories and a huge population and of the innumerable and
imponderable problems that confronted her. China’s history records a constant
struggle with social and public problems, but none seemed so beyond redress as
those of the last century (1.24).

After a visit to modem-day China, one cannot refrain from asking the press-
ing question, How could a backward country like China in the early 1900’s cope
so effectively with medical crises and social problems after the middle of the
1950’s with such small resources and means of delivery to the extent of being
one of the healthiest countries in the world at the present time? Naturally, as a
medical physiologist, I was keenly interested in the answer to this question.

Since medicine is a complex social and cultural phenomenon, it may fruitfully
be correlated with the developmental history of particular societies and is a
potent index to all aspects of social change and development. It seems undeniable

2

that there is developed medicine in developed countries and poor medicine in
poor countries. The quantity and quality of medical care available to the people
in a given society are genuine expressions of the society’s complex social struc-
ture and cultural background, including economic, political, and scientiﬁc reali-
ties.

China has had a long history of medical thought and development, only the
sum total of which may be rightly called Chinese medicine. Before King David
played his harp against the north wind, China had therapeutic systems employing
acupuncture, herbology, and many other forms of medical treatment. When the
ink on Homer’s Odyssey was barely dry, China had the Yellow Emperor’s Canon
of Internal Medicine. The Chinese discovered circulation roughly 1,700 years
before William Harvey’s rediscovery of that same phenomenon, and smallpox
was prevented by inoculation procedures in China about a thousand years ago
(1.25). It is not fair to say that the Chinese merely want to express nationalistic
sentiments by stressing the development of Chinese medicine at the present time
(1.26, 1.27). China does have venerable medical treasures that are currently
being researched, modernized, and integrated with Western medical concepts and
techniques because of their inherent worth (1 28-131).

Medicine is a total social phenomenon, and there has perhaps never been such
a rapid transformation in medical theory and practice as that which has occurred
in China during the last 25 years. It is difﬁcult to accept the notion that what is
happening in China today in the field of medicine is a mere expression of nation-
alism. China’s culture has many unique and different characteristics, and it is
necessary to discuss some of them in order to understand present-day Chinese
medicine. ,

Chinese culture is characterized by its abilities in social assimilation. This is
especially true in the ﬁeld of medicine. Chinese medicine undoubtedly began to
develop quite early, and systemic traditional Chinese medicine may have had its
origins around 1000 B.C. (1 32-134). In Chinese medicine’s several thousand
years’ history, there have’been foreign medical inﬂuences that were subsequently
absorbed, assimilated, and integrated. For example, exchange between the West
and China after the famous expedition of Chang Chien in the Han dynasty (2nd
century B.C.) must have brought back to China many medicinal herbs in addition
to plants and other curios; when Buddhism was introduced to China in the lst
century A.D., foreign medicine again must have accompanied its introduction;
Indian medicine has undoubtedly had a strong inﬂuence on China; and knowledge
.of Arabic medicine was also brought to China in the 6th to 8th centuries A.D.
(1.35-1.37). However, none of these inﬂuences had the impact of Western
Medicine, which was introduced to China in the middle of the 19th century.

The development of Chinese medicine gained new momentum following 1949,
especially during the Cultural Revolution of 1966-68 when it became the medi-
cine of the people, for the people, and by the people. According to the govem-
ment’s directive 626, a new policy was formulated that advocated putting the
emphasis in medical care on rural areas where over 80 percent of China’s popula-
tion lived. New innovations in medical care and delivery that were developed

3

during this period include mobile units for teaching and research, the assignment
of medical personnel to rural areas, and the treating of patients in their own
beds at home, all of which are important concepts in the recent development of
Chinese medicine. It has taken China only 25 years to develop a modern, inte-
grated medical system; it will take anthropologists, historians, and sociologists
far longer to determine the impact and signiﬁcance of these accomplishments.

Naturally, there are many further questions to raise. What are the new empha-
ses in medicine in China subsequent to the conquest of infectious diseases and
control of social diseases, which were effectively eliminated with public health
measures and organizational efforts (1 .38-1 .40)? How many new medical discov-
eries have been derived from traditional Chinese medicine, for example, the dis-
covery of acupuncture analgesia and the attempt to establish it on a sound and
valid scientiﬁc basis? At the present time, neurophysiologists in China, and to a
certain extent in other countries including the United States, have been very
much stimulated by the discovery of acupuncture analgesia. What will be the
impact on the Western world of the practice and employment of acupuncture
analgesia in surgical operations? What will be the contributions of traditional
Chinese medical techniques to cancer, heart disease, and emphysema therapy?
What will be the real and ﬁnal product of the integration of Western medicine
with Chinese traditional medicine? What, if any, is the significance and useful-
ness of Chinese traditional pharmacology, which has evolved and been in use in
China for several millennia? It seems undeniable that the delivery of medicine to
people in the remote frontier areas and hinterlands is one of Chinese medicine’s
most fundamental accomplishments. What is the signiﬁcance and impact, then,
of this delivery system for the peoples and medical systems of other countries,
developed and undeveloped alike?

Naturally, it is easier to raise questions than to ﬁnd answers for them. The
real concern in this monograph lies in understanding the factors that caused
these changes in medical theory and care as they apply to the ﬁeld of respiratory
physiology. Obviously, instead of depending on foreign help, as in the period
before 1949, the people of China now follow the directive “let the old serve the
new and the foreign serve China.” This motto has clearly determined the road
along which Chinese medicine has developed in recent years. China has a rich
heritage in medical technique and theory, and it is logical to look up ancient texts
and to develop and vivify them for the beneﬁt of people today. This process of
integration has been carried out with modern and scientific methodology. The
synthesis of insulin and the chemical isolation of active compounds in traditional
Chinese herbs, which have been in use for centuries, are some examples of this
process.

Being a respiratory physiologist, I do not pretend to be able to answer many
of the questions that may be raised concerning the recent development of medi-
cine and medical thought in China. It is of interest to me, however, to report
and discuss in this monograph some recent developments in medicine in China
and the progress that has been made in conquering disease, particularly respira-
tory disease, which, because of increases in world population and the expansion

4

of industrialization, is a major world health problem of increasing
dimensions.

In the United States, it has been estimated that respiratory disease causes “an
estimated 150,000 deaths, 60 million days lost from work, and 40 million days of
bed-restricted activity each year” (1.41). It has also been recognized that

, . . at present some respiratory diseases are not receiving an emphasis commensurate with
their importance to national health. A balanced program must address a spectrum of
diseases from infancy through adulthood, and an effective program must embrace a
breadth of problems and research approaches. Problems addressed must range from
etiology and pathogenesis to therapy and rehabilitation; research approaches must extend
from biochemistry and pathology to epidemiology and clinical trials. [1.41, p. 1.]

Problems in respiratory research have been well identified in recent years in the
United States; it remains to be demonstrated that the Chinese have put similar
and corresponding efforts into the solution of these problems.

This report gives a personal view of what is and has been accomplished in
China concerning respiratory physiological research and the conquering of respi-
ratory diseases. It is hoped that further scholarly exchange will be established to
facilitate the processes of mutual learning and eventually mutual collaboration to
conquer diseases for the beneﬁt of all mankind.

Any attempt to discuss the long historical development of Chinese medicine
as embodying a succinct system of medicine is a justiﬁable and necessary enter-
prise in our present state of cultural and international awareness. Modern China
has inherited a self-proclaimed “treasure-house” of medical concepts and tech-
niques, the substance of which has yet to be fully explored. The development
of systemic medicine in the West has certainly had an impact on medicine in
.China, but this may be viewed as a dynamic interrelationship that must eventually
evolve into a totally integrated form of world medicine. China has adopted such
a road and has made good progress on it. A review of China’s accomplishments
in medicine and health-care delivery, including those aspects related to respira-
tory diseases, should be made in light of comparison of the state of China before
and after these efforts to integrate the two great streams of Eastern and Western
medicine, a process that began in China in the middle of the 1950’s. A great
deal of progress has been made in medicine in China since then. The charts on
the following pages depict some of this progress.

570-225 0 - 75 - 2

Scheme Illustrating Some of the Sources of Chinese Medicine

Modiﬁed from Wong and Wu (1.31)

Chinese folk medicine Plant lore, demonic beliefs, Faith healing,
legends

Chinese systemic medicine The Yellow Emperor’s Canon of Internal
Medicine
The doctrine of the ﬁve elements and the
principles of Yin-Yang
The Treatise on Fevers—Chang Chung-ch’ing,
the Chinese Hippocrates

The period of Buddhism
contamination Indian medicine
Arabic Medicine
Taoism
Alchemy
Charms
Deep breathing, exercise, autosuggestion

The period of intensive The Tang Dynasty
specialization
The progress in The Sung Dynasty
acupuncture The four schools of the Chin Yuan Period
The period of Western The sects of the Ming and Ch’ing Dynasties
invasion
The decline of Chinese The Ch’ing and the Republic period
medicine

The period of Grand Integration

The Chinese New Medicine

Historical Development of Chinese Medicine and Some of the Important Dates

4,000 B.C. Prehistoric medicine
2,000 B.C. Magicoreligious medicine
800 B.C. Systemic medicine
20 B.C. Circulation discovered
250 Discovery of chemical anesthesia
ABC of Acupuncture published
Era of Chang, Chung—ching
Era of Hua To
450 Medical school established
600 Medicine from China spreads to Japan

Fusion of Arabic and Indian medicine

1100 Further development of acupuncture

1700 Enlightenment of and anatomy
Western medicine

Infusion of Western medicine and decline of Chimse medicine

1835 Peter Parker of Yale started inﬁrmary

in Canton
1910 Flexner Report
1916 The establishment of Peking Union
Medical College
Chaotic vs. systemic
medical education in 1929 Further decline of Chinese medicine
America
Professionalism

Fusion of Chinese tradition and Western medicine

1948 Scientiﬁc medicine 1949 Grand fusion of East and West
in medicine

1958 Discovery of acupuncture analgesia

1966 The establishment of the New Chinese
Medical System
The New Ecumenical Medicine

7

1.1

1.2

1.3

1.4

1.5

1.6

1.7'

1.8

1.9

1.10

1.12

1.13

1.14

1.15

1.16

1.17

1.18

REFERENCES

New York Times: “Nixon Arrives in Peking to Begin an 8-day Visit Met by
Chou at Airport.” February 21, 1972.

Dimond, E. G.: Medical education and care in People’s Republic of China
JAMA, 218:1552-1557, 1971.

Jen, C. K.: “My Impressions of the New China and Its Science and Technol-
ogy.” Unpublished report, December 19, 1972.

Sidel, Victor W.: The barefoot doctors of the People’s Republic of China.
New England Journal ofMedicine, 286(24): 1 292-1300, June 15, 1972.

Sidel, Victor W.: Some observations on the health services in the People’s
Republic of China. International Journal of Health Sciences, 2(3):385-395,
1972.

Side], Ruth: Social services in China. Social Work, 1725-13, 1972.

Cheng, Tsung 0.: Other medical advances transcend use of acupuncture.
Internal MedicalNews, 5:1-32, Oct. 15, 1972.

Cheng, Tsung 0.: Medicine in the People’s Republic of China. Annals of
Internal Medicine, 78(5):835, May 1973.

Cheng, Tsung 0.: Health care in the People’s Republic of China. Clinical
Research, 21 :536, Apr. 1973.

Cheng, Tsung 0.: A view of modern Chinese medicine. Annals of Internal
Medicine, 75:285-290, Feb. 1973.

Chow, Kao Liang: Brain research in China. Brain Research, 572N34-N37,
1973. ‘
Rodale, Robert: The smog in China, Environment Action Bulletin, 4:2
ff.,Mar. 17,1973.

Cobb, W. Montague: NMA China visit. Journal of the National Medical
Association, 65:3, Jan. 1973.

Geiger, H. Jack: Putting China’s medicine in perspective. Medical World
News, 14:43-49,May 18, 1973.

Geiger, H. Jack: Health care for a ﬁfth of the world. Medical World News,
14:22-28,June 1,1973.

Geiger, H. Jack: How acupuncture anesthetizes: The Chinese explanation.
Medical WorldNews, 14:51-61,July13,1973.

Griggs, Anthony: Chinese herbal treatment: A science under siege, Race
Relations Reporter, 4:19-22, May 1973.

Liang, Matthew H., Eichling, P. 8., Fine, L. J., and Annas, G. J.: Chinese
health care: Determinants of the system. American Journal of Public
Health, 63:102-110,1973. ’

1.19

1.20

1.21

1.22

1.23

1.24
1.25

1.26

1 .27

1 .28

1.29

1.30

1.31

1.32

1.33

De Haas, J. H.: Socio-medical achievements of the People’s Republic of
China. International Journal of Health Services, 3(2):275-294, 1973.

Stanley, Margaret: Two experiences of an American public health nurse in
China a quarter of a century apart. American Journal of Public Health,
63(2):]11-116, 1973.

Nygaard-Ostby, B.: What a Western dentist found out about dental prac-
tice in the People’s Republic of China. Oral Surgery, 35:668-671, May
1973.

Kaada, B., Hall, E., Ieseth, K., Nygaard-Ostby, B., Setekleiv, J., and
Stooner, J .: Acupuncture analgesia in the People’s Republic of China—with
glimpses of other aspects of Chinese medicine. Journal of Norwegian
Medical Association, 942417442, 1974.

Rosen, Samuel: Health care in modern China: An eyewitness report.
In: Risse, G. B., ed. Modern China and Traditional Chinese Medicine.
Springﬁeld, Ill: Charles C. Thomas, 1973.

Horn, Joshua 8.: Away With All Pests, New York: Modern Reader, 1969.

Kao, Frederick F.: China, Chinese medicine, and the Chinese medical
system. American Journal of Chinese Medicine, 1:1-59, 1973.

Croizier, R. C.: Traditional medicine in Communist China: Science,
communism, and cultural nationalism. China Quarterly, 23: 1-27, 1965.

Croizier, R. C .: Traditional Medicine in Modern China: Science,
Nationalism, and the Tensions of Cultural Change. Cambridge: Harvard
University Press, 1968.

Lecture Notes on Various Famous Schools and Theories of Chinese
Traditional Medicine. (In Chinese) Peking: Peking College of Chinese
Traditional Medicine, June 1968.

Theory and Application of the Organ Theory in Chinese Medicine. (In
Chinese) Shanghai: Association of Chinese Traditional Medicine of
Shanghai, Jan. 1972.

Fundamental Knowledge of Fatherland Chinese Ttaditional Medicine and

Therapeutics of New Medicine and Chinese Pharmacology. (In Chinese)
Shanghai: People’s Publication Service, Oct. 1970.

National Institutes of Health: Medicine and Public Health in the People’s
Republic of China. DHEW Pub. No. (NIH) 72-67. Washington, DC: US.
Government Printing Ofﬁce, 1972.

Wong, Chi-min, and Wu, Lieu-teh: History of Chinese Medicine. (2d ed.)
Shanghai: National Quarantine Service, 1936.

Sarton, George: Introduction to the History of Science. Baltimore: The
William & Wilkins Co., 1953

1 .34

1.35

1.36

1.37

1.38

1.39

1 .40

1.41

Wong, Ch-min: China’s contribution to medicine in the past. Annals of
Medical History, 82192-201, 1926.

Needham, J .: Science and Civilisation in China. Vol. 1. London:
Cambridge University Press, 1954.

Needham, J .: Science and Civilisation in China. Vol. 2. London:
Cambridge University Press, 1956.

Peking College of Chinese Traditional Medicine: History of Chinese
Medicine in Chinese. Peking: People’s Publishing Service, 1968.

Ma, Hat-teh (George Hatem): With Mao Tse-tung’s thought as the compass
for action in the control of venereal diseases in China. China’s Medicine,
1:52-68, 1966.

The Culture, Education, Health, and Antischistosomiasis Section of
Revolutionary Committee of Yukiang County and Yukiang Antischistoso-
miasis Station, Yukiang, Kiangsi: A great victory of Mao Tse-tung’s
thought in the battle against schistosomiasis. The 10 years since the
eradication of schistosomiasis in Yukiang County in 1958. China’s
Medicine, 10:588-602, Oct. 1968.

Chen, Wen-chieh, and Ha, Hsien-wen: “Medical and Health Work in New
China.” Unpublished manuscript, Nov. 1971.

National Institutes of Health: Respiratory Diseases. Task Force Report
on Problems, Research Approaches, and Needs. DHEW Pub. No. (NIH)

73-432. Washington, DC: US. Government Printing Ofﬁce, 1972,

pp. 2 and 5.

10

Chapter II

INSTITUTIONAL MEDICINE
IN THE PEOPLE’S REPUBLIC OF CHINA:
VISITS TO HOSPITALS AND RESEARCH INSTITUTIONS

In this chapter, I attempt to give an account of representative medical institu-
tions in present-day China in the hope that the discussion of such diverse institu-
tional styles of research and clinical work may give the reader more insight into
the status of respiratory physiology in China. The styles of practice and investi-
gation from the clinic to the urban hospital to the research institution present a
heterogeneity of investigative and clinical styles, and an encouragement of empir-
icism and clinical experiment. These descriptions hopefully will serve to present
a cross-section of medicine in China today, an overview of recent developments
in Chinese medical practices, and the relation of this practice and these health-
care priorities to modern Chinese social organization and ideology. Furthermore,
present-day Chinese medicine is presented and discussed as an integration of tra-
ditional Chinese techniques and theories with modern Western techniques and
theories to produce a synthetic fusion of medical systems, or, as the Chinese
themselves put it, a New Medicine. Detailed discussion of clinical methods in the
treatment of respiratory diseases is reserved for subsequent chapters.

Those readers who have sufﬁcient background concerning current practices
in China’s medical system should feel free to pass on to subsequent sections of
this report, since this chapter is intended to provide the necessary background
for the forthcoming discussions.

Progress After 1949

While in Shanghai, we were given an orientation by our hosts in the Depart-
ment of Health of that city, which may serve as an introduction to current
Chinese sentiments about the place of medical care and research in contemporary
Chinese society. According to our hosts, China was a semifeudal, semicolonial
country prior to 1949, and the status of medical care and research reﬂected
these conditions. Doctors of any stature or expertise were in private practice,
and the majority of the public could not afford their fees.

In 1949, there were about 7,000 Western-trained doctors in Shanghai who
were practicing medicine. Medical services were limited to and were mainly con-
cerned with therapy rather than prevention. Traditional physicians had largely
disappeared from view because of the suppression of “unscientiﬁc” Chinese
traditional medicine. There were clashes between Western and traditional
Chinese doctors, and the latter were downgraded and ridiculed. Medical equip-

ll

ment, supplies, and drugs were mainly, if not completely, imported. Pharmaceu-
tical companies located in Shanghai at that time employed the cheap labor of
the Chinese. Antibiotics such as penicillin were known to be sold by weight for
ounces of gold.

With the founding of the People’s Republic of China in 1949, the new govern-
ment formulated a broad policy for the protection of the people’s health and
established the following four basic principles for health workers:

0 To serve the workers, peasants, and soldiers

0 To emphasize prevention

0 To unite and coordinate doctors of Western and traditional medicine
0 To integrate health work with mass movements

Subsequently, conditions of health care and medical work in China began to
experience a real transformation. The current system of medical care is cooper-
ative, and kung fei lao bao, or cooperative insurance, is provided for everyone
through public funds.

At the present time, all rural villages have barefoot doctors in every one of the
production brigades, and medical workers serve all people. Medical workers are
also stationed in all factories and in the lanes or urban districts of cities. There
is no one in China who is not protected and coVered by medical care and who is
not within reach of a doctor.

Shanghai, for example, is a city with a population of 10 million. At the pre-
sent time, there are 21,000 doctors, 20,000 barefoot doctors, 24,000 nurses, and
10,000 medical technicians working there, as well as 2,000 medical students who
are being trained every year. The nUmber of hospital beds has reached 50,000.

The life span in China is increasing and now approaches 71 years of age for
males and 73 years for females. This is in contrast to conditions described in
1935 when the life span was about 28 years, the crude death rate in peace time
was 30-40 per 1,000, and the infantile mortality rate was 160-170 per 1,000 live
births (2.1, 2.2).

There are quite a few specialty areas in medicine that have recently enjoyed
great progress in China. For example, since the advent of acupuncture analgesia,
80,000 operations have beenperformed in Shanghai hospitals with the aid of
acupuncture techniques. This constitutes about 15-20 percent of all surgical
operations performed in that city.

Prior to 1949, the treatment of the mentally ill consisted of binding and
electric and insulin shock therapy. At present, the three main therapeutic pro-
cedures consist of thought education, social therapy, and the integration of
Western medical treatment with Chinese pharmacology.

The Chinese are also assisting underdeveloped countries in their medical work
through foreign aid. Antibiotics are manufactured in China and are exported to
countries in Africa, Latin America, and South Asia. There are over 20 Chinese
medical teams working in foreign countries, chieﬂy in Africa. Each team includes
surgeons, medical internists, acupuncturists, Chinese traditional physicians,
nurses, and medical technicians, and the number of personnel may vary

12

from 10 to 100 per team. Each team spends about 2 years in a foreign
country.

The Kwangtung Province People’s Hospital

On each of my two visits to China, the ﬁrst big city visited was Kwangchow,
which has a population of about 4 million. Before 1949, Kwangchow had about
10,000-20,000 Chinese traditional doctors and a handful of Western-trained doc-
tors. At present, there are at least 150,000 physicians in addition to over 50,000
barefoot doctors serving the people.

The Kwangtung People’s Hospital in Kwangchow is a polyclinic hospital,
which has about 700 beds and handles about 2,000-3,000 outpatients daily.
There are over 1,000 workers in this hospita1 who have responsibilities for teach-
ing, research, clinical service, training doctors, and providing preventive medicine
in rural areas. .

Of the 200 physicians in the Kwangtung People’s Hospital, over 68 percent
are female. Among the surgeons, one is female, whereas in the departments of
ophthalmology and of obstetrics and gynecology, only one is male. In the pedi-
atrics and medicine departments, over 50 percent of the physicians are female.

We were informed that after the Cultural Revolution, new emphasis was
placed on the integration of Chinese traditional medicine with Western medicine,
particularly in the field of acupuncture analgesia. Acupuncture analgesia, the
proper term for what is commonly called “acupuncture anesthesia,” has yielded
good clinical results that are considered satisfactory, but not ideal. It is mostly
used in brain surgery, chest surgery, and operations for the face and the neck.
The mechanism of action of acupuncture analgesia is still in the stage of investi-
gation, and clinicians and basic research workers are jointly attempting to solve
this mystery. Acupuncture analgesia is claimed to be most effective in people
from working backgrounds and not as effective in intellectuals. For chest sur-
gery, training in breathing and breath holding using the diaphragm must be
carried out. In the Kwangtung People’s Hospital, acupuncture is also used for
the treatment of incontinence and hypertension.

The Chinese have developed a new public health concept of common and re-
current diseases, which includes bronchitis. Rare diseases are not as high a health-
care priority as common recurrent diseases. The Chinese also can justly and
proudly point to the inexpensive cost of all medications used. For example,
from the beginning of pregnancy to delivery, 10 renminbi (5 dollars) will suffice
for the entire course of treatment. The typical cooperative plan, which supplies
medicine to the peasants, costs 5-20 cents per month.

Since the Cultural Revolution, the training period for physicians lasts 3 or 3%
years in contrast to the 6-8 year period before the Cultural Revolution. The
authorities, however, have not yet fully determined that this is the optimum
length of time necessary to train medical doctors. This system is felt to be ade-
quate for present needs, although some changes may eventually be required.
Residency and intern programs are very ﬂexible. The importance of

13

self-evaluation is stressed, and examinations may either be of the open- or closed-
book type.

In medical education, emphasis is placed on the social and political factors
necessary for medical progress. For example, because of the mobilization of
public efforts, the incidence of infectious diseases has greatly decreased, mental
disease is now rarer than before 1949, and venereal diseases have been wiped out
(2.3, 2.4). The social security of the people has also improved. There are ﬁve
guarantees for the people—food, shelter, clothing, medicine, and burial—the last
consideration being especially important for the elderly.

Loh Kang Commune

The Loh Kang commune was organized in 1958, during the Great Leap For-
ward, which is the year in which most of the communes were begun. The orga-
nization of this commune took about 1 year and was completed in 1959.

This commune, with a territory of 100,000 mu (15 mu = 1 hectare), consists
of 11,000 families and, altogether, about 50,000 inhabitants who are divided into
210 production brigades.

There are two hospitals in this commune, and each of the 14 brigades (one
brigade has 15 production brigades) has a health station, primary school, and
mobile movie-proje cting machine.

The hospital I visited has an area of 2,400 square meters, with a staff of over
60 workers, among whom are 16 doctors who practice both Western and Chinese
traditional medicine, 14 nurses, and 30 staff members. This hospital existed
before 1949, but only after this date was it incorporated into the commune.
Expansion was carried out in 1966 during the Cultural Revolution, and more
beds were made available and more wards built.

In 1968, the hospital I visited began to practice integrated or New Medicine,
which consists of a synthesis of both Chinese traditional medicine and Western
medicine. The hospitals produce much of their own medications, which cost
much less than those purchased from foreign sources. Intravenous ﬂuids are
also made locally. Ambulances are available to transport patients to more cen-
tralized facilities in Canton whenever necessary.

After the Cultural Revolution, the communes instituted a Cooperative Medical
Care Plan. The cost for such a program for one person is about $1.00 per year.
From this plan, a person receives all medical care free, except that he or she is
required to pay a registration fee of 5 cents with each medical visit. Surgery is
also free, but the patient pays the cost of food during hospitalization. For more
major operations, the patient is referred to a hospital in Canton if the commune
hospital does not seem to be adequate.

Blood for transfusion can be obtained from Canton, but there are always vol-
untary blood donors to be found locally. Blood typing can be done locally in
the commune hospital. Acupuncture anesthesia is used in this commune for sur-
gical procedures, and both ear loci or nose loci may be used according to the
particular case.

14

I met two barefoot doctors in this commune, each of whom had 3 months for-
mal training in medicine. At least one additional month is necessary each year
for the continuing educational training of barefoot doctors, who pay close atten-
tion to the health of their coworkers. There are two advantages to having bare-
foot doctors among the workers. First of all, if a person is ill, the barefoot doc-
tor can attend on the spot without the necessity of even taking his history, since
they have been living together for many years and the doctor is consequently
familiar with the condition of the patient. Second, the barefoot doctors can
observe the group during working hours, and if they see Someone in need of med-
ical attention, they. will make sure that the situation is taken care of , thus avoid-
ing the serious diseases or complications that might develop as a result of neglect
or the postponement of medical treatment.

The close and cooperative relationship that the workers have with their doc-
tors makes the Chinese medical delivery system unique and is one of its.principal
assets. Barefoot doctors are not detached from production. They are barefooted
workers in the ﬁelds, hence their name, but they also have professional compe- '
tence and knowledge in medical work. Barefoot doctors need no license to prac-
tice. In order to obtain further training, the government will subsidize them to
the extent of 12 renminbi per month in addition to their usual pay as a member
of the commune.

In the Loh Kang commune, there are 86 barefoot doctors and 25 regular
doctors who are constantly involved in continuing education and who can leave
to go to other places for training to improve their skills if necessary. The notion
that barefoot doctors are trained only for a brief time, between 3-6 months, is a
misconception. Barefoot doctors are constantly involved in training and retrain-
ing processes. They are sent out to hospitals and urban medical centers and also
train with specialists who travel in mobile units and teach workers throughout
the country. Such a combination and integration of learning and practice is
another unique aspect of the Chinese medical system. In the beginning of their
studies, medical students are required to integrate theory with practice.

I was informed that doctors also might perform the work of druggists; their
chores often included collecting herbs and teaching people in communes the pro-
cedures of public health and prevention of diseases.

In the Loh Kang commune, there is a small honey bottling factory that em-
ploys simple but efﬁcient equipment. It is interesting to note that the labels on
the bottles contain information concerning Chinese nutritional concepts, which
are also used therapeutically as part of Chinese medicine. For example, the
honey was claimed to be effective in treating neurasthenia,rheumatoid arthritis,
weakness in old people, and malnutrition. It was also indicated that honey
could restore health, improve arthritis, and aid bronchitis and ulcers, as well
as aid several kinds of nervous system diseases. It was said to be effective in
normalizing blood pressure.

When I visited a commune in Peking, I asked again to visit the medical facili-
ties. The Chinese medicine section of these clinics is still differentiated from the
Western medicine section: Si Yao from Chung Yao. Chinese traditional medicine

15

is made into pill and extract form from local plants that are raised in the ﬁelds of
the commune. Physicians have learned the properties of many Chinese herbs
from aged traditional practitioners.

Capital Hospital, Peking

The Capital Hospital in Peking is known as the hospital where James Reston
had his appendectomy (2.5) and where the 01d Peking Union Medical College
was located (2.6). It is a central municipal hospital that has the responsibility of
emphasizing medical care to workers in the ﬁelds, factories, and communes. It is
directly controlled by the Chinese Academy of Medical Sciences and exists to
render service to the people and to promote the integration of Western medicine
with Chinese traditional medicine.

Since the Cultural Revolution, this hospital has been equipped with 550 beds;
over 2,000 outpatients are seen daily. There are over 950 staff members, includ-
ing 400 doctors. It is a polyclinic, the department of medicine being divided
into sections on respiratory diseases, blood diseases, etc., and the department of
surgery into neurosurgery, orthopedic surgery, etc.

The Capital Hospital also trains medical personnel from rural or remote areas.
'Doctors in training usually stay for 1 year and then return to their local stations.
The hospital also trains nurses, often elevating their medical knowledge to the
level of physicians so that they can perform additional functions.

The medical department has 150 staff members, including 70 doctors, and
has 155 beds. One-half of the doctors work in the hospital full time and do
some type of research. Special attention is paid to work on blood diseases and
cancer. The target of attack in‘ research is on the most commonly seen recurrent
diseases, for example, chronic bronchitis, coronary thrombosis, leukemia,
diabetes, and cancer. The integration of Western medicine with Chinese tradi-
tional medicine was initiated in 1954 and is often referred to as a “double-track”
system. _

It is regarded as important that Western doctors learn Chinese traditional
medicine. Since the Cultural Revolution, emphasis has also been placed on de-
veloping medical care in rural areas.

The Chinese Academy of Medical Sciences is also located in the general com-
pound of the Capital Hospital. Its library now has 300,000 volumes, not includ-
ing subscriptions to 800 journals from many countries.

The Shanghai Physiological Institute

In 1949, the Physiological Institute of the Chinese Academy of Sciences to-
gether with the Biochemical Institute in Shanghai had about 20 members. In
1972, the Physiological Institute alone had more than 250 workers on its staff.
(Before 1949, “workers,” were called “members,” a somewhat elitist term.)

The goals of the Physiological Institute, following the Cultural Revolution,
are to serve rural areas, workers, and soldiers practically. Propaganda brigades

16

have been organized to carry educational and clinical work to remote areas, and
efforts are presently being made to integrate basic medical sciences with clinical
practice and to carry out experimental medical research in laboratories, factor-
ies, and rural areas.

The Physiological Institute is interested in several areas of research. Acupunc-
ture anesthesia occupies much of its attention, as do high-altitude physiology,
nerve muscle physiology, audiovisual physiology, endocrinology, and medical
electronics, all regarded as important areas of research in China.

In 1958, during the Great Leap Forward, the Institutes of Physiology and
Biochemistry were divided into two separate entities. At present, the Physiologi-
cal Institute alone has 284 workers, including 166 technical research workers. Re-
search activities are divided into the following ﬁve departments of investigation:

1. Neuromuscular physiology and its relation to nutrition

2. The central nervous system, concentrating particularly on acupuncture
anesthesia

3. Sense organ physiology, especially in relation to hearing and sight

4. Hypoxic physiology

5. Reproductive physiology

The Biochemical Institute has about 380 workers, including 260 involved in
research. The emphasis in research includes efforts in protein research (espec-
ially concerning multiple peptides), virus research (especially in relation to plant
viruses), the structure and function of insulin, trypsin inhibitors, blood factors,
nucleic acids, enzymology, and control of metabolism, including the diagnosis of
cancer.

Institute of Materia Media in Peking and in Shanghai

The Institute of Materia Medica in Peking is under the direct governmental
control of the Chinese Medical Academy. It was established in 1958 during the
Great Leap Forward. There are about 300 workers in this Institute, which is di-
vided into 10 departments, including drug synthesis, plant chemistry research,
medicinal plant research, pharmacology, drug analysis, cultivation of medicinal
antibiotics, plantation, cultivation, and others.‘

Research emphasis is being put on the treatment of common recurrent dis-
eases. Influenza and the common cold, bronchitis, anticancer drugs, cardiovascu-
lar remedies, and contraceptives are research priorities. The integration of West-
ern medicine and Chinese traditional medicine in treating various diseases is
being carried out in these endeavors.

The Institute of Materia Medica in Shanghai had very few workers prior to
1949, but now has 480 workers, two-thirds of whom are research scientists. Its
main research projects are in the areas of synthetic chemistry, plant chemistry,
pharmacology, and analytic chemistry. Currently, herbs are being experimented
with to see if they are effective in the treatment of cancer and other types of
tumors, cardiovascular diseases, nervous ailments, contraception, hepatitis, and

17

chronic bronchitis. The common recurrent disease concept clearly prevails, and
the Chinese are determined to conquer these diseases in the forseeable future.

Extracts are made from these herbs and resynthesized, and the equivalent
effects are compared and analyzed. Antibiotics from China’s own soil are being
made, and new drugs are constantly screened. In the past 20 years, more than
20 new synthetic compounds have been discovered, including several new anti-
biotics, anticoagulants, and antibronchitis drugs. More than 1,000 antitumor
drugs have been screened, synthesized, and tested clinically.

The Second Medical College in Shanghai

Before the Cultural Revolution there were 300 workers in the Second Medical
College in Shanghai and the library contained 25,000 books. After the 1952
regrouping of the medical schools, the College was expanded by a threefold in-
crease in workers and a tenfold increase in the volume of books in the library.
The Second Medical College was an amalgamation of four medical schools that
existed before the revolution: the Tung Teh Medical College, the Tung Chi
Medical College, the Chen Tan Medical School, and the St. Johns Medical School.

Since the Cultural Revolution, the enrollment has reached 3,000 students,
and the college has been divided into three schools: medicine, oral diseases, and
pediatrics. The medical division has four afﬁliated hospitals with 2,800 beds and
200 instructors and professors.

This college operates under two principles: prevention ﬁrst and emphasize
medical care in rural areas. The importance of mobile teaching and treatment
units is also stressed. Instruction materials integrate Chinese traditional medicine
and Western medicine.

Great progress was made in this medical college during the Cultural Revolu-
tion. In 1970, the July class of the medical school had 130 students and a 2-year
curriculum. In May 1972, 500 students were admitted in a 3-year curriculum.
An important aspect of classwork is politics, including political philosophy and
the history of Chinese revolution. Students participate in political activities
about 4 hours weekly.

The medical college currently operates under a 3-year curriculum, with an
extra half year added for premedical studies, during which mathematics, physics,
chemistry, and foreign languages are taught.

Summary

There are a number of important recent developments in medicine, medical
research, and medical training in China, as follows:

1. There is a generalized integration of Chinese traditional medicine with
Western medicine at all levels of clinical and research work.

2. Important discoveries have been made in the herbal treatment of a variety
of diseases, including those of the respiratory system.

18

3. There is an effective health-care delivery system in China, which includes
barefoot doctors, mobile units, and other innovations.

4. The emphasis in medical care is on the delivery of medicine to all sectors
of society. .

5. Prevention is stressed, especially in relation to chronic diseases.

6. New areas of medicinal treatment are being developed. Recent accomplish-
ments include procedures for the reimplantation of severed limbs, the treat-
ment of burns, and the treatment of industrial diseases.

7. The training period of medical students has been shortened—ﬁrst to a
2-year curriculum in 1970 and, at present, to a 3-year curriculum.

The following are photographs illustrating some of the points made in this
chapter.

19

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2-1. Newborns in a modern incubator in the Obstetrics and Gynecology
Hospital in Peking. The infant mortality in Shanghai alone fell from 150 per
1,000 live births (15 percent) in 1948 to 8.7 percent in 1972 (2.2).

 

 

 

 

 

 

 

Figure 2—2. A view of the Capital Hospital in Peking.

20

 

Figdre 2-3. A specimen showing the neck and head vessels in the
Pathology Museum in the Second Medical College in Shanghai.

 

Figure 2-4. A pathology specimen museum in the Second Shanghai Medical College.

21

570-225 0 - 75 - 3

 

Figure 2-5. One of the posters in the Pathology Museum of the Shanghai Second
Medical College depicting the use of the ”forbidden area" for the acupuncture

treatment of deafness.

Miﬁiﬁﬁﬂi

    

Figure 2-6. Posters
depicting the suc-
cess of recently dis-
covered procedures
for the reimplantation
of severed limbs.

22

.

I

n

‘ I
'1 ’33: {‘3

H'-

 

Figure 2-8. Stove with concoctions of herbs in a hospital.

23

 

Figure 2-9. Doctors and other medical workers
in a commune hospital near Kwangchow.

 

Figure 2-10. Bamboo cups are applied to a patient with shoulder
pain. A piece of paper is burned in the cup, which is then
immediately applied to the skin. As the oxygen in the cup is
exhausted, the flame will be extinguished and the
decreased pressure in the cup (due to the decrement in oxy-
gen) will cause the skin to rise. When the cups are removed,
hemorrhagic spots on the skin may be seen.

24

 

Figure 2-11. A patient with back pains is treated with cupping. These glass cups
are a modern version. In ancient times, bamboo cups were commonly used.

 

Figure 2-12. A special method of treating patients with asthma. The procedure
includes a light touch massage, as shown by the woman’s hands, burning the
skin, and then covering it with herbal plasters.

25

 

Figure 2-13. People exercising in the morning in the Nanking
Road in Shanghai. Muscular exercise has been advocated
as part of daily life for healthy bodies in China for over 2,000
years. Here people are practicing the Tai Chi Ch'uan—an
exercising procedure that has become popular in the
Western world.

Figure 2-14. Sign in a city.
“Mobilize and promote
health, lessen disease,
elevate health level"—
Mao Tze-tu ng.

 

26

2.1
2.2

2.3

2.4

2.5
2.6

REFERENCES

Horn, Joshua 5.: Away With All Pests. New York: Modern Reader, 1969.

Chinese Medical Association, Peking: Child health care in new China.
American Journal of Chinese Medicine, 2: 149-158, 1974.

Ma, Hai-teh (George Hatem): With Mao Tse-tung"s thought as the compass
for action in the control of venereal diseases in China. China’s Medicine,
1:52-68,Jan. 1966.

Chen, Wen-chieh, and Ha, Hsien-wen: “Medical and Health Work in New
China,” Unpublished manuscript, Nov. 1971.

New York Times, July 25, 1971.

Ferguson, M.: China Medical Board and Peking Union Medical College.
New York: China Medical Board of New York, 1970.

27

 

Chapter HI

DEVELOPMENT OF PHYSIOLOGICAL CONCEPTS IN CHINA

The present state of medicine in China is a product of social and cultural evo-
lutionary processes that have been in the making over a period of several thou-
sand years. Thus, to thoroughly understand the present, we must turn to the
past. China has enjoyed a splendid and long history of scientiﬁc invention and
discovery. Records of disease were kept as early as 2000 B.C., and dissection of
the human body was performed in the Chou Dynasty (1122 to 222 B.C.). At the
time of the 5th century B.C., China had sophisticated methods of making diag-
nosis through palpation of the pulse. These methods were used in conjunction
with techniques of inspection, auscultation, observation, and ophristics, or smell-
ing the patient. The ﬁrst classic of traditional Chinese medicine was the Yellow
Emperor’s Canon of Internal Medicine, which appeared long before the birth of
Christ. In the Chou Dynasty, furthermore, it is recorded that the medical pro-
fession was subdivided into the specialties of physicians, surgeons, veterinarians,
and dieticians (3.1).

There are numerous publications on Chinese medical history in the English
literature. Unfortunately, many are citations of information contained in recent
publications without a thorough review of the literature or are the products of
authors who have no knowledge of the Chinese language. Such expositions of
Chinese medical history cannot depict historical realities in their fullest dimen-
sions. Although it is not possible to include in this monograph original transla-
tions, some effort is made to present a view that will serve as a brief and accurate
representation of the development of Chinese medicine and Chinese medical lit-
erature in the particular ﬁeld.

The Early Development of Anatomy

Physiology is and has been dependent on the knowledge of anatomy for its
development. Although human dissection was recorded in the Ling Shu of 1000
B.C., anatomy never made real progress in China until modern times (3.2). There
were records in the Han and the Sung Dynasties of dissections on the bodies of
people who committed “crimes,” but there were no detailed studies of the struc-
ture and function of the human body (3.2, 3.3).

29

The Early Discovery of Circulation

The importance of various early Chinese discoveries in physiology has drawn
the attention of many scholars. Wang (3.4), who wrote copiously on Chinese
medical history, stated:

The statement is generally made by foreigners that the Chinese in ancient times knew

absolutely nothing of anatomy and physiology. As evidence they often quote the writ-

ings of Wells Williams in “The Middle Kingdom,” or of Harland in the “Transactions of
the Royal Asiatic Society.” Such conclusions, however, are not strictly true. A glance
at the Nei Ching, or Canon of Medicine, a work attributed to Huang Ti, 2697 B.C., will
show that the ancient Chinese had a fair knowledge of these subjects. Indeed, some of
their descriptions of the position, relation, and functions of the different organs of the
body were so accurate that considering the limited means at their disposal and the early
time in which they were recorded, one cannot help but admire the keen observation of
these ancient writers.

“All the blood is under control of the heart.” “The heart regulates all the blood of the

body.” “The harmful effects of wind and rain enter the system ﬁrst through the skin.

It is then conveyed to the ‘sun’ vessels [capillaries]. When these are full it goes to the

‘loh’ vessels [vein] and these in turn empty into the big ‘chin’ vessels [arteries] .” “The

blood current ﬂows continuously in a circle and never stops.” “The blood cannot but

ﬂow continuously like the current of a river, or the sun and moon in their orbits. It may
be compared to a circle without beginning or end.” “The blood travels a distance of six
inches in one respiration making a complete circulation of a body about fifty times in

twenty four hours.” [p.34]

One can easily argue that the level of understanding in ancient China concern-
ing circulation was quite rudimentary. This is true; but it can be similarly argued
that the circulation that Harvey (3.5, 3.6) described thousands of years later was
rudimentary when compared with the circulation that physiologists are familiar

with today.

The Early Practice of Surgery

In the evolution of medicine in any culture, there is a signiﬁcant and dynamic
relationship between the development of surgical and physiological concepts.
The following discussion of surgery in ancient China is an attempt to throw light
by implication on the early status and development of corresponding physiologi-
cal concepts in that country.

The practice of ‘rsurgery attained a high level of development in ancient China.
Thomson (3.7) stated that the Chinese system of surgery had its origins 4,500
years ago and that knowledge of circulation in China had existed for the greater
part of that period. Operations for castration were performed in 1100 BC;
dissections of the entire human body took place in the 10th century BC; mas-
sage and physical therapy were applied in the 4th century BC; anesthetics were
discovered, cesarean sections were performed, and trephining was proposed by
the 3rd century A.D.; and abdominal surgery had become quite advanced by the
6th century AD.

It is not my aim to conduct a lengthy discussion of such developments in sur-
gery. Nevertheless if one examines ancient Chinese history, one can gain an

30

appreciation for that country’s accomplishments in medicine. Medical knowledge
and understanding were also advanced in other ancient cultures, and the exposi-
tion of progress and accomplishments in one culture should not be considered as
a competitive means to minimize those of another. There should be a comple-
mentary attitude toward the understanding of the development of medical his-
tory in the entire world, and this seems to be the direction in which China is
advancing in the ﬁeld of medicine.’

Ancient Chinese Physiological Theories

Although the work physiology is only a comparatively new term in Western
medicine, denoting the study of normal mechanisms and functions of ani-
mate systems (3.8), the search for knowledge in physiology actually began in
ancient times.

Since the difference between a living and a dead body can be easily observed
by the presence or absence of the throbbingtpulse and of the rise and fall of the
chest, it seems natural that man’s early notions concerning the necessity of air,
or pneuma, and circulation for the maintenance and survival of animate systems
could be interpreted as the source for such theories as those of vital energy or
Ch’i1 (which has connotations including vapor, gas, air, spirit, and energy).

In China, as in other cultures, systemic interpretation of the phenomenon of
life came into being quite early and can be considered to be early theories of
physiology.‘ In the Yellow Emperor’s Canon of Internal Medicine (3.9-3.12),
the concept of Ch’i was mentioned in many places. The following is a transla-
tion by the author of some passages of this seminal work, which was written
around 1000 BC. and recorded in the annals of the Han Dynasty (206 BC. to
25 A.D.).

The Yellow Emperor said:

“If one is afflicted with abnormal respiration, he cannot sleep and his breathing has noise;
or he may not be able to sleep, but his breathing is without noise. Some may rise and
sleep as usual, and their breathing is noisy; some may be able to sleep but can exercize
only with dyspnea; some may not be able to sleep or exercize at all, but still have dysp-
nea. What organs in the body cause this? I desire to hear about the etiology .”

Ch’i Po answered:

“Those who cannot sleep and breathe with noise have disorders in the Yang Ming.
Usually the three Yang of the foot travel downward. In these cases they travel upward,
hence the noise. Yang Ming belongs to the meridian of the stomach, which is the sea of
the six viscera whose breathing also travels downward. If the Yang Ming is disordered,

it does not follow its regular routes and hence one cannot sleep. As mentioned in the
ancient classics, if there is no harmony within the stomach, one has no peace in sleep.
Hence if a man rises and sleeps as usual, but still has noisy breathing [dyspnea] , then

the blood vessels of the lungs are at fault. The blood in the lung vessels is not traveling
up and down the main blood vessels and hence the blood is stagnant. A patient with
disordered blood vessels is weak. He can rise and sleep or sleeps only with dyspnea, then

 

1Ch’i is a character composed of two portions—the vapor of air on top and the grains
below. It has the subtle concept of mixing air and food in the body, which will eventually
evolve as “energy.” The Ch’i concept perhaps has more connotations than that of pneuma.

31

edema [water] assumes the role of a ‘guest’ of the breath. Water flows through all the
glands of the body as secretions. The imbalance of water disturbs the kidney, inﬂuences
glandular secretions, disturbs the sleep [depresses pH], and produces dyspnea.”

The Emperor said: “Excellent."

In Western culture, pneuma, or pneumatic medicine, was an early discovery.
The concept of prana of Indian culture was also early and simulates the Ch’i doc-
trine of Chinese medicine (3.9, 3.10).

The Energy Theory (the Theory of Ch’i)

According to modern interpretations of the Yellow Emperor’s Canon of
Internal Medicine, the classifications of Ch’i and their various meanings may be
listed as follows:

Ch’i has a dual meaning: the first refers to microsubstances, for example,
respiratory gases; the second refers to the Ch’i, or energy, of the tissues or organs,
for example, the Ch’i of the ﬁve Tsang and six Fu, the energy in the meridians or
vessels of energy conduction.

According to its origin, the Ch’i may be divided into the Ch’i of either “con-
genital” or “acquired” character, or of Hsien-T’ien and Hou-T’ien, respectively.
The congenital Ch’i is also the original Ch’i and is hereditary, while acquired Ch’i
is derived from respiration and nutrients. Thus, it can be seen that Ch’i is a
broad concept of energy and, hence, of bodily function or physiology, which is
dependent on the intake of air and food and their interaction in a manner analo-
gous to that conceived of by modern respiratory physiology (3.13).

Ch’i is further divided into the following four types:

1. Yuan Ch’i,2 which also means original Ch’i, congenital Ch’i, or hereditary
Ch’i, encompasses the elements that accompanied birth: According to
ancient Chinese physiological concepts, the original Ch’i came from the
kidneys and was stored in Tan T’ien3 (3 inches below the umbilicus), thus
insulating the entire body through the San Chiao4 (another conceptual
organ entity in ancient Chinese physiology). The original Ch’i caused the
ﬁve Tsang5 and six Fu6 to be active.

2. Ying Ch’i7 may be literally interpreted as nutritive energy and is said to
circulate in the interior of the body. Its origin lies in the spleen and stom-
ach (nutritive function) and its energies are derived from the middle

 

2Yuan Ch’i literally means the original energy.

Tan Tim is a conceptual entity where the Ch’i is collected, a Taoist concept where the
sex organs are located.

San Chiao literally means three scorching spots or reaction chambers. They are (1) the
upper reaction chamber for gas and blood to react, (2) the middle reaction chamber for
blogd and food to react, and (3) the lower reaction chamber where waste is excreted.

Tsang encompasses the ﬁve solid organs, that is, the lungs, heart, spleen, kidney, and
liver. They are Yin organs.

Fu encompasses the six hollow organs, that is, the large intestine, small intestine, gall-
bladder, urinary bladder, stomach, and triple burner, or the three reaction chambers (San

Chiao).

Ying Ch’i is the nutritive energy. Food is its origin.

32

portion of the Triple Burner.8 Ying Ch’i is related to blood and serves as a
nutrient, ﬁnally reaching the lung and then circulating throughout the
body. This seems to be a valid interpretation of function, even by the stand-
ards of modern knowledge in physiology. Food is digested and absorbed
into the blood, which passes through the lungs and is oxygenated in order
to supply the entire body with the biological energy and nutrients neces-
sary to maintain life.

3. Wei Ch’i9 literally means the protective energy that circulates in the peri-
phery of the body. Wei is mainly composed of “air,” whereas Ying is
mainly composed of “blood.” Wei Ch’i has the function of resisting in-
vasive forces from outside the body.

4. Tsung Ch’il ° is a combination of Ying Ch’i, Wei Ch’i, and the atmospheric
air (oxygen) that is stored in the chest. In ancient texts, this Ch’i is also
named Ch’i Hai,‘1 or sea of air, and is thought to emanate from the lungs.

It is evident from the ancient Chinese texts that clear ideas existed concern-
ing the importance of circulation, air, blood, and food and their association with
body function, which we in modern terms subsume under the concept of respira-
tion. Naturally, these ancient concepts are not as clearly defined as those of
modern science, but it should be remembered that they were derived from stud-
ies conducted over 2,000 years ago.

In the Yellow Emperor’s Canon of Internal Medicine, it is also mentioned
that all Ch’i(or air) belongs to the lungs, and that the lungs “purify” the Ch’i.

It specifically discussed the necessity of having the lungs perform the functions
of purifying the air and causing it to descend. If this function is lost, then
dyspnea, cough, and malfunction of the urinary system (possibly related to the
acid-base balance) will occur. Also mentioned in this text is the relationship be-
tween the lungs and water balance and between the lungs and the kidneys.

In the Su Wen12 portion of the Yellow Emperor’s Canon of Internal Medicine,
special discussion is directed toward the close relationship between the lungs,
the skin and hair, and the sweat glands. It is claimed that sweating occurs when
the lungs are weak, because the “periphereal skin” is not solid. If there is a
deﬁciency in Wei Ch’i (protective energy), it is that cold invades the muscles
and skin and ﬁnally reaches the lungs, resulting in cough.

The interrelationship between the functions of various organs is clearly de-
ﬁned in ancient Chinese books on physiology. It seems undesirable to state that
the lungs are related to the stomach, kidneys, and skin; the relationship between
the lungs and the large intestine also seems to be obscure. However, according to the

 

8The Triple Burner is a conceptional entity of the body that divides into the upper bur-
ner (for air and blood to react), the middle burner (for food digestion), and the lower bur-
ner gfor waste disposal). These are the reaction chambers of the body.

1 ei Ch’i is the protective or surrounding energy.

llTsung Ch’i is energy related to respiration.

Ch’i Haj is the sea of air, which is the lung.

12Su Wen or Plain Questions, is the ﬁrst of the two sections of the Huang Ti Nei Ching.

Ling Shu, or Spiritual Gate, is the second section.

33

Chinese traditional medicine, the lungs and large intestine were coupled organs,
and diseases of these two organs were related in therapeutics. For example,
cathartics were used for dyspnea and phlegm, which enabled the lung energy to
circulate openly. For constipation, respiratory drugs, which affect cough and
sputum, were used. Perhaps the phenomenon of the intestinal ﬂu can explain, in
modern terms, the claim that the lungs and large intestine are related as coupled
organs.

There are many more Chinese terms and concepts that are related to Ch’i,
for example, Shuei Ku Chih Ch’i,l 3 or energy from food, and Lien Ch’i,l 4 or
training the breathing, which was thought to be a method of achieving health.
This latter technique was advocated by Chuang Tze in the 4th century B.C. and
has been practiced in China up to modern times. The principle involves making
the Ch’i circulate smoothly in the body through the vital organs. Figure 3-1 de-
pictsone possible interpretational scheme (3.14).

The Organ Theory (the Theory of Tsang-Hsiang)

Tsang-Hsiang is the functional Chinese concept underlying the physiology of
the organs and their mutual relationship as well as their pathological derangement.
According to the theory of Tsang-Hsiang, the body has three different structures:
Tsang, Fu, and Odd-Enduring Fu.15 The five Tsang(s) are all solid organs—heart,
liver, spleen, lungs, and kidneys—and the six Fu(s) are all hollow organs—gallblad-
der, stomach, large intestine, small intestine, triple burner, and urinary bladder.
The Odd-Enduring Fu(s) are the brain, marrow, bone, vessels, gallbladder (a dup-
licate designation), and uterus.

In Chinese physiology, a very intricate understanding of the relationship be-
tween organs was developed:

1. The lung (metal), when disturbed, affects the envelope of the heart (ﬁre).

2. The lung, when deﬁcient, affects the spleen (earth).

3. The liver (wood), when too excessive, causes dyspnea; when too severe,
hemoptysis occurs.

4. Deﬁciency in lungs causes kidney weakness, which feeds back to cause fur-
ther deﬁciency in the lung.

The relationship to the organs is presented in ﬁgure 3-2.

The Meridian Theory (the Chinglo Theory)

The meridian theory concerns the pathways whereby the various bodily
organs are related. The 12 major meridians are related to the organs, six Tsang(s)
and six Fu(s), and meet either in the hands or the feet.

BShuei Ku Chih Ch’ 1 is the energy from water and grains.
15 Lien Ch’i means to train or to discipline the energy through muscular exercise.
5Odd- -Enduring Fu are special organs. It may be postulated that these organs were
discovered or described later than the ﬁve Fu or six Tsang organs. The character Hueng (or
Enduring) was introduced possibly with a functional connotation.

34

YIN MERIDIANS <— —> YANG MERIDIANS

Internal, solid organs connecting External. hollow organs connecting
to hollow organs to solid organs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3-1. A philosophical and conceptual interpretation of the relationship be-
tween the 12 coupled organs of traditional Chinese medicine. A diurnal rhy-
thm of activity in these organs is also postulated, beginning with the lung in
the early morning and reaching the liver after midnight.

It should be mentioned that although these theories are very ancient, they do
represent functional interpretations of physiology, which were developed on the
basis of very subtle observations made through great experience. The modern
integration of Chinese traditional medicine with Western medicine offers us a
very important opportunity to validate and to improve these time-honored
ancient theories.

Table 3-1 and ﬁgure 3-3 present the classiﬁcation of body organs and the
mechanisms of lung disease, respectively.

35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

— Through the meridians '—— — W
l— \
I LIVER
I Cortical Concentrate Approach
or
Control and regulate Q t

i the heart ulescence
I HEART

Nei I

Kung I CHEN
l
I SPLEEN 0" '
Ch'i Regulation Embryonic
orf . breathing LUNGS

I Breathing
I
I KIDNEY
|
l
L______________ ____ __/

Figure 3-2. Ch’i Kung and its relationship to the organs. (Through cortical con-
trol and via regulation of breathing, organs are permeated by Ch’i (3.14).)

Classification

Five Tsang and
six Fu system

Odd-Enduring
Fu system

Table 3-1. Classification of body organs.

Classified name

Five (6) Tsang(s)

Six (5) Fu(s)

Name of organ

Liver, heart, spleen,

lungs, kidneys

(envelope of heart)

Stomach, large

intestine, small
intestine, triple
burner, bladder,
gallbladder

Brain, marrow, bone

vessels, uterus,
gallbladder

36

Yin or Functional
Yang concept
Yin Capacitive, not
(earth) conductive
Yang Conductive, not
(heaven) capacitive
Yin Capacitive, not
(earth) conductive

 

Envelope of heart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(pericardium)
G— —-->
Spleen Lung Kidney
— — v H- —— —
Liver

 

 

 

— — — Deficient

Excessive

Figure 3-3. Mechanisms of lung disease and their relationship to other organs.

The Yin-Yang and Five-Element Doctrines

The Chinese attained‘a high degree of interpretational and theoretical reﬁne-
ment in physiology when the Yin-Yang doctrine and the theory of ﬁve elements
were integrated into their medicine and physiology. Needham (3.10) has ex-
pertly discussed in a scholarly fashion the social background for the evolution of
these widely known Yin-Yang and five-element doctrines and their inﬂuence on
Chinese culture. It should be pointed out that in China at the present time, tra-
ditional medicine is being raised to the level of a science. Discussions of Chinese
traditional medicine in terms of the theories of Yin-Yang and the ﬁve elements
are mostly reserved for historical understanding rather than for the literal por-
trayal of the mechanisms of physiological function in the body.

The dualistic concept of Yin-Yang, or two forces that are opposed yet comple-
mentary, has had much appeal in many natural scientific disciplines in China
(3.10). According to Fung (3.15), the Yin-Yang school was associated with med-
icine in the very early history of China, reaching its height of importance in the
early Chou dynasty, and had its origin with occultists who served the functions
of psychiatrist and social arbiter in ancient Chinese society.

Physiologically, the anatomy and physiology of the body in traditional
Chinese medicine are both associated very closely with the Yin-Yang doctrine.
For example, the skin, or the external part of the body, are thought to be Yang,

37

570-225 0 - 75 - 4

and the interior to be Yin; the dorsal side to be Yang and the ventral side to be
Yin. Of the organs, hollow structures are called Fu and are Yang, whereas the
Tsang, or solid organs, are Yin. Organs are also paired according to whether they
are Yin or Yang. For example, the lung (a Yin organ) is always coupled with the
large intestine (a Yang organ). All 12 organs are paired, and there is a linear pro-
gression from the lung and to the liver over the course of 24 hours (see ﬁgure 3-1).
These organs reach a maximum of 2 hours’ activity, thus constituting the diurnal
rhythm.

The ﬁve-element theory concerns ﬁve archetypal substances—metal, wood,
water, ﬁre, and earth—each of which is associated with a hollow or solid organ.
Furthermore, the ﬁve elements are dynamic designations for the bodily organ or
substance used in a variety of functional concepts.

Other Aspects of China’s Medical Heritage

In Chinese medicine, rich historical information exists concerning a wide
variety of theoreticians and schools. In the past 3,000 years, Chinese medical
insights were mingled in sectarian activity, publication of medical literature, and
medical discoveries and inventions (3.16-3.18).

In the 3rd century A.D., the Chinese used chemical anesthesia for surgical
operations. The originator of this technique, Hua T’o, was also an important ex-
ponent of the use of exercise, which, he said, expelled the bad air in the system
and promoted circulation of the blood, thus preventing sickness. He invented
exercises in which various movements imitated those of the tiger, deer, bear, mon-
key, and bird (3.19).

The synthetic formulations of four famous medical scholars after the 11th
century in China became a landmark for the further diversiﬁcation of Chinese
medical theories: Liu Shao-chen advocated the use of cooling medicines; Chang
Tzo-ho favored purging; Li Tung-wen emphasized the importance of the spleen
and stomach (perhaps an anticipation of the concepts of nutrition and digestion);
and Chu Tan-chi extolled the value of tonics (3.17).

Hydrotherapy was in use in China in 178 BC. (3.19). Hospitals were in exis-
tence from ancient times (3.20) and were ﬁrst mentioned in the Chou Rituals
(ca. 1000 B.C.). Convalescent homes were founded during the Tang Dynasty
(3.20). Su Shih, a medical scholar of the Sung Dynasty, raised money and orga-
nized hospitals himself at this time (3.20).

The Great Herbal, which had its origin in the Sheng Nung’s time (2823-2698
B.C.), had reached definitive form by the Western Han Dynasty. Li Shen-chen,
during the years 1552-1 5 78, consulted all the preceding monographs concern-
ing materia medica as well as hundreds of other reference works and corrected
their mistakes, introduced new preparations, and arranged the entire format into
62 orders of drugs under 16 classes (3.21, 3.22). This became the ﬁrst encyclo-
pedia on materia medica in history.

38

Summary

Although Chinese traditional medicine has evolved by means of subtle and
pragmatic observation over several thousand years, the Chinese also offered so-
phisticated theories for the interpretation of biological phenomena. Both the
observational and the interpretational experiences of Chinese medicine offer a
rich medical literature, which may be viewed in terms of its historical develop-
ment. It seems clear, however, that such a rich Chinese medical literature should
be reviewed in light of modern developments in the biomedical sciences. This
process is being carried out in China today.

39

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

3.9

3.10

3.11

3.12

3.13

3.14

3.15

3.16

3.17

REFERENCES

Wong, Chi-min, and Wu, Lien-teh: History of Chinese Medicine. (2d ed.)
Shanghai: National Quarantine Service, 1936.

Hsieh, E. T.: A review of ancient Chinese anatomy. Anatomical Record,
20197-127, 1921.

Cowdry, E. V.: Taoist ideas of human anatomy. Annals of Medical His-
tory, 3:301-309, 1921.

Wang, K. Chimin: Was the circulation of the blood known in ancient
China? China Medical Journal, 38:577-579, 1924.

Harvey, William: De Motu Cordis. Frankfurt (From Singer, C. A Short
History of Anatomy and Physiolog from the Greeks to Harvey. New
York: Dover, 1957.)

Singer, C.: A Short History of Anatomy and Physiology from the Greeks
to Harvey. New York: Dover, 1957.

Thomson, John C.: Surgery in China. Section I: The history and present
position of Chinese native surgery. China Medical Missionary Journal,
6(4):219-228, I892.

Sherrington, C. S.: The Endeavor of Jean Fernel. London: Cambridge
University Press, 1946.

Needham, Joseph: Science and Civilization in China. Vol.1. Introductory
Orientations. London: Cambridge UniversityPress, 1954.

Needham, Joseph: Science and Civilization in China. Vol. 2.History and
Scientiﬁc Thought. London: Cambridge University Press, 1956.

Kao, Frederick, F.: China, Chinese medicine and the Chinese medical sys-
tem. American Journal of Chinese Medicine, 111-59, 1973.

Wang, Chi-min: China’s contribution to medicine in the past. Annals of
Medical History, 8: 192-201, 1926.

Kao, Frederick F.: An Introduction to Respiratory Physiology. (Rev. 2d
ed.) Amsterdam: Excerpta Medica, 1974.

Shanghai Association of Chinese Traditional Medicine: The Theory and
Application of the Organ Doctrine. Hong Kong, Wan Yeh Publishers, 1972.

Fung, Yu-lan: The Spirit of Chinese Philosophy. Translated by E. R.
Hughes. London: Kegan, Paul, Trench, Trubner & Co., Ltd., 1947.

College of Chinese Traditional Medicine in Peking: Notes on Various
Schools and Theoreticians in Chinese Traditional Medicine. Hong Kong,
Wan Yeh Publishers, 1968.

Wong, K. C.: Chinese medical literature. China Medical Journal,
31:154-158, 1917.

40

3.18

3.19

3.20

3.21

3.22

Dudgeon, John: A modern Chinese anatomist discourse on the brain mar-
row. China Medical Missionary Journal, 8(1): 1-13, 1894.

Wong, K. C.: China’s contribution to the science of medicine. China
MedicalJoumal, 43(12): 1 193-1208, 1929.

Wong, K. C.: Chinese hospitals in ancient times. China Medical Journal,
37(1):77-81,1923.

Chen, James Y. P.: Chinese Medicine Through the Ages: Pharmacology.
In: Quinn, J. R., ed., Medicine and Public Health in the People ’s Republic
of China. DHEW Pub. No. (NIH) 72-67. Washingtbn, DC: US. Govern-
ment Printing Ofﬁce, 1972.

Lee, T’ao: Achievements in materia medica during the Ming dynasty
(1368-1643). Chinese Medical Journal, 74: 177-1 91, 1956.

41

 

CHAPTER IV

RESPIRATORY RESEARCH IN CHINA PRIOR TO 1949

The development of medicine and physiology in China began with a splendid
system of theories based on keen observation, which resulted in the testing and
adoption of many therapeutic procedures. Nevertheless, Chinese physiology did
not blossom into the kind of modern concepts with which we are familiar. The
forces that govern scientiﬁc development are a complex social phenomenon.
Needham (4.1), in his monumental work, has indicated the opposed social forces
in ancient China that might be responsible for the lack of development and evo-
lution of Chinese medicine into a science. Future Needham publications are
awaited in order to learn his ideas concerning the “arrest” of scientific develop-
ment in China following the 15th century AD. Nevertheless, perhaps it is possi-
ble to make some observations related to more recent developments in medicine
and physiology in China after the 18th century. These observations are impor-
tant in order to gain some insight into the development of medical sciences in
modern China.

There was a great decline in the further development of medicine and physio-
logy in China in the Ming and Ching dynasties, which had begun with extraordi-
nary accomplishments in medicine (4.2).

There were medical exchanges with other cultures during the expedition of
Chengho (1405-1433), when the Yung Lo Ta T'ien (or The Great Encyclopedia
of Yung L0 Emperor) was published, which consisted of many volumes on med-
icine.- The Great Herbal, by Li Shih Chen, was completed in 1578. Publications
concerning inoculation procedures against smallpox were then in existence.

The Great Acupuncture Manual, by Yang Chi Chou, was published in 1601
(4.3).

In the middle of the 19th century, China became a land that Was inﬂuenced
by Western nations. A state of semicolonialism and semifeudalism was said to
exist; (4.2). In the beginning of the 20th century, Western-style medical schools
began to be established. In 1902, the Pei Yang Military Medical School was estab-
lished in Tiensin (4.2). This was followed by other such institutions, and
Chinese traditional medicine further declined because it was considered to be
unscientiﬁc. This decline was heightened in 1929 when a government decree was
issued to suppress the practice of Chinese traditional medicine completely. This
transition in status of Chinese traditional medicine was marked by the gradual
inﬂuence of these medical schools in China, among which was the Peking Union
Medical College of the Rockefeller Foundation, which attempted to encourage

43

the study of diseases in China using Western methodologies and concepts
(4.4).

The Transitional Period of Physiology in China

Physiology in its strict and modern sense was transformed with the establish-
ment of Western medical schools in China, most evidently the Peking Union Med-
ical College in 1919, which marked a deﬁnitive temporal line of demarcation and
transition between East and West. During the First World War, the China Medical
Board in the United States was created by the Rockefeller Foundation, and the
Peking Union Medical College was established in China. This resulted from the
work of two commissions to China from the Rockefeller Foundation in 1914
and 1915, which included Francis W. Peabody of Harvard University, William H.
Welch of Johns Hopkins University, and Simon Flexner of the Rockefeller Insti-
tute. The commissions surveyed the medical situation in China and made recom-
mendations for the development of modern medical education and public health
there.

The Peking Union Medical College began with a faculty and staff recruited
from Europe and America and with visiting prominent scientists and professors
from the West, including A. B. MacCollum, D. D. Van Slyke, A. B. Hastings, W. B
Cannon, A. J. Carlson, C. J. Wiggers, Carl F. Schmidt, H. B. Dyke, and H. H.
Anderson from the ﬁelds of biochemistry, pharmacology, and physiology. The
college began to function in 1919, and the ﬁrst class graduated three students in
1924.

The development of physiology is always dependent on research, and there
was a vigorous research program in the Peking Union Medical College, with lead-
ing scientists serving both as teachers and as workers.

Indicating the extent of interest in the United States in the development of
modern medicine in China, Ferguson (4.4) wrote: “Historically, China shares
with the International Health Division in being one of the two oldest interests of
the Rockefeller Foundation, and the Foundation has spent more money in this
country than in any other country except the United States” (p. 13).

Within a few years after the establishment of the Peking Union Medical
College, sufﬁcient scientists had been trained in different colleges and universi-
ties so that a branch of the Society for Experimental Biology and Medicine of
New York could be established in Peking in 1922. Four years later, 28 teachers
and scientists in the physiological sciences, including biochemistry, pharmacology,
and physiology, inaugurated the Chinese Physiological Society on September 6,
1926. In 1927, the first volume of the Chinese Journal of Physiology appeared
(4.5).

Of the 17 volumes published between 1927 and 1950 in the Chinese Journal
of Physiology, there were about 500 articles occupying 5,560 pages, of which 333
were in respiratory physiology, representing 25 articles. The total number of
article authors was about 878, of whom 40 were involved in research on the
various aspects of respiratory physiology.

44

A quick glance at the publications related to respiration in the Chinese Jour-
nal of Physiology makes one think that the standards of work were quite out-
standing, taking into consideration the time of their appearance. Many authors
had had training according to the Western model. For example, the ﬁrst paper
by Robert K. S. Lim, Professor of Physiology at the Peking Union Medical Col-
lege, was entitled “A Method of Vessel Anastomosis for Vivi-Perfusion, Cross-
Circulation and Transplantation” (4.6). These authors failed to mention or even
discuss Chinese traditional medicine.

Publications related to respiratory physiology and diseases appeared in the
beginning of the 20th century. Most of these articles were of clinical reports
(4.74.26, 4.29, 4.31-4.34) and some were related to physiology (4.27, 4.28,
4.30). With the appearance of the Chinese Journal of Physiology, articles con-
cerning physiology, including those in respiration, were published (4.35-4.49).

The published standards and statistical studies of physiological attributes and
parameters of the Chinese people deserve careful study. Literature exists in this
area (4.27, 4.28, 4.30), but much more information is needed.

Tsai and Wu (4.43) published an important article in relation to the statistical
study of vital capacity of students, which involved 3,572 male and 646 female
students. The authors made comparisons with other studies and correlated varia-
tions in relation to age, sex, and geographic location. This article is of great im-
portance as a comparison with findings of the post-1949 era. These post-1949
articles are of special signiﬁcance because of the great progress in social welfare
and food standards in China following 1949, which undoubtedly resulted in a
change of average height and body constitution of the Chinese people.

There are publications in the Chinese Journal of Physiology in which data are
presented concerning the basal metabolism of Chinese in Manchuria (4.42) and
in Peking (4.46), as well as in America (4.38). Other studies were conducted on
animals (4.36, 4.37, 4.44, 4.45, 4.47-4.49) concerning gas exchange and anaero-
bic metabolism.

Summary and Conclusions

The transitional period of Chinese medicine and physiology became a reality
when Western science was introduced to China in the 19th and 20th centuries.
While Western science was undergoing transition in the West, medicine in China
was also transformed in a somewhat different manner by the introduction of
scientific methodologies. The early introduction of “scientists” in China may
also have had much inﬂuence on her development in medicine, which is at least
of historical interest (4.1).

Following the introduction of Western medicine, the Chinese made some con-
tributions to world science, but important contributions were only made follow-
ing 1949, especially after the integration of Western medicine with Chinese tra-
ditional medicine, as evidenced by recent developments in China, including
Chinese pharmacology, acupuncture anesthesia, and the synthesis of insulin
(4.50).

.

45

Scientiﬁc investigation is dependent on environmental and social inﬂuences.
American medicine made great progress after 1948 when the Federal Government
began to take an active role in supporting scientiﬁc research. In China before
1949, the environment was not conducive to the furtherance of scientiﬁc re-
search. After 1949, the situation changed and, as a result, more scientiﬁc investi-
gation was carried out.

46

4.1

4.2

4.3

4.4

4.5

4.6

4.7

4.8

. 4.9

4.10
4.11

4.12
4.13

4.14

4.15

4.16

4.17

4.18

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Needham, Joseph: Science and Civilization in China. Vol. 2. History of
Scientiﬁc Thought. London: Cambridge University Press, 1956, pp. 33-
164.

Peking Medical College of Chinese Traditional Medicine: Notes on the His-
tory of Chinese Medicine. People’s Publishing Service, China: 1968.
Yang, Chi Chow: Chen Chiu Ta Ch ’eng (Great Compendium on Acupunc-
ture), 1601.

Ferguson, Mary E.: China Medical Board and Peking Union Medical Col-
lege. New York: China Medical Board of New York, Inc., 1970.

Lim, Robert K. S., and Wang, G. H.: Physiological Sciences. In: Gould,
S. H., ed. Sciences in Communist China. Washington, D. C.: American
Association for the Advancement of Science, 1961, pp. 323-362.

Lim, Robert K. S.: A method of vessel-anastomosis for Vivi-perfusion,
1 cross-circulation and transplantation. Chinese Journal of Physiology,
1:37-50,1927.

Whyte, G. D.: Notes on the urine of tuberculosis and non-tuberculosis
individuals in south China. China Medical Journal, 22:35, 1908.

Lee, C. M.: The ophthalmo reaction in tuberculosis. China Medical Jour-
nal, 23:246, 1909.

Talchell, W. A.: Surgical treatment of tubercular disease. China Medical
Journal, 23 :243, 1909.

“Tuberculosis Congress.” China Medical Journal, 23:42, 1909.

Hill, R. A. P.: Pneumonic plague: Preventive measures. China Medical
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“Asthma.” China Medical Journal, 25 :21 1, 1911.

Hume, E. H.: Notes on the surgery of tuberculosis. China Medical Journal,
25:137,1911.

Cadbury, W. W.: Suggestions for an anti-tuberculosis crusade in Canton,
China. China Medical Journal, 25:80, 1911.

Meadows, J. 0.: Suggestions for tracts on tuberculosis. China Medical
Journal, 25:76, 1911.

Dobson, W. H.: Some clinical phases of tuberculosis. China Medical Jour-
nal, 25:71,1911.

Todd, P. J .: Sanatoria for treatment of tuberculosis. China Medical Jour-
nal, 25:65,1911.

Snoke, J. H., and Strick, E. J .: Case of suspected pulmonary blastomyco-
sis. China Medical Journal, 262280, 1912.

47

4.19

4.20

4.21

4.22

4.23

4.24

4.25

4.26

4.27

4.28

4.29

4.30

4.31

4.32

4.33
4.34

4.35

4.36

Whyte, G. Duncan: Causes of the prevalence of pulmonary tuberculosis in
Southeast China. China Medical Journal, 28:71, 1914.

Phillips, E. Margaret: Treatment of tuberculosis in China. China Medical
Journal, 30:151,1916.

Roys, Charles K.: Artiﬁcial pneumothorax in the treatment of pulmonary
tuberculosis. China Medical Journal, 302163, 1916.

Lee, C. M.: Broncho-spirochaetosis, with report of case. China Medical
Journal, 32:332,1918.

Pantin, M. L.: Bronchomonoliasis in China. China Medical Journal, 32:318,
1918.

Parry, R. C.: Pneumonic plague prevention on the Tibetan border“ China
MedicalJournal, 32:81, 1918.

Roys, Charles K.: Report on epidemic of pneumonic plague in Tsinanfu,
1918. China Medical Journal, 321246, 1918.

Stanley, Arthur: Notes on pneumonic plague in China. China Medical
Journal, 32:207,1918.

Whyte, G. Duncan: Report on height, weight and chest measurements of
healthy Chinese. China Medical Journal, 32:210, 1918.

Whyte, G. Duncan: Report on height, weight and chest measurements of
healthy Chinese. China Medical Journal, 32:322, 1918.

“The epidemic of Shansi; Pneumonic plague orinﬂuenza?” China Medical
Journal, 33:169, 1919.

Hutcheson, A. ,C.: Height, weight and chest measurements of healthy
Chinese. China Medical Journal, (Anatomical Suppl.) 34(4):]3-22, 1920.
Li, Shu-fan: Phrenicotomy in the treatment of pulmonary tuberculosis.
China Medical Journal, 45: 1048, 1931 .

Campbell, H. E.: Massive atelectasis of lung. Chim Medical Journal,
45:66, 1931.

Hsu, I. T.: Amebiasis of the lungs. China Medical Journal, 45: 1097, 1931.
Lai, D. G.: Pseudo-dextrocardia due to childhood pulmonary tuberculosis.
China Medical Journal, 45:441, 1931 .

Shen, T. C., Ni, T. G., Loo, C. T., and Lim, R. K. S.: The gas metabolism
of the mechanically perfused stomach. Chinese Journal of Physiology,
5(2):103-114,1931.

Chen, T. Y.: The effect of oxygen tension in the oxygen consumption of

the Chinese fresh-water crab, eriocheir sinensis. Chinese Journal of
Physiology, 6:1-12,1932.

48

4.37

4.38

4.39

4.40

4.41

Tang, P. S., and French, C. S.: The rate of oxygen consumption by
Chlorella pyronoidosa as a function of temperature and of oxygen ten-
sion. Chinese Journal of Physiology, 7:353-378, 1933.

Benedict, F. G., and Meyer, M. H.: The basal metabolism of American-
born Chinese girls. Chinese Journal of Physiology, 7:45-60, 1933.

Yang, En-fu: Solubility of oxygen in red blood corpuscles. Chinese
Journal of Physiology, 8(4):365-382, 1934.

Yang, En-fu: Solubility of nitrogen in corpuscles. Chinese Journal of
Physiology, 8(4):383-398, 1934.

Shen, T. C., and Ling, S. M.: Studies in the metabolism of ducks {Anas

. Platythyncha L.) II. Gas metabolism and respiratory quotient. Chinese

4.42

4.43

4.44

4.45

4 .46

4.47

4.48

4.49

4.50

Journal of Physiology, 8:307-344, 1934.

Benedict, Francis G., and Garven, H. S. D.: The basal metabolism of male
Chinese’in Manchuria. Chinese Journal of Physiology, 10(1): 141-148, 1936.

Tsai, C., and Wu, C. H.: A statistical study of the vital capacity of senior
middle school and college 9+‘."J.;IltS. Chinese Journal of Physiology,
14:95-116,1939.

Chang, Chang-ying: Effect of vegetarian diet on rate of respiration of rat
organs. Chinese Journal ofPhysiology, 14(2): 147-150, 1939.

Ling, Chun-yu, and Tsai, Chiao: The relative diffusibility of carbon dioxide
and oxygen through various animal membranes. Chinese Journal of
Physiology, 14(2):]87-189, 1939.

Kung, L. C., Tsao, C. P., and Wilson, S. D.: The basal metabolism of
Chinese children, ten to seventeen years of age. Chinese Journal of
Physiology, 14:431-438, 1939.

Van Heerdt, P. F.: Respiratory regulation in eriocheir sinensis, milne-
edwards. Chinese Journal of Physiology, 15(1):25-32, 1940.

Wu, Jone, Yeh, Y. W., and Chang, I.: The anerobic metabolism of the
turtle’s auricle and the 661’s heart. Chinese Journal of Physiology,
16(3):391-402, 1941.

Chang, I., and Li, Liang: The aerobic breakdown and resynthesis of phos-
phagen in the rabbit’s heart. Chinese Journal of Physiology, 16(3):265-
276, 1941 .

Shanghai Insulin Research Group: Studies in the structure function rela-
tionships on insulin. Scientia Sinia, 14:61-78, 1973.

49

 

Chapter V

RESPIRATORY RESEARCH IN CONTEMPORARY CHINA

Numerous articles on respiratory research, which cover a wide range in the
ﬁeld of respiratory physiology, have been published in China since 1949. They
can be divided for convenience into the following categories:

. Research in pulmonary, anatomical, and functional geometrics

. Research in the kinematics of the lung system

. Research in lung dynamics

. Research in gas exchange and gas diffusion in the pulmonary system
. Research in the regulation of ventilation

. Pulmonary function testing research

. Instrumentation in respiratory research

. Smoking and air pollution studies

. Research in altitude and hyperbaric physiology

m\IO\UIJ>UJN>-‘

\0

These categories are discussed separately in this chapter.

Research in Pulmonary, Anatomical, and Functional Geometrics

From 1960-65, a series of anatomical studies of the bronchi and blood vessels
in lungs of the Chinese, including the bronchi and blood vessels of the pulmonary
hilum, lobular, and lung section ﬁssures was published (SJ-5.6). Using fresh
autopsy specimens, which had been ﬁxed with formalin, these authors measured
the diameters and lengths of the pulmonary vessels and bronchi and concluded
that the geometry of the bronchial and pulmonary vascular systems was related
to lung air volumes. Measurement of the tracheobronchial tree of 650 Chinese
(5.6) and study of the anomalous vascularization in tracheal stenosis were pub-
lished (5.7, 5.8).

Sung et al. (5.9) studied patients with various pathologies by employing pneu-
moediastiography for the purpose of making diagnosis of pathology in various
disease entities involving the chest.

Determinations of functional lung geometrics, which can be measured with
precise instrumentation, were published in the Chinese Journal of Internal
Medicine by groups of investigators in Shanghai and modiﬁed those reported in
the United States. The subjects for these studies consisted of over 1,000 healthy
male and female workers and peasants (5.10). Equations described the relation
of ventilation capacity, vital capacity, and forced expiratory volume to sex, age,
and sitting heights of the subjects, as fOIlOWS:

51

Ventilation capacity (l/min) = [1.579 + (0.00651 X age) - (0.000287 X age’)] X sitting height (cm),
for males
= [0.849 + (0.01557 X age) — (0.0003 X age’)]‘X sitting height (cm),
for females
Vital capacity (m1) = [46.95 + (0.07435 X age) — (0.004064 X age’)]' X sitting height (cm),
for males
= [31.31 + (0.4069 X age) — (0.007582 X age’)]‘ X sitting height (cm),
. for females
Forced expired volume (ml) = [41.47 — (0.05726 X age) — (0.003938 X age’)]‘ X sitting height (cm),
for males
= [33.78 - (0.187 X age) — (0.0000365 X age’)]' X sitting height (cm),
for females

Expiratory and inspiratory flow rates were studied by Mao and Chia (5.20).

A total of 115 emphysema patients was studied to determine their maximal mid-

expiratory ﬂow rate, a more sensitive measurement than the inspiratory ﬂow rate.
It was revealed that the degree of emphysema was correlated with a decrement in
the maximal expiratory flow rate.

The analysis. of pulmonary dysfunction in chronic respiratory diseases was
studied by Ho and Wu (5.11), who stressed the importance of using arterial oxy-
gen saturation measurements for evaluation of the degree of pulmonary dysfunc-
tion present. Pulmonary function testing, including determinations of ventila-
tion capacity, vital capacity, and forced expired volume, was not found to be
adequate to determine the degree of pulmonary dysfunction. The degree of
hypoxia present was stressed, and certain criteria were set for the diagnosis of
arterial hypoxemia. This clearly shows that medical workers in China do employ
sophisticated instrumentation for pulmonary function testing in their work.

Some other workers in China have also correlated ventilation capacity with
body surface in square meters for a wide variety of ages in both male and female
subjects (5.12), as follows:

52

9

vc (ml) = 3,1437M2 — 1.100, for males
= 2,387st2 — 0.591, for femalesl

RV/TLC (%) = 0.3932 age + 15.43, for males
= 0.2391 age + 23.76, for femalesz

Ventilation capacity can be predicated by means of the following equations:

Age (year) Equation
Male:
17-25 164.577 - 26.166 X body surface
26-39 61.513 + 37.904 X body surface
40 and over 7.418 + 60.46 X body surface
Female:
17-25 59.195 + 22.252 X body surface
26-39 136.972 - 30.70 X body surface

40 and over 47.617 - 22.839 X body surface

In another series of determinations, the geometries of 290 healthy Chinese
peasants were determined and the relationship of certain lung volumes with age
was established (5.10-5.12). Liang et al.’s data are presented in tables 5-1 and 5-2.

The vital capacities of Chinese were found to be apparently smaller than those
of Americans (5.13), but more data are necessary to fully substantiate this. It is
also possible that body size is closely related to the vital capacities. I have ob-
served that in recent decades, the body height of Chinese has increased consider-
ably.

In some studies, it was clearly pointed out that the vital capacities of Chinese
peasants were substantially larger than those of medical workers, 20 percent
larger in males and 10 percent in females (5.10).

Liu et a1. (5.6) measured the tracheobronchial tree in 650 Chinese patients
with pulmonary tuberculosis involving either the bronchus or the pulmonary
parenchyma by employing a bronchoscope under local anesthesia. The authors
described two types of abnormally located lobe-bronchi oriﬁces.

Research in the Kinematics of the Lung System

There are quite a few current Chinese studies regarding the measurement of
lung kinematics both in normal individuals and in patients with chronic respira-
tory disease (510-521). In addition to measurement of long volumes, there
have been studies of ventilation capacity and of forced expired volumes at dif-
ferent time intervals, including half-second intervals. Regression lines of ventila-
tion capacity, vital capacity, and forced expired volume with age and sitting
height for normal, healthy male and female peasants are available (5.12, table 10).

 

‘ VC indicates vital capacity; M"z indicates body surface in square meters.
’ RV indicates residual volume; TLC indicates total lung volume.

53

570-225 0 - 75 - 5

179

Table 5-1. Normal values of lung volumes in 200 healthy peasants.

 

 

 

Male (N = 126) Female (N = 74)
Item
Standard Standard Standard Standard
Average . . Range Average . . Range
error devnatlon error deVIatIon
Age (yr.) 30.4 0.903 10.136 17-63 34.5 1.277 10.99 17-58
Body height (cm) 164.8 0.519 5.822 152-180 154 0.549 4.728 142-168
Body weight (kg) 58.3 0.569 6.381 40-75 52.6 0.761 6.550 41-67
Body surface (m2) 1.6 0.008 0.098 1.32-1.91 1.46 0.011 0.964 1.28-1.68
Sitting position1
lC 2.764 0.032 0.478 1.8764087 2.055 0.040 0.317 1.2732789
ERV 1.237 0.019 0.326 0654-1942 0.818 0.035 0.301 0.275-1.988
VC 4.004 0.055 0.613 2.7095663 2.873 0.047 0.403 2.2134429
Lying down position1
TV 0.602 0.013 0.144 0.248-1.011 0.516 0.017 0.143 0.2530991
RV 1.409 0.046 0.511 0.6692931 1.336 0.049 0.425 0.4502709
FRC 2.070 0.057 0.637 1.070—4.430 1.786 0.069 0.591 0.7722962
TLC 5.081 0.062 0.813 3.459—7.138 4.077 0.085 0.735 2.602-7.088
RV/TLC (percent) 27.27 0.679 7.624 15.8-52.0 32.2 0.852 7.336 15484

 

1All values in liters.

Note.-—|C indicates inspiratory capacity; ERV indicates expiratory reserve volume; VC indicates vital capacity; TV indicates tidal
volume; RV indicates residual volume; FRC indicates functional residual capacity; TLC indicates total lung capacity.

SS

Table 5-2. Values of vital capacity, residual volume, and total lung capacity of individuals (lying down) with various ages.

 

Average

Average

 

 

VCl RV' TLC| RV/TLC (percent)
Sex age N bOdV
face _ — ‘-
‘V'-’ “or", ) SE so x SE so X SE so x SE so
21.2
(17-25) 49 1.568 3.982 $0.082 0.575 1.191 i0.059 0.410 4.833 10.099 0.690 24.6 +0.918 6.421
Male 31.7
(26-39) 55 1.160 4.141 +0.08 0.609 1.432 $0.069 0.513 5.216 10.113 0.849 26.7 10.855 6.34
47.4
(40-61) 22 1.61 3.712 10.138 0.647 1.839 $0.107 0.503 5.302 $0.164 0.770 34.5 $1.631 7.66
20.7
(17-25) 19 1.455 2.865 $0.079 0.347 1.154 10.069 0.299 3.917 t0.119 0.520 29.3 $1.193 5.20
Female 32.9
(26-39) 30 1.48 3.007 £09106 0.583 1.339 10.089 0.489 4.180 t0.162 0.885 31.3 $1.397 7.65
46.8
(40-58) 25 1.48 2.756 10.053 0.266 1.468 10.104 0.520 4.073 10.152 0.761 35.3 $1.522 7.6

 

‘ Values in liters.

Note.—X indicates average; SE indicates standard error; SD indicates standard deviation; VC indicates vital capacity; RV indicates residual volume;
TLC indicates total lung capacity.

Table 5-3 presents detailed data from Liang et a1. (5.10) on normal healthy
peasants regarding their ventilation capacity and forced expired volume.

Studies have also been performed by Ho and Wu (5.11) on patients with
chronic respiratory diseases. Results show deﬁnite defects in patients’ lung func-
tion test results. In some cases, the blood oxygen saturation was deﬁnitely '
affected, although there were no changes in ventilatory function. These workers
pointed out that lower oxygen saturation would be related to the ventilation per-
fusion ratio and diffusion abnormalities.

A total of 586 athletes were used for a study of pulmonary function testing
(5.14, 5.22). The ventilation capacity, vital capacity, and forced expired volume
were determined and correlated with age and different types of athletic activity.
They concluded that increased pulmonary function in athletes might also be due
to improvement in central nervous system function in relation to voluntary con-
trol of muscular movements and the “explosive” leg strength, etc.

Research in Lung Dynamics

There seems to be a lack of literature in the area of lung mechanics and lung
dynamics in China. However, from conversations with surgeons who employed
acupuncture anesthesia for chest operations, I found sophisticated knowledge in
lung mechanics and dynamics, including the application of positive air pressures
in the lungs on one side of the lung before chest operations, the training of the
patient to use an abdominal form of breathing, and the conditioning of the
patient in exerted breathing efforts when the chest was embarrassed (5.15).

Research in Gas Exchange and Gas Diffusion in the Pulmonary System

Ho and Wu (5.11) have’studied pulmonary function and oxygen saturation in
the arterial blood together with the gas exchange of patients with chronic respi-
ratory diseases. The authors stressed the importance of understanding both the
gas ventilation and the gas transportation phases of the respiratory and the circu-
latory systems in order to interpret disease phenomena.

It is interesting to note that in the discussion section of their paper, the
authors stressed the importance of employing oxygen saturation in the arterial
blood and of the use of the pulmonary function of the individual lungs. It seems
clear that these authors have an understanding of the ventilation perfusion ratio
and of oxygen diffusion capacity measurements in patients (5.24).

Research in the Regulation of Ventilation

There have been several important international conferences in the past 20
years dealing with new discoveries and information concerning the regulation of
respiration (5.25), and quite a few important papers have been published in China
in relation to respiratory control problems in physiology (5.23, 5.24, 5.26-5.28).
Ho and Chang (5.26) reported on the mechanisms of induction of hyperpnea

56

LS

Table 5.4. Ventilation capacity and forced expired volume of normal, healthy peasants.

 

Ventilation capacity

Forced expired volume ,

 

 

 

 

A
Sex ( 93 N m2 _ 1st second 2d second 3d second
y X(|/min) SE so _ _ _
Xl SE SD Xl SE SD Xl SE SD

21 .2

(17-25) 49 1.568 123.5500 12.790 ‘ 19.531 83.7 10.788 5.517 93.9 10.413 2.894 98.4 10.268 1.817
31 .7

(26.39) 55 1.60 122.538 12.971 22.042 78.8 11.047 7.769 92.4 10.339 2.511 97.0 10.240 1.747
47.4

(40—61) 22 1.61 104.758 14.252 19.945 73.8 11.23 5.78 89.7 10.781 3.664 95.4 11.70 7.99

Male

30.4

(17-61) 126 1.60 119.827 12.028 22.760 80.4 10.583 6.536 93.5 10.344 3.861 97.3 10.197 2.159
20.7

(17-25) 19 1.455 91.572 12.766 12.059 89.6 10.981 4.274 97.1 10.493 2.149 98.6 10.39 1.512
32.9

(26-39) 30 1.48 91.538 12.492 13.650 83.3 11.158 6.346 94.0 10.862 4.721 97.9 10.423 2.197
46.8

(40-58) 25 1 .48 80.297 12.693 13.465 80.2 11 .493 7.469 96.9 10.997 4.987 97.2 10.527 2.635

Female

34.5

(17-58) 74 1.96 87.985 11.649 14.185 82.7 10.834 7.176 94.6 10.536 4.616 97.9 10.271 2.181

‘ In perc_ent.

Note.—X indicates average; SE indicates standard error; SD indicates standard deviation.

by intravenous injection of ammonia chloride in rabbits, in which acid hyperpnea
was described after severing the sinus, depressor, and vagus nerves. In the cross-
perfused carotid sinus area, acid failed to produce hyperpnea in the recipient rab-
bit (acting on the carotid sinus area alone). The conclusion reached concerning
acid’s action on the respiratory centers showed that the authors were not aware
of new discoveries concerning the central chemosensitive area in the brain (5.25).
At the time of publication of their article, the peripheral chemoreceptors were
thought to play a dominant role in the regulation of ventilation.

Chung’s (5.27) paper “The Effects of Stimulation of the Lung Stretch Recep-
tors on Somatic Reﬂex Activity,” demonstrated sound knowledge of the vagal
regulation of respiratory cycles.

Hsiao’s (5.28) report on the effects of intrapulmonary pressure changes in
blood pressure stated that such changes were mainly due to “[1] impulses origi-
nating from the pulmonary stretch receptors arriving primarily at the respiratory
center and affecting the vasomotor center through irradiation; and [2] impulses
originating from the pressor receptors of other organs, presumably the great ves-
sels of the thorax, which are conducted along ﬁbers of the vagal trunk, regulat-
ing the function of the vasomotor center directly.”

Besides studies of neural control of respiration, also published in China were
articles concerning metabolic rate changes during exercise. Wang and Nee (5.29)
studied the oxygen consumption changes during a special type of muscular exer-
cise, ‘Ch’i-Kung,’ which is a Chinese traditional breathing exercise. During the
Ch’i-Kung procedure, oxygen consumption either showed no change or increased,
while ventilation was found to be suppressed (apnea or hypopnea). A mild de-
gree of anoxemia showed in the oximetric studies. A gradual return of the oxy-
gen saturation to its normal load followed, while ventilation was still maintained
at a subnormal value. These authors state:

In contrast, during the voluntary hyperventilation of untrained subjects, the oxygen
saturation curve showed .much greater ﬂuctuations than those observed in “Ch’i-Kung”
subjects. Therefore, it was assumed that during successful “Ch’i-Kung” practice there
might be a readjustment of the pulmonary circulation in accordance with the shift of
respiratory patterns in order to maintain a sufﬁcient and constant level of arterial oxygen
saturation.

The interesting problem of differentiating the pressure effect from the chemo-
sensitive effect, both conveyed via the sinus nerve, on ventilation was also studied
by a group of respiratory physiologists in Shanghai (5.30). They concluded from
their experiments on dogs, cats, and rabbits:

. . . the respiratory excitatory reﬂex is evoked by impulses from the pressoreceptors and

conducted through the sinus nerve ﬁbers of small diameter to nerve centers situated at

the level of the upper pons, which is higher than the centers responsible for the depressor
and respiratory inhibitory response.

The effect of anesthesia on the regulation of respiration, especially in relation
to the peripheral chemoreception, was studied (5.31). Early studies of respira-
tory physiology included the carotid sinus reﬂex mechanism in the rabbit (5.32),
the hibernation and respiration of the hedgehog {5.33), and related neural func-
tions (5.34, 5.35).

58

The re are numerous publications on respiratory diseases, including studies in
pediatrics (5.36), encephalopathy (5.37), and acute pulmonary obstruction and
inﬂammation (5.38). Amebiasis (5.39), lung ﬂukes (5.40), pulmonary tuberculo-
sis (5.41-5.43), and lung abscess (5.44, 5.45) studies still draw the attention of
physicians. Pulmonary function tests in patients (5.46) and related research for
therapeutic procedures have been carried out (5.47-5.49), and articles related to
pneumonia in adults (5.50) and in infants (5.51) have been published.

Pulmonary Function Testing Research

The importance of pulmonary function testing procedures for clinical and
basic research in respiratory diseases was realized long ago by physiologists in
China (5.52). During the Great Leap Forward, much progress was made in the
ﬁeld of respiratory research.

In the West, respiratory physiology has made great progress in the area of pul-
monary function testing. The invention of new technologies made it possible to
develop advanced instrumentation in the study of pulmonary diseases. Pulmo-
nary function testing, therefore, became a routine and integral portion of clinical
practice. The Chinese have also recognized the importance of such studies both
in clinical and in basic research.

The progress made in China during the 1950’s in industry and agriculture
made it possible to design new medical instruments, including those used for pul-
monary studies. Pulmonary function testing is now generally recognized as an
integral and important part of procedures and methods of clinical medicine in
respiratory diseases. By the end of 1960, there had been over 30 signiﬁcant
papers published in China dealing with respiratory physiology and the employ-
ment ofnew techniques (5.52).

In Wu et al.’s review paper (5.52), data from the important papers published
up to 1960 were cited. For example, several Chinese have investigated and pub-
lished studies of vital capacity. In one series of over 6,000 healthy students, the
average vital capacities were 2.31 and 1.8 liters for males and females, respectively,
when expressed in per square meter of body surface. Another series showed that
in 100 healthy adults, the average vital capacity of males and females was 3.65
and 2.75 liters, respectively, per meter square of body surface.

In another series of studies, the maximal ventilation capacity was reported to
be 104 and 82.5 liters per minute for males and females, respectively. Ventila-
tion reserve was found to be 93 percent, and the ratio of walking ventilation to
ventilation capacity was 0.1525.

Residual volume was studied with the aid of the oxygen washout method for
7 minutes, a technique improved by the authors. They reported that in 23
healthy adults of 17-30 years of age, the average residual volume was 1.221
liters occupying 27.5 percent of the total lung capacity. In another series of 27
adults of 31-61 years of age, the residual volume was found on the average to
be 1.448 liters or 35.42 percent of the total lung capacity.

59

Timed vital capacities were determined in a large number of students. For
example in Harbin, 2,000 female students of ages 10-24 and over 3,000 males
were studied. The results were correlated with body weight, height, etc., from
which equations were formulated. In healthy adults, the normal values were 83
percent for the ﬁrst second, 96 percent for the second second, and 99 percent
for the third second. A correlation of 0.8014 was established between the timed
vital capacity of the 1st second and the ventilation capacity.

Gas exchange function studies were also carried out. The respiratory physiol-
ogy and research that I was exposed to in 1945-47, when I was a medical student
in West China Union University, was indeed rudimentary. In the 1950’s, however,
Chinese researchers published articles concerning the determination of the arter-
ial blood partial pressure of oxygen as well as the partial pressure of gases in the
gas phase. The difference between the arterial Po, ’s at rest and during exercise
was realized. Arterial oxygen saturation and partial pressure concepts were also
determined.

Evidently, procedures have been established for pulmonary function testing
in surgery and the established safety procedures related to operations. It was
possible to determine the pathology involved in relation to the area and extent
of pathology and the thickness of the alveolocapillary membrane. Decrements
in ventilation after varying degrees of lobectomy were studied, and the impair-
ment was found to reach from 9 percent to 21 percent (as judged by ventilation
performance) when the sections involved partial or single lobectomies or pneumo-
nectomies.

Great emphasis was put on the extension of medicine and medical care in
rural areas and in industrial facilities. Extensive studies were performed in rela-
tion to pulmonary function testing and silicosis in China. In one report, it was
stated that silicosis could be divided into three stages. In normal, healthy adults,
the average vital capacity was 4.044 liters. In patients with the first stage of
silicosis, the vital capacity decreased to 3.69 liters, then to 3.5 and to 2.355
liters for the second and third stages, respectively. The ventilation capacity of
normal workers was reported to be 140 liters per minute. In silicosis patients, it
decreased to 107, 1.8, and 75 liters per minute, respectively, for the first, second,
and third stages.

Interesting results were published concerning comparative studies of vital ca-
pacity, ventilation capacity, and timed vital capacity in 100 healthy workers out-
side of the mines and 90 non-silicosis-affected workers who worked daily in the
mines (5.52). The vital capacities were found to be 4.128 and 3.861 liters, the
ventilation capacities were 127.8 and 188.9 liters, and the timed vital capacities
of the first second were 3.216 and 2.813 liters, respectively. It was pointed out
that although there were no signs of silicosis in these mine workers, there was
evidence of bronchial infections.

Reports were also published on the increase in residual volume of mine work-
ers with simple uncomplicated silicosis. For example, the residual volume of
normals was found to be 1.386 liters, whereas the residual volume of those with
silicosis was 1.857, 2.016, and 2.450 liters for the ﬁrst, second, and third degrees

60

cf afﬂiction, respectively (5.52). In another series of studies, it was shown that

the ventilation, ventilation capacity, resting ventilation, and walking ventilation

decreases about 20 percent from the normal to the first stage of silicosis and

from 20 percent to 40 percent from the second to the third stage (5.52).
Figure 5-1 ShOWS one method the Chinese use to prevent silicosis.

Instrumentation in Respiratory Research

Research requires instrumentation, which in turn depends on the level of tech-
nology and industry attained for its development. China has made great progress
in developing instrumentation for medical research since 1949. From available
reports (5.53-5.55), one can read about progress made in China in physics, for
example, which has laid a foundation for the development of all aspects of in-
dustry, including instrumentation for medical research.

In the Shanghai Industrial Exhibit, one can see the following on display: a
200,000X electron microscope, which has a resolution of 7 A; a 2-meter grating
spectrometer with a range of 2,000-10,000 A; and a mass spectrograph with mass
resolution of M/AM of 1,000 with a sensitivity of 10'9

 

Figure 5-1. An art factory in China. The dust produced during grinding is
sucked in by the vacuum outlets nearby. The working environment is im-
proved, and the development of silicosis is prevented.

6l

Computers have been developed in China with an access time of 2 microsec-
onds and a memory of 32,000 words (with 48 bit words) (5.54). This develop-
ment is obviously of great signiﬁcance for medical research.

In the Shanghai Industrial Exhibit, there also are displays of electronic equip-
ment, including multiple-channel recording machines and spectrophotometric
and electron microscopes, which are being used in several research laboratories in
China. Figures 5-2 to 5-4 illustrate some of this equipment.

In respiratory research, machines for regulating and assisting ventilation are
available. From the available literature (5.52), one can learn that instrumenta-
tion covering a wide range of respiratory research is in use. For example, spirom-
etry, double spirometry, and gas analysers, Scholander and Haldane apparatuses
for blood and gas phase analysis, respectively, and infrared CO2 meters are all
made domestically at the present time.

Although it is not possible at the present time to have modern instrumenta-
tion in all hospitals of China, especially those of the hinterlands and frontiers, the
progress made to date and future potentialities in this area are quite clear. It
was refreshing to see medical workers doing a great deal with ordinary or garden-
variety instrumentation in China. The simple, neat setting in all operating rooms
is a very good example of the efﬁciency and simplicity demonstrated by the med-
ical workers, and emphasis is now placed on the employment of practical instru-
mentation. For example, a light-weight, automatic ventilator was described in
the Chinese Journal of Surgery (5.56), in which intermittent, positive-pressure
oxygenation could be produced and supplied to the patients with a tidal volume
of 250-800 ml or more. It is understandable that when more hardware and in-
strumentation are available, use of these advanced methods will certainly make
possible more advanced study in respiratory physiology and medical research in
China (5.57).

Physicians in China have adequate knowledge to cope with clinical cases of
respiratory disturbances (5-58). For example, a chest hospital of the Chinese
Academy of Medical Sciences gives the following account concerning pulmonary
function testing in over 100 infants: infants with pneumonia showed the special
characteristics of small tidal volume and shallow breathing, with attempts to cor-
rect hypoxia by increasing respiratory frequency. In moderately severe cases,
there were increases in both total ventilation and alveolar ventilation. However,
due to pathology of the lungs and to increased dead space ventilation, which re-
sulted in an uneven distribution, the increase in alveolar ventilation was compara-
tively small.

In severe cases, there was more reduction of alveolar ventilation because of
the increased proportion of dead space ventilation. Therefore, although the total
ventilation was increased considerably, there might be no increase or even a de-
crease in alveolar ventilation.

In the most severe and critical cases, there was respiratory fatigue and lack of
strength to breathe, and the tidal volume might reach only 65 ml/min/mz, not
yet half of the normal value. With decreased respiratory frequency, the alveolar

62

 

 

 

 

Figure 5-2. Automatic respirator displayed in the Shanghai Industrial Exhibit
and made by the workers, peasants, and soldiers of the factory for medical
instrumentation in Shanghai.

«hymn-a s «a

mas-thrk‘v-R Mm“ a

a. «mu a nu
vmmt u-u

 

Figure 5—3. Another view of automatic respirators, suction pumps, and dental
equipment used in China at the present time.

63

 

Figure 5.4. An eight-channel EEG machine made in China.

ventilation might only reach one-fourth of the normal value. The elimination of
C02 was impeded.

According to the determination of blood gases and pH in the moderately se-
vere cases, the Foo, of the arterial blood falls within normal values. Some cases
had respiratory alkalosis because of compensatory action to hypoxia as a result
of hyperventilation. Only a few had respiratory acidosis.

In severe cases, only one-third had normal Pco2 , half with respiratory acido-
sis and only very rarely with respiratory alkalosis. In critical severe cases, respira-
tory acidosis was usually seen, and Paco, was elevated, ranging from 130-62 mm
Hg, with 91.6 mm Hg as the average.‘Half of these cases were accompanied by
metabolic acidosis. Infants with pneumonia had a decrease in arterial oxygen
saturation. Under oxygen inhalation, the severe cases had an So2 of 84.7 per-
cent and the critical cases had an So2 of 65.5 percent.

Respiratory fatigue in infants with pneumonia can be seen when the Paco,
reaches 50 mm Hg and the arterial blood saturation is below 85 percent. The
normal alveolar ventilation of infants averaged 3.5 l/min/m2 . Nine of 12 cases
died in 3 days. It seems clear that hypoventilation is an important cause of mor-
tality in infants with pneumonia. If effective ventilation is maintained, then
serious hypoxemia and respiratory acidosis can be corrected, and the respiratory
fatigue as well as the threat to life can be avoided, thus gaining valuable time for
infant to recover. In accordance with this idea, positive intermittent respiration
therapy was instituted in eight critical cases and succeeded in four (two cases with
tracheal intubation and simple artiﬁcial respiration—squeezing the balloon—two
cases with artiﬁcial respiration). The application of artiﬁcial respiration to in-
fants with pneumonia and other disorders is a problem undergoing active research
in China.

64

Smoking and Air Pollution Studies

Air probably is the most abundant substance in the atmosphere, and since it
is possibly the most inexpensive material available to human beings, matters con-
cerning its purity and availability have been mostly ignored. Only recently have
we become aware of how impure the air we breathe is. Industrialization and inef-
fective methods of disposing of exhaust air from machines and automobiles have
afﬂicted men with a variety of diseases.

Air pollution in the body through the lungs can be classiﬁed into two cate-
gories: voluntary and involuntary. The former refers to smokers and the latter to
nonsmokers. There are no statistics for comparison of the number of people who
smoke in China with those living elsewhere. It can be stated generally that in
the large cities of China, the air is much cleaner compared with the Western
world. The Chinese seem aware that their air can potentially be polluted, and
there are some studies concerning the composition of the pollutants emitted from
diesel engines and other sources (5.59).

Numerous brands of cigarettes are available in China, both ﬁltered and unﬁl-
tered, and are all produced by State-run enterprises. The smoking of tobacco is
part of social life, and no stigma or prohibitions seem to be attached to its use.
No information is available concerning the tar and nicotine content of these pro-
ducts, but my impression was that these cigarettes are stronger than cigarettes in
the United States. The Chinese are experimenting with cigarettes made of her-
bal materials, which are said to have beneﬁcial effects in the treatment of vari-
ous respiratory ailments, including bronchitis and asthma. Detailed information
on these products is not available at the present time.

Research in Altitude and Hyperbaric Physiology

China offers a unique location for the study of altitude physiology. Of the
nine and a half million kilometer squares of China’s territory, more than 25 per-
cent has an altitude of over 3,000 meters, and more than 10 percent is over
5,000 meters (5.60, 5.61'). The following gives an idea of the extensiveness of
high altitude land in China:

Averaging 4,000 meters above sea level, the Chinghai-Tibet Plateau embraces the high-
lands and mountains of Tibet, Chinghai, western Szechuan and southern Sinkiang. It is
the world’s largest plateau with 2,200,000 square kilometers occupying more than one
fifth of the country’s total area. {5.62, p. 40]

Figure 5-5 shows China’s plateaus.

Altitude physiology did not have an early development in China, although there
were early protoscientiﬁc notions of Ch’i, or pneuma. The late development of
altitude physiology is probably due to the facts that altitude physiology is only
a recent development within respiratory physiology itself and that the Chinese
did not develop early enough in their culture to embark on scientiﬁc studies in
the ﬁeld of respiratory physiology. The present policy of the Chinese govern-
ment, however, indicates that China will develop her natural resources, agriculture,

65

570-225 0 — 75 - 6

 

 

     
   
 

Greater Khingan
Mountains

 

v" V 7‘; i
3“” Wk Y MEICHO‘N (4/?
,. PLATEAU - l <7 a? [l
51'1” "allucf/ O f ’1 \ § ~ 1
, . a 1 .' u
2M: i. . - ;. .

 

 

 

 

 

Figure 5-5. China’s plateaus. (From China Reconstructs, pp. 38-42, Feb. 1974)

and industries in mountainous areas for the national welfare (ﬁgures 5-6 and 5-7).
Such development projects require knowledge concerning many aspects of the
environment, including the physiological adaptation of man. It is because of

this new surge of Chinese interest in the development of mountainous areas that
altitude physiology will certainly play an important role in China in years to
come and that the Chinese undoubtedly will make substantial contributions in
this area of scientiﬁc endeavor.

The Historical Development of Altitude Physiology in China

Long before the birth of Christ, China had contact with the Western world and
other countries in Asia. The silk road, which was in existence several centuries
B.C., traversed the highest plateau of the world—the Pamirs Plateau—which the
expedition of Chang Ch’ien followed in its journey to the West in 138 BC (5.63).
In early Chinese history, there were undoubtedly numerous accounts of travelers
who journeyed through such highlands. The failure of these expeditions might
have been partially caused by the lack of knowledge of how to cope with high
altitude, which made it impossible for the soldiers to overcome the obstacle of
unbreathably thin air. China systematically published Historical Annals for over
2,000 years and actually recorded events that occurred during the various dynas-
ties. However, there is no study as yet that reveals the experiences and hardships
encountered by people who traveled in the highlands or who resided on top of
high mountains.

66

the Taitzu Snow
Mountain, 7,000 me-
ters above sea level,

in the Tiching Tibetan
Autonomous Chou,
Yunnan province.

 

Figure 5-7. The
development of
mountain slopes
into terraces of
farmland. This
photograph _
showstachai-type f
terraces in the K
Awa Mountains
(Yunnan prov-
ince) Li Yu—lung.

  
 

Marco Polo (1254-1324), who journeyed to China twice, had some relevant
experiences while traveling through the high plateaus (5.64):

. . . On leaving this country, and proceeding three days, still in an east-north course, ascen-

ding mountain after mountain, you at length arrive at a point of the road where you may

well think the surrounding summits to be the highest lands in the world. . . . For twelve
days the course is along this elevated plain, which is named Pamer Pamer (Pamir Plateau),
and during all that time you do not meet with any habitations, it is necessary to make
provision at the outset accordingly. So great is the height of the mountains that no birds
are to be seen near their summits; and however extraordinary it may be thought, it is
affirmed that from the rareness of the air, ﬁres when lighted do not give the same heat

as in lower locations, nor produce the same effect in cooking food . . . .

With the general progress made in respiratory physiology at the turn of the
century and especially in the 'ist two decades, we understand much more about
the effect of thin air on the physiological processes of the human body (5.65).

In 1961 , Sir Edmund Hillary and Dr. Grifﬁth Pugh led an international expedi-
tion party, the Himalayan Scientiﬁc and Mountaineering Expedition (which was
sponsored by the World Book Encyclopedia of Chicago), to the Great Himalaya
Mountain where they lived for 6 months in a camp of prefabricated aluminum
huts set up in the Mongbu Valley 10 miles south of Mount Everest. At an alti-
tude of 19,200 feet, the group lived without artiﬁcial supplies of oxygen. Tests
were made of the explorers’ blood, their IQ’s, and other characteristics in an
effort to learn whether human beings might adapt themselves successfully to con-
ditions in which the amount of available oxygen was about 50 percent of that at
sea level (5.66).

A Chinese team scaled the north face of Mount Everest for the ﬁrst time on
May 25, 1960, lead by Wang Fu-chou (5.67). This team calculated the elevation
of Mount Everest at 29,133 feet above sea level, with a 20-foot ﬂuctuation allow-
ing for snow accumulation, which is somewhat higher than the previous figure of
29,028 feet.

The ﬁrst scientiﬁc expedition of the Chinese to Mount Everest took place in
1966-68, and some of their results were published in scientiﬁc journals and in the
People’s Daily of the 18th of January 1968. It should be noted that in China all
geographical names in national minority regions are in the original language.
Thus, Mount Everest has been renamed Mount J olmo Lungma, which is the term
used by the natives of that region.

As revealed in the People is Daily newspaper, January 18, 1968, there were
over 100 scientists of 30 different specialties participating in this expedition.
They made observations for several months at an altitude of over 7,000 meters.
The expedition was organized by the Chinese Academy of Sciences and employed
23 nationally well-known scientiﬁc teams. Material collected included that rele-
vant to geophysics, geology, phytotaxonomy, entomology, zoology, soil mechan-
ics, glacier study, astronomy, and altitude physiology. Fossils were discovered
that were 1.8 million years old. Algae was studied, and the stratigraphy of the
Mount J olmo Lungma Region in southern Tibet was investigated (5.68, 5.69).

From January to March of 1967, physiologists from the Shanghai Physiologi-
cal Institute studied several important problems in human adaptation at high

68

altitude. Some of the work was performed at an altitude 4,000 meters above sea
level to test human coordination, hearing, sight, etc.

Maximal oxygen consumption and maximal ventilation and oxygen saturation
as well as the electrocardiogram during muscular activity were studied. The pul-
monary functions of 1,500 highlanders and 6, 000 lowlanders were studied.

Since no journals or magazines were published in China during the Cultural
Revolution, articles related to the ﬁndings from this expedition only began to
appear in 1973. Several papers have already appeared 1n relation to the study of
geology, soil micromorphology, climatology, and palaeobotany in the region of
Mount J olmo Lungma (5.68-5.76). Full publication of physiological studies
made during this important expedition is awaited.

The increasing interest of the Chinese in high-altitude physiology and respira-
tory diseases associated with thin air can be seen from the increasing publication
in this area after 1949 (5,776.80). The Peking Review has devoted a series of
articles to the high mountain medical network (5.81). Pulmonary edema of
high-altitude origin has drawn much attention from Chinese physicians and
scientists.

Many high-altitude areas have been transformed in recent years in China. The
province of Chinghai has received migrants from the large cities, including people
who are advanced in knowledge and technical skill. It seems inevitable in China
that all corners of her territory must be explored for her large and expanding pop-
ulation to reside in. At the present time, the high plateaus are thinly populated.
Since there are many natural resources in these mountainous areas, it is only logi-
cal that people with advanced skills should eventually settle on the frontiers and
develop their potentialities.

There are reports in the literature on cardiac diseases of pulmonary origin at
high altitude in central China. For example, a preliminary report was made con-
cerning 404 cases of heart disease patients who were admitted and treated from
January 1963 to September 1971 (5.77). These 404 cases constituted 3.2 per-
cent of all inpatients and 31.6 percent of the total cardiac patients admitted dur-
ing that period Cor pulmonale patients are the second most numerous of all
cardiac disease patients seen.

In the 293 cases that received detailed study, the ratio of men to women was
1.1.6, with 83.6 percent of the patients being less than 40 years old and the old-
est being 82 years old. A total of 27.9 percent of the cases were less than 5 years
in duration, 28.6 percent were between 5-10 years, and 43.5 percent were over
10 years. A total of 78.5 percent of the illnesses were due to chronic bronchitis,
15.0 percent were due to pulmonary tuberculosis, and the remaining 6.5 percent
were of miscellaneous origin. The mortality rate was 18.1 percent, among whom
one-third was due to pulmonary tuberculosis.

The electrocardiogram, X-ray findings, and clinical signs and symptoms of this
group of patients were similar to those reported from the lowlanders in the in-
terior region. However, there were elevations in hemoglobin content of the
blood and in the number of red blood corpuscles among highlanders. A total of
32.6 percent of the patients had 14 gm of hemoglobin, 27.6 percent had 14-16

69

gm, 39,8 percent had over 16 gm, and the highest ﬁnding reached 26 gm. A total
of 38.8 percent of these cases had 4.5 million red blood cells or less, 47.4 per-
cent reached up to 6 million and 13.8 percent were over 6 million, with a maxi-
mum of 8.1 million. ‘ .

The incidence of cor pulmonale in this group of patients studied was higher
than that in the interior lowland group. Possible reasons for this were attributed
to the high altitude of the land and the ever changing climate. The whole pro-
vince is 1,700 meters above sea level, with one-half over 4,000 meters. The
average yearly temperature in Sining (the capital of Chinghai) is 5.5° C, with a
variation of 26° C. Sining district is 2,200 meters above sea level. From Novem-
her to February, the temperature is always below 0° C. The main weather fac-
tors causing, inﬂuencing, or exacerbating chronic bronchitis are coldness and
sudden changes in temperature. When a chronic condition lasts for a long time,
cor pulmonale is the result. Once cor pulmonale is in existence, hypoxia occurs,
and the situation is worsened by the environment, which is characterized by low
oxygen pressure reﬂected by the increased hemoglobin and red blood cells.

Hyperbaric Physiology

At the Fukien Medical College of Foochow experiments were performed in
which animals were subjected to 3 ATA (atmospheric pressure absolute), and
patients with a variety of diseases were treated with hyperbaric oxygenation
(5.82). The chamber used was 3 meters in diameter and 7 meters in length, with
a compression time of about 20 minutes to 3 ATA and a compressing rate of
6 m3 /min. The report further mentioned that

. . . animal experiments carried out in a hyperbaric chamber on large numbers of dogs

showed that at 3 ATA they could tolerate complete circulatory arrest for 30 minutes at

30 C body temperature and for 65 minutes at 21 C. The experiments also showed that

they could tolerate a loss of more than 50% of the blood volume much better at 3 ATA

(90% long term survival) than at 1 ATA (100% death). From 1964 to 1965 we treated

71 cases by hyperbaric oxygenation, which included diseases such as tetanus, lobar pneu-

monia, Buerger’s disease, shock, coronary thrombosis and severe heart failure, and major

operations like nephrectomy, esophagectomy for carcinoma, pericardiectomy, ligation
of patent ductus arteriosus, comrnissurotomy for mitral or pulmonary steno sis, repair of

auricular and ventricular septal defects as well as extra corporeal circulation combined
with hyperbaric oxygenation for repair of auricular septal defect.

Summary and Conclusions

Considerable progress has been made in China in the past quarter of a century
in respiratory research in all areas. What is more interesting is the progress made
in clinical respiratory research employing Chinese pharmacology. This is the
topic of Chapter VI.

70

5.1

5.2

5.3

5.4

5.5

5.6

5.7

5.8

5.9

5.10

5.11

5.12

5.13

REFERENCES

Chen, Er-yu eta1.: The bronchi and blood vessels in lungs of Chinese: 1.
The bronchi and blood vessels of the upper lobe of the right lung.
Anatomic Records, 3:30, 1960.

Lin, Cheng-chin et al.: The bronchi and blood vessels in lungs of Chinese:
2. The bronchi and blood vessels of the middle lobe of the right lung.
AnatomicRecords, 5:299, 1962.

Ho, Huang-hu et al.: The bronchi and blood vessels in lungs of Chinese:
3. The bronchi and blood vessels of the lower lobe of the right lung.
Anatomic Records, 6:163, 1963.

Chung, Shih-chen et al.: The bronchi and blood vessels in lungs of Chinese:
4. The bronchi and blood vessels of the upper lobe of the left lung.
Anatomic Records, 6: 183, 1963.

Chang, Su-chen et al.: The bronchi and blood vessels in lungs of Chinese:
5. The bronchi and blood vessels of the lower lobe of the left lung.
Anatomic Records, 7:201, 1964.

Liu, Chang-chin et al.: The bronchi and blood vessels in lungs of Chinese:
6. Bronchi and blood vessels of the pulmonary hilum, lobular and lung sec-
tion ﬁssures. Chinese Journal of Surgery, 13 :164-1 67, 1965.

Liu, Fang-sheng, Li, Chung-heng, Ch’en, Tsung-fan, Chang, Tse-jung, Chu,
Mei-ti, Yang, Lan-hua, Ku, Yi-ping, Hsieh, Yu-chi, and Chang, Yun-ch’ing: 1
Measurement of the tracheobronchial tree in 650 Chinese. Chinese Medical
Journal, 832331-333, 1964. .

Hu, Chih-hsiang: Anomalous left pulmonary artery causing stenosis of
trachea. Chinese Medical Journal, 83:475-477, 1964.

Sung, Hsiang-ming et al.: Techniques of pneumoediastiography. Chinese
Journal of Surgery, 10:665-669, 1962.

Liang C. S. et al.: Investigations on 200 healthy peasants of their vital
capacity, ventilation capacity and gas exchange functions. Chinese Journal
ofInternalMedicine, 12:573-577, 1964.

Ho, Kuo-chun, and Wu, Chao-ch’iu: An analysis of pulmonary dysfunction
in chronic respiratory diseases. Chinese Journal of Internal Medicine,
12:10-13,1964.

Hsueh, Han-lin, and Wang, Ying: Reports on the normal values of the vital
capacity and ventilation capacity of healthy workers. Chinese Journal of
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Kao, Frederick F .: An Introduction to Respiratory Physiology. (Rev. 2d
ed.) Amsterdam: Excerpta Medica, 1974.

71

5.14

5.15

5.16

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Wu, Shao-ch’ing et al.: The determination of residual volume and its clini-
cal signiﬁcance. Chinese Journal of Tuberculosis, 6:125, 1958.

Wu, Shao-ch’ing et al.: Normal values of the timed vital capacity and its
signiﬁcance in relation to ventilation. Chinese Journal of Tuberculosis,
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Wu, Hsiu-chin: The relationship of body surface and vital capacity.
Chung Shan Hsueh Bao, 6(7,8):3, 1951.

Wang, Ming-ch’i et al.: Pulmonary function testings in mine workers.
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Yen, Pi-yen et al.: Preliminary report on the determination of residual
volume employing the thermal conductivity gas analysis method. Chinese
MedicalJournal, 48:549, 1962.

Mao, Pao-ling, and Chia, Chu-ts’ai: Clinical applications of respiratory ﬂow
determinations. Chinese Journal of Internal Medicine, 13:337-338, 1965.

Mao, Pao-ling et al.: The clinical signiﬁcance of respiratory flow velocity
index. Chinese Journal of Tuberculosis Prevention, 4:11, 1963.

Tao, Hsin-ming, Ch’eng, Yﬁ-Lii, and Hsueh, Han-Lin: Respiratory func-
tion tests on 586 athletes. Chinese Journal of Internal Medicine, 13:52-54,
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Hsiao, Chun: The effect of intrapulmonary pressures on the arterial
blood pressure. Acta Physiologica Sinica, 25:49-56, 1962.

Wang, Shih et al.: The application of blood oxygen meter in pulmonary
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Brooks, C. McC., Kao, RF. and Lloyd, B.B. Cerebrospinal Fluid and the
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Ho, Shiu-yong, and Chang, Fan-yu: Mechanism of induction of hyperpnea
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Chung, Tse-sheng: The effects of stimulation of the lung stretch receptors
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of respiratory excitatory response to pressure stimulation of the carotid
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Dung, Kyan-sheng, and Huang, Zhung-zun: The effect of anaesthetic on
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Chang, Ching-ju, and Su, Ch’ing-fun: Analysis of the mechanism of respi-
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Feng, T. P., Hsu, C. H., and Liu, ‘Y. M.: The mechanism of the recovery of
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Chang, Ching-ju et a1.: The relationship of respiratory mechanisms to the
vegetative nervous function. ShangI Hsueh Bao, 257, 1958.

Department of Pediatrics, Peking Friendship Hospital: Traditional-
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Department of Medicine, Szechwan Medical College, Chengtu: Pulmonary
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Meng, Hsien-yung, Ch’ien, T’ung—sun, and Chang, K’o-chih: Pleuropulmo-
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Chung, Huei-lan, Ho, Lien-uie, Cheng, Ling-ts’ai, and Ts’ao, Wei-chi: The
discovery in Yunnan Province of two new species of lung ﬂukes —
paragoniums transhanensis Sp. Nov. and paragoniums menglaenis Sp. Nov. .‘
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Li, Shu-sen, and Hsiao, Ch’eng-chih: Factors affecting the results of ambu-
latory chemotherapy in pulmonary tuberculosis. Chinese Medical Journal,
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Chu, Soong-shan, Hua, Meng-lan, and Sung, T’ung-nien: Adrenocortical
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‘Sung, Tung-nien, Teng, Wie-wu, and Yu, Chi-ju: The results of different
methods of chemotherapy in the treatment of pulmonary tuberculosis.
Chinese Medical Journal, 83 :1 55-162, 1964.

Wang, Chih-hsien, Chao, An-jen, and Hsiao, Tze-fan: Paravertebral abscess
penetrating into the lung: Report of 11 cases. Chinese Medical Journal,
82:678-683, 1963.

Liu, Yu-ch’ing, Wu, Hsia, and Yu, Wei-nan: Roentgenopathologic study
on lung abscess of tumorous form. Chinese Medical Journal, 85:397-402,
1966.

Hu, Mao-hua, and Wang, Chung-ch’i: Roentgenologic examination of the
pulmonary ventilation function in patients with silicosis. Chinese Medical
Journal, 82:432-439, 1963.

Hsin, Yu-ling, Hu, Chi-pang, Chao, Chih-wen, and Chou, Mien: Bronchial
stump closure in pulmonary resection: 1. Animal Experiments; II. Clinical
study. Chinese Medical Journal, 83:89-103,\l964.

Chu, Er-mei, Ch’en, Lun-yuan, Ts’ai, Chien, Sha, Ch’i-yueh Liu, Ch’i, and
Ts’ui, Ssu-yu: Middle lobe atelectasis in adults: A clinical and pathologic
study. Chinese Medical Journal, 82: 1 38-147, 1963.

Ch’en, Wan-ch’un, Tung, Ch’eng-lang, Huang, Wei-ming, and Wu, Kuang-
huei: Phasic respiratory paroxysmal tachycardia and reversed reciprocating
rhythm. Chinese Medical Journal, 84: 1 74-1 79, 1965.

Hsi'l, Ch’eng—pin, Chang, Yun-ju, and Mu, Kuei-chin: Staphylococcal
pneumonia in adults. Chinese Medical Journal, 842666-671, 1965.

Hsiung, Chih-ch’uan: Adenovirus pneumonia in infants and children:
Pathologic studies of 40 cases. Chinese Medical Journal, 82:390-398, 1963.

Wu, Shao-ch’ing et a1.: Researches in pulmonary function in the past 10
years. Chinese Journal of Internal Medicine, 40(1): 7-10, 1960.

Yang, C. N.: C. N. Yang discusses physics in the People’s Republic of China.
Physics Today, 24:61 , Nov. 1971.

Lubkin, G. B.: Physics in China. Physics Today, Dec. 1972.
Tsu, R.: Scientific Today, 227113, 1972.

Wang, Ching-yang, and Mi, Cheng: A light weight automatic artiﬁcial
respiratory device. Chinese Journal of Surgery, 122976-978, 1963.

“Portable oxygen producer.” Chinese Medical Journal, 53(2): 128, 1973.

Recordings of seminars concerning the problem of preventing infantile
pneumonia. Chinese Medical Journal, 53(12):741-748, 1973.

Division of Environmental Health, Institute of Health, Chinese Academy
of Medical Sciences, Peking: A quantitative study of major pollutants
emitted from diesel engines. Chinese Medical Journal, 53(1):57-59, 1973.

74

5 .60

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5.62
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5.64

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5.66

5.67

5.68

5.69

5.70

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5.75

Liu, C., and Huang, C. S. W.: Geography of China. Hong Kong: Hsin Yii
Publishing Co., 1972.

Ling, Yang: Medical network in a mountain country. Peking Review, No.
34, p. 17, 1973;No. 35-36, p. 49, 1973.

China Reconstructs, Feb. 1974.

Needham, Joseph: Science and Civilization in China. Cambridge: Cam-
bridge University Press, 1954.

Rugoff, Milton: The Travels of Marco Polo. New York: The New
American Library, 1961.

Lenfant, C., and Sullivan, K.: Adaptation to high altitude. New England
Journal ofMedicine, 284: 1 298-1309, 1971.

Milledge, J. 8.: Respiratory regulation at 19,000 ft. (5700 M). In:
Cunningham, D. J. C., and Lloyd, B. B., eds. The Regulation ofHuman
Respiration. Oxford: Blackwell Scientiﬁc Publications, 1963, pp. 397-403.

Trevor, Lloyd. Americana Annual, New York: Americana Corporation,
1961, p. 297.

Tibetan Scientiﬁc Expedition of Academic Sinica: The physical environ-
ment and geological history of the Mt. J olmo Lungma region in southern
Tibet, China. Kexue Tongbao, 18(1): 1 1-21 , July 1973.

Mu, An-tze, Wen, Shih-hsuan, Wang, Yi-kang, Chang, Ping-kao, and Yin,
Chi-hsiang: Stratigraphy of the Mount J olmo Lungma region in southern
Tibet, China. Scientia Sinica, 16(1):96-111, Feb. 1973.

Hsii, J., Kong, Z. C., Sun, X. J., Tao, J. R., and Du, N. C.: Quanternary
palaeobotanical studies on the Mount J olmo Lungma Region and the
Himalayan uplift. Kexue Tongbao, 18:274-279, 1973.

Guo, Xu-dong: Climatic changes in the Mount J olmo Lungma Region
southern Tibet, China. Scientia Geologica Sinica, 1:74-78, 1974.

Chang, Yung-tzu: A study of soil micromorphology and natural conditions
of the Mount Jolmo Lungma area. Kexue Tongbao, 18(3): 134-138, Sept.
1973.

J a0, Chin-chih, Chu, Hui-chung, and Li, Yao-yin: Notes on the freshwater
algae of the Mount J olmo Lungma region in southern Tibet, China.
Kexue Tongbao, 18(1):30-32, July 1973.

Laboratory of Isotopic Geology, Kweiyang Institute of Geochemistry,
Academia Sinica: Isotopic dating of the metamorphic rocks from the
Mount Jolmo Lungma area, China. Scientia Sinica, 16(3):385-395, 1973.

Chang, Cheng-fa, and Cheng, Hai-lan: Some tectonic features of the
Mount J olmo Lungma area, southern Tibet, China. Scientia Siniaz,
16(2):257-265, 1973.

75

5.76

5.77

5.78

5.79

5.80

5.81

5.82

Section of Chemical Geography, Institute of Geography, Academia Sinica,
Department of Chemistry, Peking University, and Institute of Glacier,
Permafrost and Desert Research, Lanchow, Academia Sinica: Distribution
of isotopes in some national waters in the region north of Mount Jolrno
Lungrna. Scientia Sinica, 16(4):560-564, 1973.

Department of Internal Medicine of the Afﬁliated Hospital of Ch’inghai
Medical College: Preliminary observations on chronic heart diseases due
to pulmonary origin at high altitude in Ch’inghai Province. Chinese
MedicalJoumal, 53:762, 1973.

Wu, Tien-i, Wang, Tsu-wei, and Li, Chung-hua: An analysis of 22 cases of
cardiac disease of high altitude origin in adults. Chinese Journal of
Internal Medicine, 13:700-702, 1965.

Hsiao, Ta-liu, and Chen, Hsﬁn-chuan: A case report of pulmonary edema
at an altitude of 3,800 meters above sea level. Chinese Journal of Internal
Medicine, 132159, 1965.

Wu, T’ien-i: Opinions concerning altitude-conditioned lung edema.
Chinese Journal of Internal Medicine, 46( l ) : 68, 1966.

Chiang, Shan-hao: Conquering the “evil air.” Peking Review, Jan. 18,
1974, pp. 16-19.

Fukien Medical College, Foochow: Clinical application of hyperbaric
oxygenation. China’s Medicine, 47(11):830-838, 1967.

76

Chapter VI

CLINICAL RESPIRATORY RESEARCH

Whatever discoveries in the basic medical sciences, including those in respira-
tion physiology, the final testing ground is in clinical application. Thus, clinical
research is the ﬁnal step in the implementation of medicine, that is, in the treat-
ment of the sick. This implementation has been well done in present-day China.

Chinese Priorities in Respiratory Disease Research

Several areas were given primary importance in medical research in China fol-
lowing 1949. After the elimination of infectious and parasitic diseases, the most
important task in medicine consisted of conquering heart disease and cancer, in
addition to developing techniques of acupuncture anesthesia and the control of
respiratory diseases—namely, bronchitis and emphysema. In the area of respira-
tory diseases, inﬂuenza, the common cold, bronchitis and lung cancer are all pri-
mary targets for attention. Since bronchitis is frequent in factories and villages
where mines were in existence, and since it largely affects the aged, special atten-
tion is paid to the treatment of those who are afﬂicted by this disease. Chemical
factories and areas suffering from air pollution problems are thought to contrib-
ute to such diseases.

Health Stations and Mobile Unit Concepts

In order to reach patients who are affected by respiratory ailments, health sta-
tions have been built in the rural villages where people with bronchitis and other
respiratory diseases may be treated on the spot. In addition, mobile units includ-
ing experts in respiratory disease are sent to the frontiers and rural hinterlands of
China to do research in places where respiratory diseases are most frequent.

Clinical Reports on Respiratory Diseases

Clinical reports of respiratory diseases include a wide variety of conditions
such as pulmonary anomalies (6.1), broncholithiasis (6.2), pulmonary aspergilloma
(6.3), sarcoidosis (6.4), and diagnosis employing supersonic waves (6.5). Infan-
tile pneumonia still draws the attention of pediatricians in China (6.6-6.8).

Lung tumor, carcinomas, and the treatment of lung hemorrhage and hemopty-
sis, as well as the use of antibiotics, are all reported in recent publications

77

(6.9-6.15), but more attention seems to be paid to the treatment of status asth-
maticus and the management of respiratory failure (6.16-6.26). Not only has
bronchitis drawn considerable attention in China but it has also been treated
with new pharmacological methods employing Chinese herbology (6.27-6.29).
In relation to physiology, the development of a synthetic theory in interpret-
ing the mechanisms of acute respiratory obstruction in the lower passageways has
been reported (6.30). Reports on the treatment of acute inflammation and ob-
struction of the lower respiratory tract indicate that the use of a combination of
several therapeutic procedures—including antibiotics, hyaluronidase, Ma-huang,
and positive pressure oxygen inhalation therapy—alleviated the symptoms
of patients with acute infection and obstruction and that the combination
of procedures decreased their mortality (6.30). The interpretational patho-
physiology of this type of acute inﬂammation and obstruction is shown in
ﬁgure 6-1.

Obstruction of bronchioles

due to edema, spasm, and
{ increase in secretion I
Increase in pulmonary 7 .
circulatory resistance DIsturbance
exchange

Spasm and flexation

intensity
Heart weakened

with arrythmia
Respiratory 7
Center increase

in stimulation

Organic and
tissue death Cardiac Ioad' Increases,

heart muscle increases
in its irritability and

hypoxia
Compensatory breathing :zfrcialls:oln
failure, coma effgrt ry
Hypoxia and
l Respiratory acidosis h J
and brain edema ‘ magm'icnia
disturbance

Figure 6-1. The sequence of events in the pathophysiology of acute obstruction
of the lower respiratory passageways (6.30).

'78

Advancements in Respiratory Drugs

Chinese herbology has been acclaimed as a treasure house in modern China.
Herbs have been reported by Chinese medical authorities to be beneﬁcial to the
health and welfare of the people of China since ancient times. The Great Herbal
(Pen Ts ’ao) was attributed to Sheng Nung, who was thought to have lived about
5,000 years ago. Recent excavation in Wuwei county, Kansu Province, in China
of 92 inscribed wooden slips from a tomb marked a highly signiﬁcant ﬁnding of
medical records in their original form (6.31). These slips dated from the Eastern
Han dynasty (A.D. 25-220) and contained as many as 30 prescriptions for treat-
ing various diseases of the ear, nose, throat, eye, mouth, and teeth. In the cate-
gory of internal medicine, the slips refer to various fevers and diseases of the res-
piratory, digestive, circulatory, reproductive, urinary, and nervous systems. They
mention about 100 different medications, including 11 made from animal, 61
from vegetable, and 16 from mineral substances in the form of decoctions, pills,
powders, plasters, drips, and suppositories. Excipients used as drugs in semisolid
form included honey, milk, lard, and cream.

The original Pen Ts ’ao described 365 drugs. In the years to follow, many
more items were added. Tao Hung-ching, in the 5th century A.D., added another
365 medicinal substances, and more than 844 drugs were listed in the Tang
dynasty. During the Sung dynasty, Tang Shen-wei increased the number of drugs
to about 1,750 (6.32).

The most famous ﬁgure in Chinese herbology is Li Shih-chen (1518-1593),
who spent more than 27 years compiling the Compendium ofMateria Medica, a
masterpiece of pharmacology of the Ming dynasty, which listed 1,892 kinds of
herbs. By the time of the founding of the People’s Republic of China in 1949,
no more than 2,000 kinds of herbs were in use in China. Because of the integra-
tion of Chinese traditional medicine and Western medicine, about 5,000 kinds
of herbs are used in China’s current medical system, and the number is increas-
ing steadily.

At the present time, much effort is being made to cultivate these herbs and to
make scientiﬁc investigation of them. In the area of research for the treatment
of respiratory diseases, several important herbs have been studied for their
effects in symptoms occurring in lung infections. New synthetic forms of
natural ingredients, which are effective for certain respiratory symptoms, are
also currently produced in China.

One of the respiratory drugs currently being studied in the Shanghai Institute
of Materia Medica is Han Tsai or Roripa montana (Wall) Small (Cruciferae). In
the Compendium of Materia Medica it is said that Han Tsai is an “acrid and tem-
perate, nontoxic, primary medication for elimination of cold breath, advanta-
geous to the diaphragm to release cold phlegm” (6.33, p. 506). It has long been ‘
used in China as a folk medicine for releasing phlegm, for its action as an anti-
cough agent, for smoothing dyspnea, and for the treatment of bronchitis. Re-
cently, Han Tsai was investigated and two compounds, rorifone and rorifamide,
were isolated from Roripa montana (Wall) Small (Cruciferae). Both ingredients

79

were used clinically on over 100 chronic bronchitis patients, who received an

oral dose of 200-300 mg/d for a period of 20 days. It was reported that 90.8 per-
cent of the patients showed deﬁnite improvement. Another series of 337

patients were studied with this drug, and 88.43 percent showed improve-

ment (6.34). In another study, 100 patients with chronic bronchitis took daily
oral doses of 200 mg, with increases to 300 mg, for 10 days. An 81 percent
effective rate was reported 6.34).

Rorifone and rorifamide have now been synthesized and their actions on bron-
chitis compared with those of the isolated ingredients. The structure of rorifone
*was shown to be 10-methylsulphonyl decylnitrile and the structure of rorifamide
was shown to be lO-methylsulphonyl decylamide, as follows (Roripa indica
(Linn.) Bailay and Roripa monfana (Wall) Small):

Rorifone
T
CH3 — 8‘ CH2 ‘ (CH2)7 — CH2CN
l
O Ronfamrde
T
CH3 _ S _ CH2 _ (CH2)7 _ CH2 _ CONH2
l
O

Ardisia Japonica (Ai Ti Ch’a) is also used for the treatment of chronic bron-
chitis. This again is a traditional Chinese folk remedy being used for cough and
other pulmonary diseases. It has been conﬁrmed that this substance is effective
for chronic bronchitis. Its chemical structure has the following formula (6.29):

CH2 OH
HO 0 OH
OH
CH2O
H0 0
0

Extensive studies have been carried out in experimental animals, mostly rats,
to deﬁne the effects of this drug on the central nervous system, its antitussive
effects, its expectorant action, and its antiasthmatic as well as its antibacterial
actions. It has been concluded (6.29) that Ardisia Japonica is effective as an
antitussive and expectorant drug, with the further advantages of low toxicity,
few adverse actions, and the absence of tolerance.

Anthorhododendrin has also been used in treating chronic bronchitis in China.
Recently, a report of 212 cases (6.28) treated with this drug was published.

Over 2,600 cases of chronic bronchitis were treatedin this manner by the

80

Lau-Chow Medical College, and this form of treatment was claimed to be effec-
tive (6.28). Oral administration was capable of producing a 93 percent effective
rate; aerosol administration was similarly effective with a success rate of 93.8
percent. Its actions as an expectorant, antitussive, and antiasthmatic were con-
sidered to be 91, 85, and 57 percent effective, respectively, in the oral group and
93.6, 93.8, and 95.2 percent effective, respectively, in the aerosol group. There-
fore, it was further concluded that the aerosol method was much more effective
against asthmatic symptoms. During anthorhododendrin therapy, few patients
developed adverse reactions—such as dryness of the pharynx, dizziness, nausea,
palpitation, and gastrointestinal symptoms—in the oral group. Adverse reactions
were relatively mild and not exacerbated on continuation of use (6.28).

In the Kwangtung People’s Hospital, we were informed that acupuncture may
be employed for the treatment of bronchitis. The Ho-Ku locus on the large in-
testine meridian is used in treating bronchitis; for emphysema, the loci Ta Chuei
and Ch’i Chuan are speciﬁcally recommended. Bronchitis is also treated with
the aid of Chinese herbs. There are distinct geographical variations in the herbs
used for the treatment of bronchitis. In the south, Yu Hsing Tsao is used;
whereas in the north, Man Shan Hung is used.

In the treatment of pneumonia, mild cases require Chinese herbs and severe
cases require the addition of antibiotics. In cases of tuberculosis, Western medi-
cine is used but Chinese herbs are also employed for tonic purposes and for build-
ing the constitution. For example, Ginseng is used for this purpose as a general
toniﬁer of the body. In infant cases, Pai Kuo is used for its anticough effect.

While visiting a commune in Peking, we were told that the Chinese have a
special medicine for treating colds, which is called Yin Ch’iao Chieh Tu Wan, a
pill with detoxiﬁcation properties consisting of Lonicera Forsythl'a. What is in-
teresting about this pill is that its formula has been known for a few hundred
years. In 1799, the Chinese physician and scholar Wu Chue-tung wrote a book
on the differential diagnosis of febrile diseases in which he described the use of
this drug for the treatment of colds.

The Capital Hospital in Peking has supported a mobile research team that has
investigated about 100,000 cases of chronic bronchitis in the entire country dur-
ing the past 2 years. The overall number of reported cases of bronchitis in the
country reached 1.9 million, among which 240,000 were under control at the
time of this study.

The method of treating bronchitis involved attacking the problem through
the street and commune clinics where doctors came to the patients and con-
ducted their clinical investigations. The main treatment for bronchitis at the
present time in China employs Chinese herbs. At ﬁrst, about 100 Chinese herbs
were selected for use in treating bronchitis. Over the course of 2 years’ time,
150 herbs were found to be effective in such treatment. These selected herbs
are made into extractions. Four of these drugs were found to be very effective
in the treatment of bronchitis. They include Man Shan Hung and Tu Chuan Hua,
which are nontoxic and seem to grow easily in ordinary places. ‘Ai Ti Cha, Man
Shan Hung, ginger, and red sugar are used therapeutically. This again emphasizes

81

570-225 0 - 75 — 'l

the exploration of Chinese traditional pharmacology, which is considered to be
a treasure trove of medical techniques. Appendix I illustrates some respiratory
drugs made in China and other aspects of herbology;

Theoretical studies have also been carried out concerning the etiology of
chronic bronchitis (6.27). The Chinese Academy of Medical Sciences has con-
ducted some ﬁeld investigations in the rural areas of Changchiakou district,
north of Peking. In a study of over 2,000 cases of bronchitis in this district,
where the average annual temperature is 7.5° C, and in another area where the
annual average temperature is 1.1° C, it was reported that the etiologic factors in
almost 80 percent of the cases were exposure to cold temperatures, the common
cold, and acute bronchitis. It is interesting to note that the incidence of chronic
bronchitis was two to three times higher among smokers than among nonsmokers
(6.27).

Six meteorological factors (average temperature, daily temperature variation,
daily temperature variation in decades of days, average atmospheric pressure,
average wind velocity, and absolute humidity) were studied and quantitatively
expressed in the form of the following regression line:

Y=.0013X1- 0.335 X: + 0.142X3 + 1.208

where Y is time in minutes required for lowering water temperature from 37° C
to 27° C; the degree of coldness is 1— X 100,X1 is temperature in centigrade,X2
is wind velocity (m/sec) in log, X 3 is total solar radiation in cal/min/cmz.

Sudden exposure to cold was found to reduce the ciliary movement of the
columnar epithelium of animals. Coldness also slowed down the ciliary move-
ment of the lower respiratory tract epithelium (6.37). This report stressed pre-
vention with extensive education concerning common colds and acute chronic
bronchitis. Methods of prevention of inﬂuenza and common cold included
active treatment of acute bronchitis and advising patients to give up smoking.

Summary and Conclusions

Clinical respiratory research in China currently emphasizes preventive work
and the delivery of care directly to those who suffer from respiratory diseases.
The health stations of the interior regions and hinterlands of China are effective
means of studying diseases on location and of delivering medical care directly to
those who need it. Much progress has been made in developing and producing
low-cost, multiple-function drugs, including those derived from ancient herbal
lore.

82

6.1

6.2

6.3

6.4

6.5

6.6

6.7

6.8

6.9

6.10

6.11

6.12

6.13

6.14

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Department of Pediatrics, Peking Friendship Hospital, Peking: Traditional-
Westem medicine in treatment of infantile pneumonia. Chinese Medical
Journal, 53(2):30, 1973.

Seminar (held in Peking): Important records of the seminar on “Problems
Related to Infantile Pneumonia.” Chinese Medical Journal, 53(12):741-
748, 1973.

Wang, Nai-pin: Surgical procedures in first aid of massive hemoptysis.
Chinese Journal of Surgery, 1 :79-80, 1960.

Leptospirosis Research Laboratory, Szechwan Medical College, Chengtu:

1 Emergency treatment and pathogenesis of leptospirosis with massive pul-

monary hemorrhage. Chinese Medical Journal, 53(5):60, 1973.

Yu, Li-fa, and Tsang, Chum-fang: Effects of antibiotics on respiration.
Chinese Journal ofSurgery, 12(10):1018-1022, 1964.

Department of Radiology, and Obstetrics, and Gynecology, Peking, and
Fanti Hospital, Chinese Academy of Medical Sciences, Peking: Roentgen
manifestations of pulmonary metastasis of choriocarcinoma and chorioade-
noma destruens. China’s Medicine, 47(3):215-229, 1967.

Departments of Pathology, Shanghai Chest Hospital and Tumor Hospital

of the Shanghai First Medical College, Shanghai: Cytodiagnosis of sputum
in primary carcinoma of the lung. China’s Medicine, 47(10):759-764, 1967.
Li, Tih-yi, and Ch’en, Ching-ch’eng: X-Ray diagnosis of tumors in deep soft
tissues of the chest wall. Chinese Medical Journal, 53(7):73, 1973.

83

6.15

6.16

6.17

6.18

6.19

6.20

6.21

6.22

6.23

6.24

6.25

6.26

6.27

6.28

Teaching and Research Group of Pathoanatomy and Teaching Group of

Internal Medicine, Shanghai First College of Medicine: A symposium of
clinical pathology 62nd case—cough, chest pain, dyspnea and emaciation.
Chinese Journal of Internal Medicine, 53(1 2):991-993 , 1973.

Departments of Traditional Medicine, Internal Medicine, and Biochemistry,
Shanghai First Medical College, Shanghai: Treatment of bronchial asthma
with traditional Chinese medicine—long term results and effect after with-
drawal of prolonged steroid therapy. China ’s Medicine, 47(3):230-235,
1967.

Wang, Kuang-chieh: Intravenous sodium bicarbonate in severe status asth-
maticus. Chinese Medical Journal, 53(4):53, 1973.

Chao, Chun: Resuscitation techniques. Chinese Journal of Surgery, 13(7):
677-679, 1965.

Chu, Yang-jung et a1.: Emergency management of acute respiratory failure.
Chinese Journal of Surgery, 13(3):255-256, 1965.

Chan, Ming-shu, and Liu, Chan-chieh: Treatment in neurosurgical patients
with respiratory disturbances. Chinese Journal of Surgery, 1 1(10):810-
812, 1963.

Yang, K. T., Hsii, C. K. and T’ung, K. F.: Scopolamine in emergency treat-
ment of respiratory failure in very severe encephalitis B. Chinese Medical
Journal, 53(5):283-285, 1973.

Shanghai Hospital for Infectious Diseases, Shanghai: Tracheostomy and
ventilation control in epidemic encephalitis B with respiratory failure.
Chinese Medical Journal, 53(9): 1 20, 1973.

Department of Medicine, Szechwan Medical College, Chengtu: Pulmonary
encephalopathy and some problems of treatment. Chinese Medical Journal,
53(11):146, 1973.

Lu, T’ing-sheng: Report of .an emergency treatment of severe respiratory
failure due to epidemic Japanese B encephalitis with a large dose of atro-
pine. Chinese Journal of Internal Medicine, 13(5):454, 1965.

Chin, P., Chang, H., and Chia, F. C.: Experience on emergency treatment
of cases with acute respiratory dysfunction. Chinese Journal of Surgery,
10(11):734-735,1962.

T’ao, Jen, and Shen, Yﬁ: “Petit Triad” via the umbilical vein for resusci-
tation in asphyxia neonatarum. China’s Medicine, (2): 1 54-1 58, 1966.

Prevention and Treatment of Chronic Bronchitis Research Field Unit,
Chinese Academy of Medical Sciences, Peking: A study on the etiology of
chronic bronchitis. Chinese Medical Journal, 53(12):714-71 7, 1973.

Clinical Unit of Prevention and Treatment of Chronic Bronchitis, Lanchow
Medical College, Lanchow: Anthorhododendrin in treatment of chronic

' bronchitis. Chinese Medical Journal, 53(12):711-713, 1973.

84

6.29

6.30

6.31

6.32

6.33

6.34

Department of Pharmacology, Hunan Medical College, Changsha: Experi-
mental studies on Ardisia J aponica in treatment of chronic bronchitis.
Chinese Medical Journal, 53(12):706-710, 1973.

Cheng, Chih-hsuing: Experiences in the management of acute obstructions
and inﬂammation of the lower respiratory tract. Chinese Journal of
Surgery, 12(10):981-985, 1964.

“Prescriptions of 2,000 years ago.” China Reconstructs, Feb. 1974, pp.
1920.

Hu, Shih-liu: Discovering and studying medicinal herbs. China Recon—
structs, Feb. 1974, pp. 16-19.

Shanghai Institute of Materia Medica: Studies on the active principles of
Han-Tsai. Scientia Sinica, 16(4): 506-51 1, 1973.

“New compounds for treating chronic bronchitis—Rorifone.” Chinese
MedicalJoumal, 53:73, 1973.

85

 

Chapter VII

ACUPUNCTURE AND RESPIRATORY RESEARCH

Acupuncture is but one of the modalities of therapeutics in Chinese tradi-
tional medicine. It can be thought of as the tip of the iceberg in its therapeutic
armamentarium. Nevertheless, it has caught the attention of the Western world,
especially since the resumption of diplomatic ties between China and the United
States in 1971. The technique of employing acupuncture for the treatment of
many diseases has been known in China for several millennia, and it is an integral
part of the Chinese medical system.

In additionto several other medical uses, acupuncture is being used to treat
diseases of respiratory origin. I observed this phenomenon during visits to var-
ious hospitals in China. Respiration is intimately related to anesthesia, and the
evaluation of anesthetic agents is invariably judged partly by their respiratory de-
pression effects. Acupuncture is being used in China extensively (about 20 per-
cent of all surgical cases) in producing analgesic effects for surgical operations.
Therefore, this chapter focuses on acupuncture and respiratory research.

A Short Historical Account of Acupuncture

The word “acupuncture” has two Latin roots: acus, which means needle, and
punctura, which means puncture (7.1). Acupuncture is the technique of inser-
tion of a needle or needles into the body at various speciﬁc and strategic spots
for the purpose of curing diseases, therefore, it is a form of medicine. There
were ﬂintstone “needles” used about 2000 BC for acupuncture, and in the
Peking Palace Museum, gold needles, which were used 2000 years ago, are on
display. In the Yellow Emperor’s Canon of Internal Medicine, many chapters
describe the use of acupuncture for treating a variety of diseases, not only those
related to pain. Acupuncture therapy was claimed to have a regulatory effect on
the body in performing certain physiological functions.

The ﬁrst monograph on acupuncture was published in the third century AD.
by Huangfu mi, and acupuncture was taught in the medical schools in China in
the Sung dynasty (7.2). It spread to Europe perhaps earlier than the time Marco
Polo visited China (7.3), and translations of Chinese acupuncture texts were in
existence in the 17th century (7.4). Some of the European countries accepted
acupuncture as a therapeutic means of treating disease, but in the United States,
only certain communities in which old-fashioned Chinese physicians practiced
accepted acupuncture. The art of healing employing acupuncture was not

87

known to most of the people in the United States until 1971 when James Reston
ﬁled his report in the New York Times on July 25, after he personally received
acupuncture treatment at the Friendship Hospital in Peking following an appen-
dectomy operation (7.5).

In China, 1958 marked an important year in the development of acupuncture.
There already was integration of Chinese traditional medicine and Western medi-
cine beginning with the year 1950, but the development of acupuncture did not
progress until 1958 when acupuncture anesthesia (which should be properly
named acupuncture analgesia) was invented (7.6, 7.7). After the Cultural Revolu-
tion, there was a generalized employment of acupuncture anesthesia in China,
(see ﬁgure 7-1), and many visitors to China had firsthand personal experience
witnessing open-chest and open-heart surgery with anesthesia produced only by a
few hair-thin, stainless-steel needles. The needles are energized by a convenient
small electrical stimulator powered by a few pen batteries (7.8-7.11). (See ﬁgure
7-2 for an illustration.)

In two visits to China, I saw a number of surgeries, including open-heart and
open-chest surgery, subtotal gastrectomy, brain tumor removal, meniscectomy,
cesarean sections, thyroidectomies, and many others. Many physiologists and
neurophysiologists are currently engaged in research in China aimed at elucidat-
ing the mechanism of action of acupuncture anesthesia and acupuncture thera-
peutics.

The discovery of acupuncture anesthesia has greatly stimulated the research
interest of physiologists in China and in many other parts of the world, and may
be said to have created its own special subﬁeld of scientiﬁc investigation. The
interest in these.techniques in China can be seen by the numerous articles in
Scientia Sinica (7.12-7.14), the Chinese Medical Journal (7.15-7.31), and the
Kexue Tongbao, (7.32-7.35).

Acupuncture and Respiratory Diseases

Reports are available in the literature concerning the experimental use of
acupuncture in humans and in animals. Ventilation was reported to increase
after acupuncture of the loci Jen Ying, Ta Sha, and Fei Shu. Other investigators
have reported changes in oxygen consumption, ventilation, and ventilation capa-
city, some of which have been recently veriﬁed by experiments in the present
author’s laboratory (7.16, unpublished data).

It has been suggested that changes in the “sensitivity” of the respiratory regu-
latory apparatus might be involved in the effects of acupuncture in conjunction
with hypercapnia (7.37). Some ‘workers in this field hypothesize that the change
in respiration involves neuroﬂex mechanisms, and others maintain that some
acupuncture loci, for example, Jen Ying, might involve neuropathways while
other loci, for example, Fung Men and Fei Shu, might not involve reﬂex mecha-
nisms (7.37, 7.38).

It should be emphasized that while acupuncture treatment for bronchitis,
asthma and related diseases has claimed efﬁcacy in China, a variety of therapeutic

\

88

 

 

 

 

 

 

 

Figure 7-1. A view of the Shanghai Industrial Exhibit area showing the
highlights of acupuncture anesthesia and progress made in China.

 

Figure 7-2. An 18-year-old patient receiving acupuncture analgesia produced by
means of application of needles on the ear loci during an operation for
removal of a thyroid adenoma.

89

measures have been used in these respiratory conditions, such as herbology and
the application of plasters, or Gao Yao, which are composed of many ingredients
including herbs (see ﬁgure 7-3).

Bergsmann reported that acupuncture could correct unilateral respiratory
obstruction. Acupuncture loci of the diaphragm may be used to regulate func-
tion on the affected side (7.37). In certain conditions with diaphragmatic spasms
or pleun'sy, acupuncture of the loci on the diaphragm can cause respiratory
changes and can balance deﬁciency on the affected side of the chest.

Acupuncture Anesthesia and Respiration

Since the discovery of acupuncture anesthesia, there had been about half a
million cases of various surgical procedures performed in China, as of 1971. It is

 

 

 

 

 

 

 

 

Figure 7—3. A patient with asthma is treated by means of massage and
the application of plasters.

90

estimated that by now perhaps a million surgical operations have been accom-
plished without the conventional chemical anesthesia.

Chemical anesthesia was known in China since the second century A.D., and
the surgeon Hua To’ (112-207 AD.) used chemical anesthesia for his major oper-
ations (7.39). Chemical anesthesia was discovered in the West during the 1840’s
(7.40). Other forms of anesthesia that have been discovered in the past include
hypnosis (7.41), electroanesthesia (7.42), cryoanesthesia (7.43), and auditory
anesthesia (7.44), but none have gained as much popularity as chemical anes-
thesia.

Acupuncture anesthesia is perhaps the most significant discovery in anesthe-
sia since the use of ether in the 1940’s. There are numerous reports on the efﬁ-
cacy of acupuncture and its lack of untoward effects on respiration and other
vital functions during operative procedure. One of the most interesting questions
to raise is How can open-chest surgery be performed without the employment of
a positive pressure breathing apparatus (see figure 7-4)? Some explanation is pro-
vided by the procedure preparing the patient before the operation—namely,

 

Figure 7-4. A positive pressure respiratory machine used in a patient undergoing
open—chest surgery with acupuncture analgesia. Sometimes, the operation is
performed without theme of the positive pressure apparatus.

91

breathing exercises that stress diaphragmatic breathing. Prior to the operation,
positive pressure in the pleural space of the lung to be operated on is created by
the injection of air. This evidently causes the mediastinum to shift toward the
other side. During the operation, the release of pressure on the operated lung
following incision produces a sensation of relief in the patient. It is very possible
that during the operation the patient may experience some hypoxia and hyper-
capnia, without positive pressure breathing, but these effects do not seem to be
of a degree sufficient to cause alarm or any lasting negative effects.

More investigation is needed to determine the effect of acupuncture anesthe-
sia on the respiratory system, as well as its mechanisms of action. Regarding
these mechanisms, several authors are in favor of a neural theory (7.12-7.14,
7.32, 7.33, 7.35, 7.45-7.49); others point to multiple neurohumoral factor
mechanisms (7.34, 7.49-7.51).

Summary and Conclusion

Acupuncture, the rediscovered ancient art of healing in China, has been used
not only to treat pain, but also to prevent pain in surgical operations. The regu-
latory mechanisms of acupuncture in affecting body functions deserve further
investigation by scientists in all ﬁelds of medicine.

92

7.1
7.2
7.3

7.4

7.5
7.6
7.7
7.8
7.9
7.10

7.11

7.12

7.13

7.14

REFERENCES

Kao, Frederick F.: China, Chinese medicine and the Chinese medical sys-
tem. American Journal of Chinese Medicine, 1:1-59, 1973.

Lee, Tao: Achievements of Chinese Medicine in the Northern and South-
ern Sung dynasties. Chinese Medical Journal, 7:65-82, 225-242, 1954.

Roccia, L.: Chinese acupuncture in Italy. American Journal of Chinese
Medicine, 2:49-52, 1974.

Stiefvater, E. W.: Gekurzte iibersetzung der estern europ'aischen
Veroffentlichung (1683) uber die chinesisch-japanische Akupunktur and
Moxapraxis. In: Die Akupunktur des Ten Rhyne. Ulm/Donau: Karl F.
Huag Verlag, 1955.

Reston, James: Now about my operation in Peking. New York Times,
July 25,1971.

“China Creates Acupuncture Anesthesia.” Peking Review, August 13,
1971, pp. 7-9.

“A Small Needle Works Wonders.” Peking Review, August 13, 1971 , pp.
9-11.

Rosen, 8.: Acupuncture anesthesia in the modern Chinese operating room:
Personal observations. In: Risse, G. B., ed. Modern China and Tradi-
tional Chinese Medicine. Springﬁeld, 111.: Charles C. Thomas, 1973.

Dimond, E. G.: Acupuncture anesthesia: Western medicine and Chinese
traditional medicine. Journal of the American Medical Association, 218:
1558-1563,1971.

Bonica, John J .2 Anesthesiology in the People’s Republic of China.
Anesthesiology, 40:175-186, 1974.

Kaada, B., Noel, E., Leseth, K., Nygaard-Ostby, B., Setekleiv, J ., and
Stovner, J.: Acupuncture analgesia in the People’s Republic of China with
glimpses of other aspects of Chinese medicine. Journal of the Norwegian
Medical Association, 94:417-442, 1974.

Chang, Hsiang-tung: Integrative action of thalamus in the process of acu-
puncture for analgesia. Scientia Sinica, 16(1):25-60, 1973.

Chiang, Chen-yu, Chang, Ching-tsai, Chu, Hsiu-ling, and Yang, Lian-fang:
Peripheral afferent pathway for acupuncture analgesia. Scientia Sinica,
l6(2):210-217,1973.

Peking Acupuncture Anesthesia Coordinating Group: Preliminary study
on the mechanism of acupuncture anesthesia. Scientia Sinica, 16(3):447-
456, 1973.

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7.15

7.16

7.17

7.18

7.19

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7.21

7.22

7.23

7.24

7.25

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7.27

Department of Anesthesiology, Hsiian Wu Hospital, Peking: Acupuncture
anesthesia in neurosurgery. Chinese Medical Journal, 53(2):67-70, 1973.

Hua Shan Hospital of Shanghai First Medical College, Shanghai: Observa-
tions on analgesic effect of needling Chuanliao point in neurosurgery: Re-
port of 619 cases. Chinese Medical Journal, 53(2):71-73, 1973.

Shanghai First People’s Hospital, Shanghai: Acupuncture anesthesia in
thyroidectomy. Chinese Medical Journal, 53(2):74-77, 1973.

Eye, Ear, Nose, and Throat Hospital of Shanghai First Medical College,
Shanghai: Laryngectomy under acupuncture anesthesia. Chinese Medical
Journal, 53(2):78-79, 1973.

Shanghai First Tuberculosis Hospital, Shanghai: Pulmonary resections
under acupuncture anesthesia. Chinese Medical Journal, 53(2):80-84,
1 973 .

Section of Thoracic Surgery of Peking Acupuncture Anesthesia Coordi-
nating Group: Acupuncture anesthesia in thoracic surgery: Clinical anal-
ysis of 818 cases. Chinese Medical Journal, 53(2):85-88, 1973.

Thoracic Section, Acupuncture Anesthesia Group of Second Teaching
Hospital of Human Medical College, Changsha, Hunan: Acupuncture anes-
thesia in cardiac surgery. Chinese Medical Journal, 53(2):89, 1973.

Ch’angshan County People’s Hospital, ‘Ch’angshan, Chekiang: Acupunc-
ture anesthesia in splenectomy: Report of 305 cases. Chinese Medical
Journal, 52(2):90, 1973.

Department of Surgery, Peking Children’s Hospital, Peking: Acupuncture
anesthesia in pediatric surgery: Report of 1,308 cases. Chinese Medical
Journal, 53(2):91-94, 1973.

Department of Anesthesiology, Teaching Hospital of Anhwei Medical
College, Hofei, Anhwei: Acupuncture anesthesia for operations in shock
and critical cases. Chinese Medical Journal, 53(2):95-97, 1973.

Department of Physiology, Anhwei Medical College, Hofei, Anhwei:
Effect of needling of the philtrum on hemorrhagic shock in cats. Chinese
Medical Journal, 53(2):98-100, 1973.

Shanghai Institute of Physiology, Shanghai: Electrical response to now-
ous stimulation and its inhibition in nucleus centralis lateralis of thalamus
in rabbits. Chinese Medical Journal, 53(2): 131-135, 1973.

Acupuncture Anesthesia Coordinating Group of Shanghai College of Tra-
ditional Chinese Medicine, Shanghai Normal College, and Shu Kuang Hos-
pital of Shanghai College of Traditional Chinese Medicine, Shanghai: The
role of midbrain reticular formation in acupuncture anesthesia. Chinese
MedicalJournal, 53(3):136-138, 1973.

94

7.28

7.29

7.30

7.31

7.32

7.33

7.34

7.35

7.36

7.37

7.38

7.39

7 .40

Acupuncture Anesthesia Research Unit, Hsu Yi County People’s Hospital,
Hsu Yi County, Kiangsu: Electrophysiologic study of spinal reﬂexes under
acupuncture anesthesia. Chinese Medical Journal, 53(3): 139-143, 1973.

Morphologic Section of the Acupuncture Anesthesia Research Unit,
Shenyang Medical College, Shenyang: Preliminary experimental morpho-
logic and electron microscopic studies of the connection between acupunc-
ture points on the limbs and segments of the spinal cord. Chinese Medical
Journal, 53(3):144-150, 1973.

Research Group of Acupuncture Anesthesia, Peking Medical College ,"
Peking: Effect of acupuncture on pain threshold of human skin. Chinese
MedicalJournal, 53(3):151-157, 1973.

Li, Chao-t’e, Chang, P’ei-lin, Hsu, Lu-hsi, and Yang, Pao-lin: Survey of

electrical resistance of rabbit pinna during experimental peritonitis.
Chinese Medical Journal, 53(7):428-433, 1973.

Coordinating Group of Acupuncture Anesthesia of I-Iua Shan Hospital,
Department of Physiology of First Medical College, Shanghai: The effect
of certain neurologic diseases on needling “Teh-Chi.” Kexue Tongbao, 18:
90-93, 1973.

Wei, J. Y., Feng, C. C., Chu, T. H., and Chang, S. C.: Observations on ac-
tivity of some deep receptors in cat hind limb during acupuncture. Kexue
Tongbao, 18: 184-186, 1973.

Kung, C. H., Sun, A. C., Tsao, C. 1., Chang, Y. L., and Fan, L.: An obser-
vation of the humoral factor in acupunctural analgesia in rat. Kexue
Tongbao, 18:187,1973.

Wu, Chien-‘ching, Chao, Chih-chi, and Wen, Jen-yu: Inhibitory effect on
responses of cat dorsolateral column tract ﬁbers to nocuous stimulus pro-
duced by stimulation of afferent nerves. Kexue Tongbao, 8(5):238-240,
1973. -

Sakamoto, Noboru, and Naito, Yoshio: Investigations on the effect of
acupuncture on the vital capacity. Japanese Journal of the Acupuncture
Therapeutics Association , l 5(1):442-448, 1966.

Bergsmann, 0.: Zur Physiologie des Punktes Blase. Deutsche Zeitsdurft
Akupunktur, 16(1):1-11, 1967.

Gillet, J ., and Pgnet, C.: Experiments on acupuncture therapy—its reac-

tions to asthmatic patients. Japanese Journal of the Acupuncture Thera-
peutics Association, 15:243-265, 1966.

Peking Medical College for Chinese Traditional Medicine: Notes on
Chinese Medical History. (In Chinese) China: People’s Publishing Service,
1968.

Drill, Victor A.: Pharmacology in Medicine. New York: McGraw-Hill
Book Co., 1954.

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7.41

7.42
7 .43
7.44

7.45

7 .46

7.47

7.48

7 .49

7.50

7.51

Kroger, W. S. et al.: Use of hypno-anesthesia for cesarean section and ,
hysterectomy. Journal of the American Medical Association, 163:442-44,
1957.

Geddes, L. A.: Electronarcosis. Med. Biol. Eng., 3:11-16, 1965.
Allan, F. M.: Refrigerated anesthesia. Anesthesiology, 4:12-16, 1943.

Gardner, W. J. et al.: Auditory analgesia in dental operation. Journal of
the American Dental Association, 59:1144, 1959.

Acupuncture Anesthesia Research Group, Human Medical College,
Changsha: The relation between acupuncture analgesia and neurotrans-
mitters in rabbit brain. Chinese Medical Journal, 53(8):478-486, 1973.

Acupuncture Anesthesia Group, Shanghai Institute of Physiology,
Shanghai: Electromyographic activity produced locally by acupuncture
manipulation. Chinese Medical Journal, 53(9):532-535, 1973.

Department of Physiology of Shanghai First Medical College, and Acu-
puncture Anesthesia Coordinating Group of Hua Shan Hospital, Shanghai:
Acupuncture sensation and electromyogram of the needled point in pa-
tients with nervous diseases. Chinese Medical Journal, 53(10):619-622,
1973.

Chiang, Chen-yu, Liu, J en-i, Chu, Teh-hsing, Pai, Yao-lin, and Chang, Shu-
chieh: Spinal ascending pathway for effect of acupuncture analgesia in
rabbits. Kexue Tongbao, 19:31-33, 1974.

Research Group of Acupuncture Anesthesia, Peking Medical College,
Peking: The role of some neurotransmitters of brain in ﬁnger-acupuncture
analgesia. Scientia Sinica, l7(l):112-130, 1974.

Lee, Genius T. C.: A study of electrical stimulation of acupuncture locus
Tsusanli (St 36) on mesenteric microcirculation. American Journal of
Chinese Medicine, 2:53-66, 1974.

Kao, Frederick F.: “Efﬁcacy and Mechanisms of Acupuncture: A Pro-
posal of Neurohumoral Mechanisms.” Paper presented at the meeting of
the Alpha-Omega-Alpha Honorary Society lecture, University of Kansas,
May 1974.

96

Chapter VIII

PUBLICATION OF PHYSIOLOGICAL JOURNALS IN CHINA

Publication of literature in medicine and physiology constitutes one of the
major routes of professional communication among scientiﬁc communities.
China has had a voluminous amount of scientiﬁc publication in medical ﬁelds
through the many centuries of its history. The publication of periodicals and
journals devoted to medicine began in the late 19th century. The Chinese Medi-
cal Journal was the ﬁrst to be published as a periodical in China and was initially
named the China Medical Missionary Journal. It was inaugurated in March- 1887
as a quarterly and was published through Volume 10 in 1896. In 1887, Volume
1 of the China Medical Journal appeared, which changed its name again in 1940
to the Chinese Medical Journal (8.1 , 8.2).

The China Medical Missionary Journal’s original editors included J. G. Kerr,
M.D., Canton; J. K. Mackenzie, M.R.C.S., L.R.C.P., Tiensin; E. Reifsnyder, M.D.,
Shanghai; and Rev. L. H. Gulick, M.D., Business Manager, Shanghai. A yearly
subscription cost $2.00. In 1888, Mackenzie died and A. Lyall, M.B.C.M., of
Swatow was appointed editor (8.1).

In 1966, the name of the Chinese Medical Journal was changed to China ’s
Medicine, which was published until the end of 1968. In 1973, the Chinese
Medical Journal resumed its publication with Volume 53 (8.3, 8.4).

The Chinese Journal of Physiology was inaugurated in 1927 with R. K. S. Lim
of the Department of Physiology at the Peking Union Medical College as the
managing editor. The Editorial Board consisted of Hsien Wu, Department of
Biochemistry, Peking Union Medical College, Bernard E. Read, Department of
Pharmacology, Peking Union Medical College, and H. G. Earle, Department of
Physiology, University of Hong Kong (8.5). The journal published papers writ-
ten in several languages, including Chinese, English, French, and German, but
required an abstract in Chinese of papers in foreign languages. This journal ap-
peared quarterly and published 14 volumes between 1929 and 1939. Volumes
15 and 16 were published following World War II to cover the years 1940-48.
Volume 17 was published in 1949 and Volume 18 during 1951-52. The name of
this publication was then changed to Acta Physiologica Sinica, with Volume 19
(Nos. 1,2, and 3) published during 1953-55. Volume 20 was published in 1956,
and publication continued to Volume 29 (No. 2 in June 1966).when it was sus-
pended. (Table 8-1.)

Following the Cultural Revolution, many journals were reevaluated and some
resumed publishing. As of the Spring of 1974, neither the Chinese Journal of

97

570-225 0 - 75 - B

Table 8-1. Years and volumes of the Chinese

 

 

Jounw/ofPhygbkmy.
Year Volume
1927 1
1928 2
1929 3
1930 4
1931 5
1932 6
1933 7
1934 8
1935 9
1936 10
1937 11
1938 12
1939 13
1940 14
1941 15
1945 16
1949 17
195L52 18

Name changed to Acta Physiologica Sinica

1953 19,No.1
1954 19,No.2
1955 19,No.3
1956 20
1957 21
1958 22
1959 23
196061 24
1962 25
1964 27
1965 28
1966 29

Suspended after Volume 29, No. 2, June 1966

 

Physiology nor Acta Physiologica Siniaz has yet appeared, but many articles in
relation to physiology are being published in Scientia Sinica and Kexue Tongbao
(8.6, 8.7). A list of journals published after the Cultural Revolution is shown in

98

table 8-2; the names of the Editorial Committee members of Acta Physiologica
Sinica are listed in table 8-3 (8.8).

The Chinese Journal of Physiology enjoyed a good reputation in the United
States (8.9). Figure 8-1 presents the overall number of pages, authors, and arti-
cles published in this journal, whose publication was suspended between
1941-49. After the resumption of its publication in 1950 with the change of
name to Acta Physiologica Siniaz, there was a steady increase in the number of
pages printed and authors publishing in the area of physiology, especially during
the years 1960-65.

Physiological papers were not only published in the Chinese Journal of Physi-
ology. Lim and Wang listed 34 journals published in China related to physiology,
most of which were inaugurated after 1949 (table 84).

After 1968, all medical journals ceased publication in China, including China’s
Medicine. In 1973, when the publication of medical journals resumed, this peri-
odical was again named the Chinese Medical Journal and was again a monthly
publication. Table 8-5 summarizes the contents of the various papers and indi-
cates the number of articles and pages in the ﬁeld of respiratory physiology.

Scientia Sinica also resumed publication in 1973, and the Volume 16, 1973,
issue included articles in physiology (8.7) (table 8-6). According to the National
Library of Medicine, Bethesda, Md., there were over 200 journals published in
China before the Cultural Revolution, about half of which included articles re-
lated to medicine and physiology.

Table 8-2. Journals related to medicine and
physiology published by the Chinese after the
Cultural Revolution.

(with English title, summary, or abstracts)

 

Scientia Sinica, published‘in February, May,
August, and November in English
and in Chinese

 

Acta Zoologica Sinica, quarterly

Acta Botanica Sinica, quarterly

Vertebrata Pa/asiatica, quarterly

Acta Microbiologica Sin/'ca, biannual

Acta Genetica Sinica, biannual

Chinese Medical Journal, monthly

Science Bulletin, monthly

Acta Biochimica et Biophysica Sinica, biannual

Genetics Bulletin, quarterly

Science Bulletin (or Kexue Tongbao), bimonthly
- Acta Phytotaxonomica Sinica, quarterly

Chemistry Bulletin (Huaue Tongbao), bimonthly

 

99

Table 8-3. Editorial committee of
Acta Physiologica Sinica, 1964.

 

Fung, Teh-pei (Editor in Chief)
Hsu, Feng-yen (Associate Editor)
Hsu, Ke (Secretary)
Tuig, Kuang-shen
Wang, Chih-chun
Wang, Hsung-chiu
Lu, Cheng-tung
Chu, Jen-pao

Liu, Jung

Liu, Shin-hao

Liu, Y'Li-min

Wang, Kuen-jen
Shen, Shao-wen
Chang, Chang-shao
Chang, Hsiang-tung
Chang, Hsi-chun
Chao, Chin-huang
Chin, Yin-ch’ang
Chao, Yi-ping
,Hou, Hsiang-ch’uan
Hu, HsiJ-ch’u

Ts’ai, Ch’iao

 

A Bibliography of Chinese Sources on Medicine and Public Health in the .
People’s Republic of China Between 1960-1970 lists 75 Chinese journals (8.10),
many concerned with respiration, pulmonary diseases, and chest diseases. In the
section on chest diseases, articles on altitude and pulmonary functions were also
included (8.10) (table 8-7).

It can be seen that although China only began to publish modern journals re-
lated to medicine and physiology in the late 19th and early 20th century, there
was a large volume of publications concerning all aspects of medicine and physi-
ology. Recent issues of the Chinese Medical Journal, Kexue Tongbao (8.6), and
Scientia Sinica (8.7), which all resumed publication about a year ago, clearly
show that copius material has been generated in the following ﬁelds: acupunc-
ture anesthesia, limb replantation, treatment of severe burns, and Chinese
pharmacology—all of which are new developments in medicine ultimately in-
volving the integration of Eastern and Western medical concepts and techniques.
Physiologists in the West are awaiting with interest the resumption of the Chinese
Journal of Physiology . ,

100

[OI

 
  

 

 

 

 

 

 

 

 

 

199 — . . .
g ‘— llie Bhinese lournal of Physiology «—Acla Physiologica Sinica——v—-—~
g «Suspended ?
‘= _ Se 1.1941—19-19
1:,— 50 000000000 003 p o0 o ‘5
z "I gain-goo]. 0].. l I I.- ol I

21111 — 0 10131 ‘ ,
3 ° Respiration Alone 9)
a o i
*5 1111] ~ o
E; (LOOOOOOOQ 008 E 0

0| gal-cool .1- I. I In. Cl- 1

9110 -
to LO 0 ‘ o O ? ?
gown— 00000 61112.3 cl 0 l
2 o o =
5‘ 299 — 6

ﬂl‘.o’.0..l. ’1' l ' l 1.. o|_ I
1925 1939 1935 1949 1945» 1951] 1955 1960 19115 19111 Year
I l‘l 11111] 1'IVIIV'IIV'111'9 1;: 1'5 1.5 In is 19 2'1. 2'1 2'1 2'3 '24. 2; 2; 2'1 2'3 2'! Volume

 

No.11, 3.4 ‘I, 2, 3. 4

Figure 8-1. A chronological exposition of the number of articles, authors, and pages published in the Chinese
Journal of Physiology since its inauguration in 1927.

Table 84. Journals published in China that are related to

 

 

physiology.
Journal ‘Began
ln year

Chinese Journal of Physiology 1 927
Acta Biochimica Sinica 1958
Acta Biologica Experimentalis Sinica 1953
Acta Botanic Sinica 1952
Acta Laboratorium Clinicarun 1957
Acta Microbiologica Sinica 1955
Acta Nutrimenta Sinica 1956
Acta Pharmaceutica Sinica 1953
Acta Physiologica Sinica 1953
Acta Phytotaxonomia Sinica 1953
Acta Psychologia Sinica 1959
Acta Taxonomia Sinica 195?l
Acta Zoologica Sinica 1948
Biology Teaching 1959
Bulletin of Biology 1957
Bulletin of Plant Physiology 195?1
Chinese Journal of In termedia te Medicine 1948
Chinese Journal of Neurology and Psychiatry 1955
Chinese Journal of Pediatrics 1950
Chinese Journal of Pathology 1955
Chinese Journal of People’s Health 1959
- Chinese Journal of Tuberculosis 1959
Chinese Journal of Zoology 1958
Chinese Medical Journal 1887
Fo/ia Pharmaceutica Sinica 1953
Pharmacology Archives 195.71
Pharmacy Archives 1949
Progress in the Physiological Sciences 1959
Science 1924
Science Abstract in English 195.71
Science Record (New Series) Russian and English 1957
Science and Technique 195.71
Scientia 1949
1952

 

Scientia Sinica in Russian and English

lYear not available but published after 1949.

102

Table 8-5. The 1973 issues of the Chinese Medical Journal.

 

 

 

 

. . Traditional
Respiration Acupuncture . . Traumatology
medicine
Number N umber
Issue of of
number . Number Number Number Number Number Number Number Number
articles pages
of of of of of of of of
articles pages articles pages articles pages articles pages
1 ............ 1 7 64 — — — — 2 1 1 1 8
2 ............ 16 62 2 10 12 38 — — — —
3 ............ 13 63 — -— 5 28 1 4 — —
4 ............ 14 63 2 7 — — — — 1 8 34
5 ............ 14 63 3 12 — — 2 10 — —
6 ............ 15 63 — — — — — — 21o 32
7 ............ . 15 64 1 3 — — 1 4 —- -—
8 ............ 15 62 — - 1 9 3 5 1 1
9 ............ 1 5 63 1 4 1 4 - — 1 4
10 ............ 13 63 — —- 1 4 3 16 ,1 — —
1 1 ............ 1 8 63 1 6 — — 2 4 1 4
1 2 ............ 1 2 57 5 25 — — — - -— ——
Total ..... 174 748 15 67 20 83 14 54 22 82

 

lBurn.
2Fleplantation.

Note.—Dash indicates no article.

Table 8-6, Subject matter and number of pages and articles in
Volume 16, 1973, Scientia Sinica.

 

 

Subject matter Number of pages Number of articles
Agricultural sciences 28 2
Astronomy 13 1
Biology 67 8
Chemistry 34 3
Earth sciences 144 9
Engineering sciences 89 4
Mathematics 1 15 6
Medical sciences 84 6

Acupuncture 52 3
Cancer 32 3
Physics 42 4

 

Table 8-7. Subject matter and number of articles in 75 Chinese
periodicals (8.10).

 

 

Subject Number of articles
Clinical
Acupuncture and moxibustion 582
Anesthesia 1 1
Pulmonary disorders 10
Allergy 293
Asthma 10,
Anesthesiology 213
Cardiovascular disease 581
Pulmonary arteries 12
Pulmonary heart disease 28
Chest disease 247
Techniques 17
Mechanic 14
Respiratory drugs 1 1
Dentistry and oral surgery 206
Dermatology 375
Endocrinology, metabolism, and nutrition 363
Gastroenterology 1 ,020
Hematology 219
Infectious disease 1,703
Influenza and respiratory viruses 39

104

Table 8-7. Continued.

 

Subject Number of articles

 

Clinical (continued)

Tuberculosis (respiratory tract) 159

Pneumonia “ 109
Neurology 212
Obstetric and gynecology 679
Occupational medicine 145
Oncology 1,025

Respiratory tract 70
Ophthalmology 354
Orthopedics 400
Otolaryngology 318
Parasitology 783
Psychiatry and psychology 128
Surgery 1,273

Surgical instrumentation 3O

Thoracic 14
Toxicology 388
Urology and kidney disease 500
Miscellaneous 397

Health related

Biomedical research 249
Biochemistry and biophysic (technic) 10
Physiology 52

Pharmacology 1,103
Respiratory drug 2

Public health 502

Health manpower training 95

Hospital service 147

’Nursing 74

Human development 59

Publications 205

Political 248

Total 15,023
Chest disease

Altitude 4

Blood gases 4

Chinese medicine for respiratory disease 18

105

Table 8-7. Continued.

 

Subject Number of articles

 

Chest disease (continued)
Pulmonary function 15
Techniques 9

Disease (treatment, diagnosis, case report, etc.)

 

General 20
Bronchial disorders 32
Emphysema 16
Hemoptysis 12
Lung abscess 17
Pleural disease 60
Others __L
Total 247
Monographs
Acupuncture and moxibustion 2O
Cardiovascular 9
Child health and human development 15
GaStroenterology 6
Infectious diseases 17
Neoplastic disease 6
Neurology 4
Obstetric and gynecology 9
Ophthalmology 7
Otorhinolaryngology 6
Pharmacology 34
Public health and hygiene 10
Surgery 27
Traditional medicine 39
Old medical texts 38
Miscellaneous 32
Total 279

 

Summary and Conclusions

The publication of the Chinese Medical Journal began in 1887; the Chinese
Journal of Physiology was inaugurated in 1927. There were numerous publica-
tions concerning various medical ﬁelds in China following 1949. Since the
Cultural Revolution, over 20 major journals have resumed publication. The

106

Chinese Journal of Physiology, which had been published since 1953 under the
title of Acta Physiologica Sinica, has not yet appeared since its last volume in
1966. Much of the research in physiology currently conducted in China is being
published in Scientia Siniaz, Kexue Tongbao, and other publications at the
present time.

107

8.1
8.2
8.3
8.4
8.5

8.6
8.7
8.8
8.9
8.10

REFERENCES

China Medical Missionary Journal, Volume 1, No. 1, Mar. 1887.
China Medical Journal, Volume 3 5, 1921 .

China ’s Medicine, Volume 1 , 1966.

Chinese Medical Journal, Volume 53, Nos. 1-12, 1973.

Lim, R. K. S., and Wang, G. H.: Physiological sciences. In: Gould, S. H.,
ed. The Sciences in Communist China. Washington, D.C.: American As-
sociation for the Advancement of Science, 1961, pp. 323-362.

Kexue Tongbao, Volume 18, No. 1-6, 1973.
Scientia Sinica, Volume 16, 197 3.

Acta Physiologica Sinica, Volume 27, 1964.
Gray, John 5., personal communication.

John E. F ogarty International Center: A Bibliography of Chinese Sources
on Medicine and Public Health in the People ’s Republic of China, 1960—
1970. DHEW Pub. No. (NIH) 73-439. Washington, D.C.: U.S. Govern-
ment Printing Ofﬁce, 1973.

108

Chapter IX

MEDICAL EDUCATION AND
THE TRAINING OF PHYSIOLOGISTS

The background of the Chinese medical education system is relevant not only
to the understanding of the development of respiratory physiology in China fol-
lowing 1949, but also to understanding the medical system in general. In the
pre-1949 period, China’s medical schools operated on a system calling for a
3-year premedical, 4-year medical and 1-year internship involvement as the
complete curriculum of medical training. Other institutions operated on a 6-year
instead of an 8-year program.

Lim and Wang (9.1) estimated that in 1949 there were about 33 medical
schools in China, two-thirds of which were supported by the government and the
rest by private funds. In 1949, the new government immediately made new
arrangements concerning medical schools and education. Some were amalga-
mated and others were newly instituted. In the decade that followed, China’s
medical schools increased in number. Table 9-1 lists the medical schools in
China in 1949-59 as reported by Lim and Wang.

During the Cultural Revolution, all medical schools and universities were
closed. In 1959, for example, the China Medical College had been set up as a
“reincarnation” of the old American-run Peking Union Medical College, but was
criticized, as evidenced by articles in China’s Medicine during 1967 and 1968
(9.2, 9.3). The China Medical College of Peking, which was established in 1959,
however, took the initiative to convert the long training period in medical col-
leges into a more practical system following the directive: education must serve
proletarian politics and must be combined with productive labor.

The principle of “less and better” was observed, the curricula and the amount
of teaching materials employed were curtailed, and examination methods were
reformed. In the new system, the procedure of rote learning and cramming stu-
dents with knowledge was abolished, and teaching methods that developed stu-
dent initiative were introduced. To air their resentment against antiquated
teaching methods, the students recited the following:

These 8 years in the old CMC, the havoc they wrought!

In 3 years, no medicine did we glean,

In 5 years, no patients were seen,

A full eight years and no contact with workers and peasants brought.

Institutional medical training in China resumed in 1970. At the present time,
every province has at least one medical school, and large cities such as Peking

109

Table 9-1. Medical schools in China in 1949-59.

 

 

Province School Location
Anhwei Anhwei Medical College Hofei
Chekiang Chekiang Medical College Hangchow
Fukien Fukien Medical College Foochow
Heilungkiang Heilungkiang Medical College Chichihar
Honan Honan Medical College Kaifeng
Hopei Hopei Medical College Paoting
Hopei Peking Medical College Peking
Hopei China Union Medical College to 1959 Peking
Hopei Tientsin Medical College Tientsin
Hunan Hunan Medical College Changsha
Hupei Hupei Medical College Wuchang 7
Hupei Wuhan Medical College (formerly Hanchow

National Tungchi Medical College
Kansu Lanchow Medical College Lanchow
Kiangsi Kiangsi Medical College Nanchang
Kiangsu Kiangsi Medical College Nantu ng
Kiangsu Fifth Military Medical College Nanking
Kiangsu Second Military Medical College Shanghai
Kiangsu First Medical College of Shanghai Shanghai
Kiangsu Second Medical College of Shanghai Shanghai
Kirin Changchun Medical College Changchun
Kirin Harbin Medical College Harbin
Kwangsi Kwangsi Medical College Kweilin
Kwangtung Chungshan Medical College Canton
Kweichow Kweichow Medical College Kweiyang
Liaoning Liaoning Medical College Mukden
Liaoning Dairen Medical College Dairen
Ninghsia Ninghsia Medical College Ninghsia
Shansi Shansi Medical College Taiyuan
Shantung Shantung Medical College Tsinan
Shantung Tsingtao Medical College Tsingtao
Shensi Fourth Military Medical College Sian
Sinkiang Urumchi Medical College Urumchi
Szechwan Szechuan Medical College Chengtu
Szechwan Chungking Medical College Chungking
Szechwan Seventh Military Medical College Chungking
Yunnan Yunnan Medical College Kunmin

 

110

and Shanghai have more than one. There are about 45 medical schools in China,
all of which operate with a 3-year curriculum and an additional half-year for
premedical training.

Of these 45 medical colleges, the following 10 are in the direct control of the
Ministry of Health: Peking Number One Medical College, Shanghai Number One
and Number Two Medical Colleges, Shenyang Medical College, Shangtung Medi-
cal College, Hupei Medical College, Wuhan Medical College, Szechuan Medical
College, Hunan Medical College, and Chungshan Medical College.

Many medical colleges have several faculties. For example, Number One
Medical College of Peking has the following ﬁve: Faculty of Medicine with a
3%-year curriculum, Faculty of Dentistry with a 3-year curriculum, Faculty of
Public Health with a 3-year curriculum, Faculty of Pediatrics with a 3-year cur-
riculum, and Faculty of Pharmacy with a 3-year curriculum. Before the Cultural
Revolution, those faculties were operating on curricula of 5 or 6 years, 4 years,
5 years, 5 years, and 4 years, respectively.

Besides these medical colleges, there are 10 colleges of Chinese traditional
medicine, in which the basic sciences curriculum is similar to that of other medi-
cal colleges. The clinical curriculum, however, is oriented toward Chinese tradi-
tional medicine.

‘ The basic schooling years in China are as follows: A child enters primary
school, which last 5 years, at the age of 7; at the age of 12 the youngster enters
secondary school, which also lasts 5 years. After secondary school, the student
must work in rural areas or in a factory for at least 2 years, after which he or
she may enter college or other institution of higher learning, including medical
school.

The young people admitted to medical colleges are often those who had been
previously working as barefoot doctors. Admission to medical school consists of
the following four steps:

1. The student must voluntarily apply.

2. Following the student’s application, there is a meeting among his co-
workers or commune members. After deliberation, the student is or is not
recommended.

3. If he is recommended, he must then receive permission from the leaders of
the commune.

4. The leaders of the commune then forward his documents to the medical
school to be reexamined by its admission committee, according to the
following conditions:

a. The student must have a very excellent record in political study.

b. He must have had at least 2 years of practical experience, including
work in “class struggle,” “production struggle,” and “scientiﬁc experi-
mentation.”

c. 'He must have an adequate cultural background, which means that he
must be a graduate of primary, middle school, or secondary school.

111

d. He must be between 18 and 25 and unmarried, and his health must be
good.

The conclusion was ﬁnally reached that the optimal length of time for train-
ing medical students was between 2 and 3 years. Students who were admitted in
1970 thus graduated in 1973. In 1972, it was decided that 600 students would
be admitted for 3 years, plus a half year for premedical training; the length of
the premedical period is ﬂexible. Those who graduate from senior high school
can go on to medical studies without taking premedical courses. From experi-
ence gained during the Cultural Revolution, it was concluded that the cultural
background of a student is very important, and a student who is deﬁcient in cul-
tural background could not be a good doctor.

Before the Cultural Revolution, there were 36 medical courses over a 6-year
period. After the Cultural Revolution, a lS-course curriculum was offered.
Those subjects that were repetitious were eliminated. Those thought to be de-
ﬁcient but necessary were strengthened. The current 15 courses for medical
students are the following:

1. English.

2. Physics, which includes medical physics and chemistry.

3. Normal human body studies, which consists of the study of the functions
of the body. In the old system, this was taught as anatomy, embryology,
histology, biochemistry, and physiology.

. Pathology with emphasis on pathophysiology and pathoanatomy.

. Pathogenesis, or medical microbiology and parasitology.

. Pharmacology, which includes Chinese herbology.

. Foundations of Chinese medicine, which deals with the theory of Chinese
medicine, the Yin-Yang doctrine, the Chinglo system, and the theories of
Chi.l
8. Foundations of diagnosis.

9. Hygiene in rural areas for workers and miners.

10. Internal medicine.

11. Pediatrics.

12. Surgery.

13: Obstetrics and gynecology.

14. Dermatology.

15. The ﬁve sense organs.

\lam-P

The teaching timetable is as follows: Each year, classes are held for 42 weeks.
There are 22-24 hours of lectures each week. Thirty percent of the total

 

1The ﬁve elements are not actively discussed anymore, but the Yin-Yang doctrine is still
being taught. Possibly, a transition is occurring from the old theory of the Yin-Yang and
five-elements doctrine to modern scientiﬁc attitudes, which will probably generate new
theories in time to come.

112

curriculum is devoted to labor activities, political discussion, and gymnastics or
physical education.

The 6-year curriculum that was in practice before the Cultural Revolution
produced many unsatisfactory situations. There are many poems describing
what happened during those 6 years. One reads:

In the first year, one does not learn medicine

In the second year, one does not see patients

In the third year, one does not serve the workers and peasants

This resulted in the three detachments:

The doctors are detached from the proletariat, from the working peasants, and from

practicalities.

In order to avoid the three detachments, a 3-year medical curriculum was in-
stituted. In these 3 years, medical students have a chance to go to rural areas
with professors in order to avoid “ivory towerism.” During the second year, ,
the students engage in clinical “practice” that is coordinated with their studies
in pathology and pharmacology. In the third year, emphasis is placed on clinical
experience. Every student is practically a hospital intern. Surgery can even be
performed by students under supervision. During this year, there are 2 months
of Chinese medicine, 2 months of obstetrics, and 2 months of work either in
rural areas, in the factories, or in the mines.

Each medical college has two or more professors of physiology and, according
to the size of the student body, additional instructors and assistants. For exam-
ple, a medical college may have three professors, ﬁve or six instructors, and
about 10 assistants in physiology.

Physiology is taught in the ﬁrst term of the second year, with a total of about
145 hours of classroom work presented. Although the student body in one class
may reach a size of 600, the classes are divided into groups of about 100-150
with rotating lecture schedules. For conferences, the class is further divided into
groups of 15 or 20 each, and for practical laboratory work, the students may
work in teams of two. Thus, the teaching schedule forms a very efficient and
small group for close tutorial teaching.

From the number of medical schools in China, it can be estimated that there
may be 400-500 full-time teachers in physiology, including professors, instruc-
tors, and assistants. This number would be further increased if one counted
those who are engaged in physiological research. Teaching assistants in physiol-
ogy are recruited with the aid of a central planning committee. Additional per-
sonnel are assigned to teach wherever there is a need.

During the years 1956-59, assistants in physiology were also trained by
Russians, and a degree of “PhD. candidate” was given to those who received
such training. This procedure was discontinued in 1959.

At present, physiologists are trained in a teaching-learning fashion, employing
practical experience and learning in groups. There are many small congenial
groups that deﬁne study and solve research problems in a total collaborative way.

Finally, numerous textbooks have been published since the Cultural Revolu-
tion. Many are concerned with the respiratory system, both in physiology and
in clinical medicine.

113

570-225 0 - '75 - 9

Summary and Conclusions

Medical schools in China copied both European and American systems and
curricula prior to 1949.

The signiﬁcant aspects of modern medical education in China are related to
the radical changes in curriculum and educational priorities instituted to directly
address the health-care needs of the Chinese nation after 1949. It is recognized
by authorities in China that the medical education system is still undergoing
metamorphosis, but it is certain that the 8-year curriculum of the early 20th
century will not be repeated. There have been dramatic changes in the philoso-
phy of medical training in China in the last quarter century that may have bear-
ing on the medical educational systems of other societies.

114

9.1

9.2

9.3

REFERENCES

Lim, Robert K. S., and Wang, G. H.: Physiological Sciences. In: Gould,
S. H., ed., The Sciences in Communist China. Washington, DC: Ameri-
can Association for the Advancement of Science, 1961 , pp. 342-343.

China’s Khrushchev resurrected PUMC to advance revisionist line in educa-
tion. China ’3 Medicine, (12):890-892, Dec. 1967.

Ferguson, Mary E.: China Medical Board and Peking Union Medical
College. New York: China Medical Board of New York, 1970.

115

 

Chapter X

CONCLUSION AND FUTURE PROSPECTS

Respiratory research in the People’s Republic of China at the present time re-
flects the general philosophy and ideology of medical practices in that country.
The integration of Western medicine and Chinese traditional medicine into a uni-
ﬁed system of medical research and health care is being carried out at all levels of
professional activity. The Chinese have a rich heritage in medicine in general and
respiratory physiology in particular. One of the most striking aspects of the cur-
rent integration of ancient and modern medical theory and practice in China
concerns the use of integrated approaches for the treatment of common and re-
current lung diseases, including bronchitis and emphysema.

The extent of Chinese accomplishments in medicine since 1949 should not be
underestimated. The Chinese have made dramatic progress in the last quarter
century in the areas of providing primary health care of good quality; educating
health-care professionals, including paramedics such as barefoot doctors; devel-
oping concise and pragmatic teaching materials and methods; research publica-
tion; and orientation of investigational efforts toward understanding and con-
trolling common and recurrent diseases for the beneﬁt of the public welfare and
health. This progress is reﬂected in the style and content of current Chinese
work in respiratory research and clinical developments.

The status of respiratory research in China prior to 1949 reﬂects two funda-
mental styles and approaches to medicine. First, the protoscientific notions of
physiology are derived from millennia of ﬁeld-tested clinical experience, many
aspects of which might easily be translated and annotated to become fundamen-
tal works of the theory and practice of Chinese traditional medicine for our
present use. Such a task is currently being carried out in China. Many new text-
books and translations of ancient classic works in medicine are being written in
modern Chinese style. The Western world is awaiting the day when scholars will
show more interest in Chinese traditional medicine and made accurate and judi-
cious translations of these texts. It cannot be denied that rich sources of infor-
mation are contained in these classic works.

The second fundamental approach in respiratory research prior to 1949 in
China concerns the introduction of Western medical concepts. These concepts
were constantly changing, improving, and metamorphosing into the modern
medicine that we know today. Western medicine during this period certainly did
not address itself to the health-care needs of the vast majority of China’s people.
It was not carried out on a sufﬁciently large scale to reach all of the people, who

117

were thus largely dependent on medical care derived from traditional sources. In
a way, respiratory research was carried out in China over the course of several
thousand years. It was based on a collection of subtle, clear-minded observations
of the facts and interpretations that had been distilled over centuries of experi-
ence.

Respiratory research, and for that matter medicine in general in China, ex-
perienced a new and historical transformation when the integration of Western
and Eastern medical concepts and techniques was put into practice in the 1950’s.
Further strides in this process of integration were made during and after the Cul-
tural Revolution of 1966-69. Salient features in this development included the
following:

.1. The effort to put Chinese traditional medicine on a scientiﬁc basis has
largely been carried out by scientists who were trained in, and are inti-
mately familiar with, Western methodologies and techniques.

2. A genuine integration of Western medicine with Chinese traditional medi-
cine is being developed. At the present time, doctors trained in Western
techniques also learn the fundamentals of Chinese traditional concepts and
vice versa. Such an infusion of new concepts and talents into the system
of traditional Chinese medicine will do much to transform and upgrade it
to a scientiﬁc level of practice. -

3. New discoveries that will be of great clinical and basic scientiﬁc impor-
tance are imminent and will stem from the investigation and interpretation
of different cultural forms of medicine that have been exhaustively carried
out. Acupuncture analgesia, for example, is indeed a signiﬁcant discovery.
Its mechanism is not fully understood, but one should give serious consid-
eration to its beneﬁcial aspects in the treatment of elderly patients and
those who are poor risks for anesthesia, its impact on the cost of medical
care, and its challenge to a world densely populated with neurophysiolo-
gists compared with the numbers of physiologists in other areas of investi-
gation. Certainly, we need more and better research to conclusively eval-
uate and scientiﬁcally validate acupuncture analgesia and other techniques
of traditional Chinese medicine. The use of Chinese herbs has opened a
great new treasure trove of medical materials to the rest of the world, with
potential beneﬁts in the treatment of respiratory diseases. It is difﬁcult to
deny that ancient observations have and will pave the road to new discov-
eries.

4. The new health-care delivery system in China has revolutionized and made
obsolete many older concepts that had been in practice in China and other
parts of the world. It is not my intention to emphasize the success of the
medical delivery system in China per se, although its beneﬁts and accom-
plishments are of interest. “Now we have doctors come to our door and
treat us in our own beds” is an oft-repeated saying among the public in
China. People now have guarantees of security in medical care. This sys-
tem may perhaps not only be of utility and relevance in China’s social

118

system but in the systems of social medicine in other countries as well.
The control of respiratory diseases in China deﬁnitely reﬂects what its
social system is capable of accomplishing in terms of upgrading public

health conditions.

The discussion of the history and present status of respiratory physiology and
diseases in China must be, in style and content, much like a discuSSion of Chinese
medicine in general. Many perspectives are called into play. The specialist must
in some sense be a generalist as well in order to appreciate the full dimensions of
this particular subject ; history, sociology, philosophy, politics, and anthropology
are all legitimate perspectives for this discussion as are the more strictly medical
subspecialties of public health, health-care administration and delivery, research,
pharmacology and drug manufacture, medical education, equipment design for
clinical work and research, etc.

In this monograph, I have given a preliminary survey of modern Chinese med-
icine in the hope that future prospects may be indicated for research work and
cooperative exchange between medical scientists of China and the United States.
The questions that must now be raised are, What are the future prospects of
Chinese medicine? and What is the relevance of Chinese work in respiratory
physiological researchand clinical work to our own efforts?

First of all, if we deﬁne Chinese medicine as an integration of Western medi-
cal concepts and techniques with Chinese traditional medical concepts and tech-
niques, then it may be said that China is closer to an “ecumenical” or universal
system of medicine that we are in the West. In other scientific disciplines—for
example, chemistry, physics, biology, and astronomy—we speak of one uniﬁed
and international system, whereas we still associate medicine with its culture of
origin. The Chinese have made great contributions in the past in astronomy, yet
no one speaks of Chinese astronomy. Why then do‘we speak of Chinese medi-
cine?

If medicine is deﬁned as the art and methodology of treating illness, then
medicine, no matter where its origin, should be fully applied, since illness is an
urgent world problem and no stone should be left unturned in attempting to
conquer this age-old enemy of man. An enlightened eclecticism would thus seem
to be in order.

Western medicine has made great progress in the past several decades, improv-
ing the health of the Chinese people and lengthening their life expectancies.
However, we cannot deny that there are still many pressing medical problems
facing us that require an open mind for their solution. The Chinese have many
goals for the development of the ﬁelds of clinical and investigative medicine. It
seems clear that in the future Chinese scientists will be launching comprehensive
studies related to respiratory diseases, including tuberculosis, bronchitis, bron-
chiectasis, lung cancer, pulmonary cysts, and lung infections. The importance of
the integrative study of cardiac physiology and pulmonary physiology is clearly
recognized in China, and cooperative study will be carried out in this area in
China in the forseeable future. There will be more emphasis in industrial

119

hygiene, especially with the aid of respiratory studies as a monitoring system to
improve working conditions. Emphysema is one of the important common and
recurrent diseases to be conquered, and respiratory studies are of primary im-
portance in this effort. There will be more cooperative studies between clinical
medicine and basic physiological sciences. There will be less of a strict demarca-
tion between basic and clinical physiology, and they will be approached as a uni-
Fred phenomenon with two principal aspects.

The following suggestions are directed to the physiological community in this
country: We should establish and develop scholarly exchange between China and
the United States, and we should deﬁne the areas of exchange in terms of special
interest ﬁelds with high priority. In medicine, acupuncture analgesia may be
considered an important area for potential exchange; this has already been real-
ized (10.1-10.3). Perhaps a group of scientists should be organized to jointly
study the therapeutics of respiratory diseases (e.g., bronchitis) using an integra-
tive form of medicine such as the Chinese are developing.

It seems evident that medical exchange between China and the United States
will be broadened. It is also evident that the Chinese will certainly continue to
make medical progress in the future, as evidenced by what has already been ac-
complished in China up to the present time. That future has perhaps already
arrived.

120

10.1

10.2

10.3

REFERENCES

Brown, Harrison: Scholarly exchanges with the People’s Republic of
China. Science, 183:52-54, 1974.

Keatley, Anne, Staff Director, Committee on Scholarly Communications
with the People’s Republic of China, Ofﬁce of the Foreign Secretary,
National Academy of Sciences, 2102 Constitution Avenue, N.W., Washing-
ton, DC. 20418, personal communication.

John E. Fogarty International Center: Topics of Study Interest in Chinese
Medicine and Public Health: Report of a Planning Meeting. DHEW Pub.
No. (NIH) 72395, Washington, DC: US. Government Printing Ofﬁce,
1972.

121

 

Appendix I

RESPIRATORY DRUGS MADE IN THE
PEOPLE’S REPUBLIC OF CHINA

123

 

 

Figure l-1. From left to right, the drugs are Chikuanyenpien, pills for
bronchitis; Tanchiapien, anticough, dissolves sputum, and anti-
inflammatory action; and Kanmaoling, for colds.

 

Figure l-2. From left to right, the drugs are Kanmaotuijehchungchi, for
cold, fever, and respiratory infections; Yinchiaochiehtupien, for fever
due to cold with stuffy nose; and Shangfungkesoutunchi, for headache,
stuffy nose, and cold—has sudorific action.

 

Figure l-3. From left to right, the drugs are Hsiaochuanchungchi, for dysp-
nea and cough; Chihsouhyatanwan, for bronchitis, cough, dyspnea, cold,
and chest pains; and Kanmaochingjehchi, for headache, cold, and chills.

125

A4+ﬁﬂﬁﬁﬁ”“”

 

Figure l-4. From top to bottom, the drugs are Kanmaopien, for
colds; Niuhuangchiehtupien, for sore throat; and Paihuating-
chuanpien, for difficulty in breathing, insomnia, and cough.

 

Figure l-5. The drugs are Chihsouchingkuowan, for cough, dyspnea, and
dry throat (top left); Shiaochuanpien, for cough, dyspnea, profuse spu—
tum, and chronic bronchitis (top right); Baihequjinwan, for tonification
of the lung (bottom left); and Jubei Banxiaqu, for bronchitis (bottom
right).

126

 

Figure l-6. From top to bottom, the drugs are
Chingliangjunhouwan, throat tablets; Yinchiao-
wan, for influenza, cough, and sore throat;
Paohouwan, for chronic bronchitis and sore
throat; and Yinchiaochiehtupien, for colds.

 

Figure l-7. From left to right, the drugs are Ban-
hsiapien, anticough and dissolves sputum;Tong-
xuanlifeiwan, for dyspnea, colds, and cough; and
Fufongaitichapien, for upper respiratory tract in-
fections and chronic bronchitis.

127

 

 

Figure l-8. From top to bottom, the drugs are Sangchupien, for cough and
fever; Tunghsuanlifeiwan, for dyspnea, colds, and cough; Lienchiaopaituwan,
for fever (not to be used for pregnant women); and Chingfeinihopien, for
sore throat, fever, and cough.

128

, TIA snow; mew;-

 

Figure I-9. From top to bottom, the drugs are Yunhsiangching, for cold and
influenza; Hsiaoerhpaishopien, for cold and influenza in pediatrics; and
Yinchiaochiehtupien, for cold and influenza.

129

570-225 0 - 75 -10

 

Figure I-10. Herb plants in the garden of a medical college in Shenyang.

’)
L.

£38m w" '
“Mum “WW“
1 $3 ﬁ
if” $3 ‘tg Vuﬁ-Jé‘d’ﬂ
’ i“- at It: A

 

Figure M 1. Plants of rhododendron in the garden of a medical school. The sign
states that this plant can arrest cough, loosen sputum, and treat chronic bron-
chitis and chronic cough.

130

 

Figure l-12. Some herbs that are under investigation, including Han Tsai, an herb
that can be used to treat chronic bronchitis.

Figure l-13. Han Tsai——Roripa
montana (Wall) Small (Cru-
ciferae)—the molecular for-
mula of which has been in-
vestigated with the aid of
mass spectroscopy (6.33).

 

131

 

Figure l-14. Youngsters learning herbology in a youth
palace in Shanghai.

Figure l-15. Herbs are being
made into pills in a Nanking
pharmaceutical factory.
The modernization of Chi-
nese herbs is a new en-
deavor. In ancient times,
hand—mixed concoctions
were usually used.

 

132

 

 

 

 

 

 

 

 

 

 

 

Figure l-16. Drug recipes posted on the wall in a pharmacy. Each square con-
tainsa special recipe that can be used for a certain disease. The large rectangu-
lar sheet on the right gives the detailed procedure for making concoctions
with the ingredients of each recipe.

133

 

A

ABC of Acupuncture, 7
Abdominal surgery, early, 30
Acidosis, respiratory, 64
Acta Biochimica et Biophysica Sinica, 99
Acta Botanica Sinica, 99
Acta, Generica Sinica, 99
Acta Microbiologica Sinica, 99
Acta Physiologica Sinica, 98, 99
editorial board of, 100
Acta Phytotaxonomica Sinica, 99
Acta Zoologica Sinica, 99
Acupuncture
Analgesia, 4, 12, 13
discovery of, 7
anesthesia, research on, 17
animal experiments with, 88
articles on, 104, 106
brain tumor surgery, in, 88
deafness, in, 22
ear loci in, 89
historical progress in, 6
hypercapnia, and, 88
monograph on, the ﬁrst, 87
more research needed on, 92
neuroflex mechanisms, and, 88
open-heart surgery, in, 88
pain prevention, for, 92
positive pressure respiratory machine,
used with, 91
respiratory depression, and, 87
respiratory research, and, 87-96
surgical statistics and, 90
thyroidectomy, and, 88
translations of early texts on, 87
United States, in the, 87
Acupuncture Manual, The Great, 43
Adenoma, thyroid, acupuncture in, 89
Africa, Chinese medical teams in, 12
Age and lung capacity studies, 53, 54, 55
Agriculture in mountainous areas, 65-66
Air pollution studies, 65
Alchemy, 6
Alkalosis, respiratory, 64
Allergy, 104
Altitude and cardiac diseases, 69
Altitude chest diseases, articles on, 105

INDEX

Altitude physiology -
historical development of, 66-70
studies of, 65

Ambulances availability, 14

American Journal of Chinese Medicine, 1

American medical delegation to China, 1

American medicine, progress in, 46

Analgesia, acupuncture, 4, 12, 13

Anatomical studies, pulmonary, 51

Anatomy, early development of, 29-30

Anesthesia
acupuncture, 13
articles on, 104
chemical, 38, 91

Anesthesiology, 104

Animal experiments,
hyperbaric, 70
pulmonary studies, in, 58

Anoxemia, 5 8

Anthorhododendrin, 80-81

Antibiotics
cultivation of medicinal, 17
manufacture, of, 12

Anticoagulants, new, 18

Anticough drugs, 125, 126, 127

Anti-inﬂammatory drugs, 125

Antitussive effects of Ardisia Japonica, 80

Arabic medicine, 3

Ardis'ia Japonica, 80

Artificial respiration in infants, 64

Aspergilloma, pulmonary, 77

Asthma
herbal cigarettes and, 65
massage and plasters in, 90
treatment for, illustrated, 25

Auditory anesthesia, 91

Awu Mountains, 67

Back pain, cupping treatment in, 25

Bamboo cups treatment illustrated, 24, 25

Barefoot doctors, 117

Basal metabolism of Chinese in Manchuria,
45

Blood ﬁndings in Chinese highlanders, 69-70

Blood gases, 105

Body organs classiﬁcation, 36

135

Body surface and ventilation capacity
correlations, 52
Brain tumor surgery, acupuncture in, 88
Breathing exercises, 92
traditional Chinese, 5 8
Breathing regulation, 36
Bronchitis
environmental conditions and, 70
herbal cigarettes and, 65
herbal treatment of, 79-80, 81, 131
pills for, 125, 126, 127
research on, 77
smokers and nonsmokers, in, 82
Broncholithiasis, 77
Buddhism, 6

Cancer research, 16
Capital Hospital, Peking, 16, 81
Carcinoma, 77
Cardiac diseases and high altitude, 69
Cardiovascular disease, 104
Cardiovascular remedies, 17
Carthartics, early use of, 34
Castration, early, 30
Central nervous system research, 17
Cesarean section, 88
early, 30
Chang Chien’s expedition, 3
Chang Chung—ch’ing, 6
Chemical factories and bronchitis, 77
Chemistry Bulletin, 99
Chest diseases, articles on, 104, 105-106
Chest pains, drugs for, 125
Ch’i defined, 31, 32
Ch’i Hai, 33
Ch’i Kung, 36, 58
Ch ’i, or vital energy, 31, 32-34
Ch’i theory, the, 32-34
Child health and human development,
articles on, 106
China Medical Journal, 97, 99
China Medical Missionary Journal, 97
China-US. relationship, 1
China ’s Medicine, 109
Chinese Journal of In ternal Medicine, 51
Chinese Journal of Physiolog, 44, 45
chronological details of, 101
years and volumes of, 98
1927 beginning of, 106, 107
Chinese Journal of Surgery, 62
Chinese Medical Journal, 88, 97, 99, 100
1887 beginning of, 106
1973 issues of, tabulated, 103
Chinese medicine
period of decline of, 6
sources of, 6
Chinese Medicine, American Journal of, 1
Chinese traditional medicine, suppression
of, 11

Ch’ing period, the, 6
Chou Dynasty, 29, 37
Cigarette smoking, 65
Circulation, comments on, 30
Clerks and Craftsmen in China and the West,
11

Clinical application of respiratory research,
77

Coldness and bronchitis, 82

Colds and fever, drugs for, 125, 126, 128,
129

Common cold, the, 77
smoking, and, 82

Commune hospital workers illustrated, 24

Concepts, physiological, 29-41

Contraception research, 17

Convalescent homes, ancient, 38

Cooling medicines, 38

Cooperative Medical Care Plan, 14

Coronary thrombosis research, 16

Corpulmonale, 69, 70

Cough, drugs for, 125, 126, 127, 128

Courses for medical students, listed, 112

Cryoanesthesia, 91 ‘

Cultural Revolution, the, 3, 14, 69, 98, 118
physicians’ training since the, 13
publishing since the, 106
schools closed during, 109

Cupping treatment, illustrated, 25

Curricula, medical, 111, 112, 113

D

Deafness, acupuncture treatment of, 22

Death rate, crude, 12

Dental equipment, illustrated, 63

Dentistry and oral surgery, 104

Dermatology, articles on, 104

Developments, medical, summarized, 18

Diabetes research, 16

Diagnosis, pulse, 29

Diaphragmatic breathing, 92

Diesel engine pollutants study, 65

Disease, recurrent, 13

Diseases treated by hyperbaric oxygenation,
7O

Dissections, early, 29

Diurnal rhythm theory, 35

“Double track” medical integration, 16

Drug recipes in pharmacy, 133

Drug synthesis, 17

Drugs, respiratory, 123-133

advancements in, 79-82
Dry throat, drugs for, 126
Dyspnea, drugs for, 125

E
Ear loci in acupuncture anesthesia, 14

Ecology and pulmonary diseases, iii
“Ecumenical” medical system, 119

136

Ecumenical Medicine, The New, 7
Edema, pulmonary, 69
Education in China, standard form of, 111
Education, medical, 13, 14, 109-115
Education of barefoot doctors, 15
Education, physical, 113
Educational priorities, 114
EEG machine illustrated, 64
Electric shock therapy, 12
Electroanesthesia, 91
Electron microscope for pulmonary

research, 61
Emphysema, 52, 77

articles on, 106

Endocrinology, 104
Engineering, social, 2
Environment and scientiﬁc investigation, 46
Environment in an art factory, 61
Exercises, invention of, 38
Exercising illustrated, 26
Expectorant, Ardisia Japonica as an, 80

F

Factories

medical workers in, 12

respiratory diseases, and, 77
Faculties of medical schools, 111
Failure, respiratory, 78
Famine in Honan, 1943, 2
Five-Element doctrine, 6, 37-38
Five Tsang and six Fu system, 36
Flexner Report, 1910, 7
Flexner, Simon, 44
Food, energy from, 34
Forced expiration measurements tabulated,

57

Fossil findings on Mount Everest, 68
Friendship Hospital, Peking, 88
Fukien Medical College of Foochow, 70
Fusion of medical systems, 11

G

Gas exchange research, 51, 56, 60
Gastroenterology, articles on, 104
Genetics Bulletin, 99

Grand Integration, the period of, 6
Great Herbal, The, 38, 43, 79
Great Leap Forward, 14, 17, 59
Guarantees for the people, 14

H

Han dynasty, 29, 79

Han Tsai, 131

Harvard University, 44

Headache, drugs for, 125

Health-care concepts, American, 1
Health—care delivery system, 19

Health promotion message illustrated, 26

Health stations, 77
Health workers’ principles, 12
Height and vital capacities, 53
Hemoptysis, 34
articles on, 106
Hemorrhage, lung, 77
Hepatitis research, 17
Herb plants, illustrated, 130, 131
Herb plasters, 90
Herbal cigarettes, 65
Herbology, youngsters learning, 132
Herbs
collected by doctors, 15
experiments with, 17
into pills, illustrated, 132
isolation of compounds in, 4
on stove, illustrated, 23
properties of learned by physicians, 16
2,000 in use in China, 79
Hibernation and respiration, animal, 58
Highlanders, blood counts in, 69-70
Hillary, Sir Edmund, 68
Himalayan Expedition, the, 68
History, Chinese medical, 30
Honan, 1943 famine in, 2
Honey, uses of, 15
Hospital at Loh Kang Commune, 14
Hospitals, ancient existence of, 38
Hospitals in China, visits to, 11-27
Huaue Tongbao, 99
Hyaluronidase, 78
Hydrotherapy, ancient, 38
Hyperbaric physiology, 51, 70
Hypercapnia, 88
Hyperventilation, voluntary, 58
Hypnosis, 91
Hypoxemia, 64
arterial, 52
Hypoxia, 52, 70
Hypoxic physiology, 17

Indian medicine, 6
Industrial diseases treatment, 19
Industrialization air pollution, and, 65 ,
respiratory disease and, 5
Infant mortality, 12, 20
Infants with pneumonia, 63, 64
Infectious diseases,
articles on, 104
conquest of, 4
incidence of, 14
Inﬂuenza, 82
articles on, 104
research on, 17
Insomnia, drugs for, 126
Institutes of Materia Medica, 17-18
Instrumentation in respiratory research,
61-64
Insulin shock therapy, 12

137

Insulin, synthesis of, 4, 45

Insurance, cooperative, 12

Integration, medical, 12, 13, 14, 16, 117

Intern programs, ﬂexibility of, 13

Internal Medicine, Chinese Journal of, 51

Investigation scientiﬁc, inﬂuences on, 46

Investigative and clinical styles in Chinese
medicine, 11

J

Johns Hopkins University, 44

Jolmo Lungrna, Mount, 68

Journals related to physiology published in
PRC, list of, 102

K

Kinematics of lung system, research in,
53-56
Kissinger, Dr. Henry, 1
Koxue Tongbao, 88, 98, 99, 100, 107
Kwangchow, 13
medical workers at, illustrated, 24
Kwangtung Province People’s Hospital,
13-14, 81

L

Languages tuition, 18
“Let the old serve the new,” 4
Leukemia research, 16
Library of Chinese Academy of Medical
Sciences, 16
Lien CM, 34
Life span in China, 12
Literature, Chinese medical, 39
Lobectomy and ventilation studies, 60
Loh Kang Commune, 14-16
Lonicera Forsythia, 81
Lung abscess, articles on, 106
Lung disease mechanisms, 37
Lung dynamics research, 51, 56
Lung volume
forced expired, 56
studies, 53, 54

M

Malnutrition, 15

Manchuria, basal metabolism of Chinese in,
45

Marco P010, 68

Mass movements and health work, 12

Massage in asthma treatment, 25, 90

Materia Medica, Compendium of, 79

Materia medica encyclopedia, 38

Materia Medica, Institutes of, 17-18

Mediastinum, shift of, 92

Medical delivery system transformed in
China, 2

Medical doctors’ training, 13
Medical education system, Chinese, 109
Medical exchange, China-U.S., 120
Medical heritage, China’s, 38-39
Medical instrumentation, 61-64
Medical insurance in China, 12
Medical personnel, training of, 16
Medical profession divisions in Chou
Dynasty, 29
Medical records, ancient, 79
Medical research, Chinese instrumentation
for, 61—64
Medical school admission, steps of, 111
Medical school teaching timetables, 112,
1 l 3
Medical schools’ curricula, 111
Medical Sciences, Chinese Academy of, 16
Medical subspecialties, 119
Medical supplies, imported prior to 1949,
12
Medical system, “ecumenical,” 119
Medical teams working in foreign countries,
12
Medical training
philosophy, changes in, 114
qualiﬁcations for, 111-1 12
resumption of, 109
Medical units
mobile, 15
serving overseas, 15
Medications, low cost of, 13
Medicine
Chinese accomplishments in, 117
Chinese, historical development of, 6, 7
deﬁned, 119
developmental history of societies, and,
2
nationalism, and, 3
systemic, in the West, 5
traditional, evolution of, 39
Meniscectomy, 88
Mental illness treatment, 12
Meridian theory, the, 34
Metabolism, articles on, 104
Ming Dynasty, 79
Mobile medical units, 15
Mount Everest, 68
Mountain farmland development, 67
Moxibustion, articles on, 104, 106
Muscular activity and altitude studies, 69

N

Needham, Joseph, ii, 43

Nei Ching, the, 30

Neoplastic diseases, articles on, 106
Neurasthenia, 15

Neurology, articles on, 105
Neuromuscular physiology, 17

I38

New Medicine, the, 14

See also Integrated medicine
Nixon, Richard, 1
Nose loci in acupuncture anesthesia, 14
Nurses, training of, 16
Nutrition, articles on, 104
Nutritional concepts, Chinese, 15

0

Observation, theories based on, 43

Obstetrics and Gynecology Hospital, Peking,
20

Obstruction of lower respiratory
passageways, 78

Ocultists, early functions of, 37

Odd-Enduring Fu system, 34, 36

“Old serve the new, let the,” 4

Oncology, articles on, 105

Open-heart surgery with acupuncture, 88

Ophthalmology, articles on, 105

Oral diseases, 18

Organ theory, the, 34

Organs of body, classification of, 36

Organs, pairingrof, 38

Otolaryngology, articles on, 105

Otorhinolaryngology, articles on, 106

Oximetric studies, 58

Oxygen inhalation therapy, 78

Oxygenation, hyperbaric, 70

P

Pain, bamboo cups treatment for, 24, 25
Pain prevention, acupuncture for, 92
Pamir Plateau, the, 68
' Paramedical studies, 18
Paramedics, l 17
Parasitology, articles on, 105
Pathogenesis, 112
Pathology Museum specimen illustrated, 21
Patients’ backgrounds and acupuncture
analgesia, 13
Patients treated at home, 4
Peasants, lung volume studies in, 53, 54
Pediatrics, cold and inﬂuenza drugs used in,
129
Pei Yang Military School, the, 43
_ Peking Capital Hospital, 16, 20
Peking Review, the, 69
Peking Union Medical College, 7, 16, 44
Pen Ts’ao, 79 ‘
Penicillin sold by weight, 12
People’s Republic of China, founding of, 12
Periodicals, Chinese subject matter of,
tabulated, 104
Peter Parker of Yale, 7
Pharmacology
research in, 17, 70
traditional, 82
value of traditional, 4

Physicians at Kwangtung People’s Hospital,
13
Physiological concepts development, 29-41
Physiological journals published in China,
97-108
Physiological research, respiratory, 5
Physiological theories, ancient Chinese, 31
Physiologists, the training of, 109-115
Physiology
altitude, 65
See also Altitude physiology
anatomy and, 37
ancient theories, and, 35
Chinese journals related to, 102
development of anatomy, and, 29
doctrines and, 37
hyperbaric, 70
medical school, in, 113
respiratory, studies of, 62
transitional period of , 44-45
Physiology, Chinese Journal of, 97, 98, 100,
101, 102 ‘
Plant chemistry, 17
Plasters, herbal, 25, 90
Plateaus of China, 66
Pneumatic medicine, 32
Pneumonectomies and ventilation studies,
60
Pneumonia in infants, 62
Population of high altitude areas, 69
Prana, Indian concept, 32
Premedical courses, 112
Prevention, emphasis on, 12, 18, 19, 82
Private practice, 11
Progress, medical, in China, 5
Propaganda brigades, 16
Protein research, 17
Provinces’ medical schools listed, 110
Psychiatry, articles on, 105
Public health, articles on, 106
Publishing of physiological journals, 97-108
Pugh, Dr. Grifﬁth, 68
Pulmonary diseases and local ecology, iii
Pulmonary disorders, articles on, 104
Pulmonary dysfunction, 52
Pulmonary function testing, 60
See also Respiratory research
research on, 59—61
Pulmonary geometries research, 51-53
Pulse diagnosis, 29
Purging, 38

Rabbits, pulmonary studies on, 58
Recurrent diseases

care of, 13

research on, 16
Registration fee for medical visit, 14
Reimplantation of severed limbs, 19, 22

139

Remote areas, delivery of medical care to, 4
Reproductive physiology, 17
Research
biomedical, articles on, 105
medical, 16, 17
physiological, published results of, 107
respiratory
See Respiratory research
Residency programs, ﬂexibility of, 13
Respiration and silicosis, 60, 61
Respiration, early comments on, 31
Respirator, automatic, illustrated, 63
Respirator, illustrated, 23
Respiratory disease
Chinese progress against, 4-5
clinical reports, and, 77
future study programs on, 119
herbal treatment of, 18
industrialization and, 5
publications on, 59
research called for, 5
US. statistics on, 5
Respiratory drugs,
advancements in, 79-82
Chinese, 123-133
under study, 79, 80
Respiratory machine, positive-pressure, 91
Respiratory physiology
China, in, 11
present status of, 1
Respiratory research
acupuncture and, 87-96
altitude studies in, 65
bronchitis, in, 77
clinical, 77-85
clinical reports on, 77
common cold, in, 77
contemporary, 51-76
current status of, 119
development of, features of, 118-119
emphysema, in, 77
health stations and, 77
long history of, 118
mobile health units in, 77
more needed, 118
pre-1949, 43-49
progress in, 70
prospects for, 117
Reston, James, 16, 88
Rheumatoid arthritis, 15
Rhododendron used in respiratory diseases,
130
Rockefeller Foundation, the, 43
Rockefeller Institute, the, 44
Rorifamide, 80
Rorifone, 79
Roripa monfana, 79
Rorippa montana, 131
Rural areas,
bronchitis in, 77

medical care in, 18, 60
medical personnel sent to, 4

S

San Chiao, deﬁned, 32
Sarcoidosis, 77
Schools, medical
increase in number of, 109
list of, 110
Science Bulletin, 99
Science, Chinese contributions to, 45
Scientia Sinica, 88, 98, 99, 107
subject matter tabulated (Volume 16,
1973), 104
Second Medical College, Shanghai, 18
pathology specimens at, 21
Self-evaluation of physicians, 14
Sense organ physiology, l7
Severed limbs reimplantation, 19, 22
Sex differences in respiratory ventilation
capacity, 59, 60
Sex distribution of physicians at
Kwangtung, 13
Shanghai
infant mortality rate in, 20.
medical personnel in, 12
Shanghai Department of Health, 11
Shanghai Industrial Exhibit, 61, 62, 63, 89
Shanghai Physiological Institute, 16-17, 68
Shanghai, Second Medical College in, 18
Shock therapy, 12
Shoulder pain, bamboo cup treatment in, 24
Silicosis, 60, 61
Silk road, the, 66
Six Fu system, the, 36
Smallpox inoculation, 43
historic, 3
Smoking, 65
bronchitis incidence, and, 82
studies on, 51
Social and medical system in China, new, 2
Social diseases, control of, 4
Social implications of medical care
availability, 3
Social security, 14
Sore throat, drugs for, 128
Sources of Chinese medicine, 6
Status asthmaticus, 78
Student, medical, qualifications of , 111-112
Suction pumps, illustrated, 63
Sun Weng, 33
Sung Dynasty, 6, 29, 87
Supersonic wave diagnosis, 77
Surgery
acupuncture analgesia in, 4
articles on, 105
early practice of, 30-31
pulmonary function testing, and, 60
students performing, 113

140

Surgery, Chinese Journal of, 62
Surgical concepts, early, 30
Systemic medicine, Chinese, 6

T

Tai Chi Chuan exercise, 26
Taitzu Snow Mountain, 67
Tan Tien, described, 32
T’ang dynasty, the, 6
Taoism, 6
Terraced farmland, 67
Textbooks
being rewritten, 117
publishing of, 113
Thin air and respiratory physiology, 68
Thought education, 12
Throat tablets, 127, 128
Thyroidectomy and acupuncture, 88
Toxicology, articles on, 105
Tracheal intubation, 64
Tracheal stenosis, 51
Tracheo-bronchial tree, 51
Traditional medicine
acupuncture a part of, 87
decline of, 43
downgraded, 11
evolution of, 39
Training
medical students, of, 19
premedical, 112
Travel at high altitude, 66
Trephining, early, 30
Triple Burner, deﬁned, 33
Tsang, deﬁned, 32
Tsang-Hsiang, theory of, 34
Tuberculosis, pulmonary, 53, 69
articles on, 105
Tumor research, 17
Twelve coupled organs, 35

U

\

Urology, articles on, 105
U.S.-China relationship, 1

U.S.-China scholarly exchange suggested,
120

US. National Library of Medicine, 99

U.S., respiratory disease statistics in the, 5

V

Vagal regulation of pulmonary function, 58
Venereal diseases wiped out, 14
Ventilation regulation, pulmonary, 51, 56,

57

machines for, 62

Vertebrata Palasiatica, 99
Vessel anastomosis, paper on, 45
Vital capacity measurements, 53, 60

W

Wang Fu-chou, 68

Wei-Ch‘i, described, 33

West China Union University, 60

Western and Chinese medicine, fusion of, 7

Western Han Dynasty, 38

Western inﬂuence in China, 43

Western medical concepts and respiratory
research, 117

Western medicine, introduction to China of,
45

Workers, pulmonary function tests on, 60

Working conditions monitoring, 120

XYZ

Yang Ming disorders, 31
Yellow Emperor’s Canon of In ternal
Medicine, 3, 6, 29, 31, 32, 87
Ying Ch’i, 32
Yin-Yang doctrine, 37-38
principles of, 6
teaching of, 112
Yuan Ch’i, 32
Yung Lo Ta Tien, 43

141

'GPO : 1975 O - 570—225

 

 

 

 

 

 

 

 

 

 

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