Reinterpreting the Role of Traditional

Chinese Medicine in Public Health in

Rural China in 1970s

Xiaoping Fang, Ph.D.

University of Technology, Sydney

12:30-2:00pm, 13 March, Wednesday

The Global Health Histories seminar series

The World Health Organization (WHO)

Chinese barefoot doctors attending the World Health Assembly (WHA), 1974

Map of Zhejiang Province, China

Map of Hangzhou Prefecture, Zhejiang Province, China

Map of Jiang Village Township, Yuhang County, Hangzhou Prefecture

Knowledge Transmission and Structures

Age Distribution of Barefoot Doctors (Unit: Person)

• Sources: The barefoot doctor survey in Hangzhou Prefecture conducted from 2003 to 2005; Xiaoshanxian weishengju [Xiaoshan County Health Bureau], “1971 nian eryue tuijian qu hangwei xuexi mingdan” [The Trainee List Recommended to Study in Hangzhou Health School in February 1971], XSA, Vol. 25-1-38; Huanshan renmin yiyuan [Huanshan People’s Hospital], “Fuyangxian chijiao yisheng fuxun dengjibiao” [Registration Forms for Fuyang County Barefoot Doctor Re-training Class], October 1978, FYA, Vol. 74-3-29; Gaoqiao renmin yiyuan [Gaoqiao People’s Hospital], “Qingyunqu 1981 nian diyiqi chijiao yisheng peixunban huamingce” [Roster of the First Barefoot Doctor Training Class in Qingyun District in 1981], April 9, 1981, FYA, Vol. 74-3-29; Sandunzhen zhongxiyi jiehe yiyuan [Sandun Township of Integrated Chinese and Western Medicine], “Sandunzhen xiangcun yisheng qingkuangbiao” [Roster of Village Doctors in Sandun Township, Hangzhou City], January 17, 2005, SDA.

0

2

4

6

8

10

12

14

16

18

20

Number

Percentage of Woman Barefoot Doctors in Hangzhou Prefecture,

1968-1985

Sources: Hangzhoushi weishengzhi, pp. 84-87.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1974 1975 1976 1977 1978 1979 1980 1981 1982

Female

Male

Educational Backgrounds of Barefoot Doctors

in Selected Years and Comparison with Villagers (Unit: 100%)

Period College High School Primary School Illiterate

Senior Junior Senior Junior

1978 0.00 24.1 44.8 18.9 12.0 0.00

1981 0.00 15.5 46.7 24.4 13.3 0.00

Average 0.00 19.8 45.7 22.65 12.65 0.00

1982 rural census 0.08 3.77 15.85 40.59 39.85

Sources:

•Barefoot doctor survey in Hangzhou area conducted from 2003 to 2007;

•Huanshan People’s Hospital, “Fuyangxian chijiao yisheng fuxun dengjibiao” (Registration Forms for Fuyang County

Barefoot Doctor Re-training Class) (October 1978), FYA. vol. 74-3-29;

•Gaoqiao People’s Hospital, “Qingyunqu 1981 nian diyiqi chijiaoyisheng peixunban huamingce” (The First Barefoot Doctor

Training Class Roster in Qingyun District in 1981) (June 10, 1981), FYA vol. 74-3-29.

•Zhongguo renkou: Zhejiang fence (Population of China: Zhejiang) (Beijing: Zhongguo caizheng jingji chubanshe, 1988), p.

348.

Barefoot Doctor Textbooks and Journals 1969-1981

Collected by National Library of China (Unit: book)

Sources: National Library of China website.

0

1

2

3

4

5

6

1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981

Books

Journals

Barefoot Doctor Xu Peichun’s Reading List

Book Place & Time Way of obtaining

Textbook for Rural Health Workers Hangzhou 1966 No indications

Common Medicine Dosage for

Child

Shanghai 1966 bought on May 24, 1969 in Fenkou

District training class

Preventing Respiratory Infectious

Diseases,

Hangzhou 1970 Pamphlet distributed from the above

Common Chinese and Herbal

Medicines in Zhejiang Province

Hangzhou 1970 Bought at District June 26 Mao Zedong

Thought Study Class in July 1970

Pesticide Usages and Poisoning

Prevention

Hangzhou 1971 No indications

Manual for Health & Epidemic

Prevention

Hangzhou 1974 Awarded by Chun’an County Health &

Epidemic Prevention Station in June 1976

Common Medicines Used by

Barefoot Doctors

Shanghai 1975 Awarded by Hangzhou Prefecture Health

Bureau in June 26, 1976

Population Must Be Controlled Hangzhou Pamphlet distributed from the above

Sources: Supplied by barefoot doctor Xu Peichun, March 2004.

The Knowledge Structure of Candidates

for the Excellent Village Doctor Award in China, 2005 and 2010

Category

2005 2010

Time of becoming barefoot doctors

Total Before 1983 After 1983 Total

Number % Number % Number % Number %

Western 94 64.8 38 69 132 66 147 73.5

Chinese 36 24.8 15 27.2 51 25.5 51 25.5

Integrated 13 8.9 2 3.6 15 7.5 1 0.5

Mongolian 1 0.7 0 0 1 0.5 - -

Tibetan 1 0.7 0 0 1 0.5 - -

Chinese-Tibetan - - - - - 1 0.5

Total 145 100 55 100 200 100 200 100

Source: Zhonghua renmin gongheguo weishengbu [The Ministry of Health of the People’s Republic of

China], http://www.moh.gov.cn/moh (access June 20, 2005); “2010 nian quanguo youxiu xiangcun yisheng

houxuanren mingdan” [List of Candidates for the Excellent Village Doctor award in 2010], Jiankangbao

[Health Bulletin], November 30, 2010 (accessed May 28, 2011).

Average Number of Medical Staff Members in Commune Clinics (or Union

Clinics) of Selected Counties within Hangzhou Prefecture (Unit: person)

County 1950s 1960s 1970s 1980s

Fuyang 5.3 5.7 9.6 12.9

Xiaoshan 5.3 6.15 10.4 16.5

Lin’an 5.2 6.6 10.8

Hangzhou Prefecture 6.12 12

Average 5.3 14.7

National average 5.8 13.9

Sources: Xu, Fuyangxian weishengzhi, 68–69; Xiaoshan weishengju, Xiaoshan weishengzhi, 54–56;

Lin’anxian weishengzhi bianzhuan weiyuanhui, Lin’anxian weishengzhi, 107–16; Hangzhoushi weishengju

[Hangzhou Prefecture Health Bureau], “1965 nian weisheng shiye zonghe baobiao” [Comprehensive

Statistical Health Work Form in 1965], HZA, Vol. 87-3-262; “Hangzhou diqu nongcun shengchan dadui

shengchandui weisheng zuzhi qingkuang” [Survey of Health Organizations in Production Teams and

Production Brigades in Rural Areas of Hangzhou Prefecture], 1975, HZA, Vol. 87-3-302; “Hangzhou diqu

nongcun shengchan dadui shengchandui weisheng zuzhi qingkuang” [Survey of Health Organizations in

Production Teams and Production Brigades in Rural Areas of Hangzhou Prefecture], 1976, HZA, Vol. 87-3-

307; Zhongguo weisheng nianjian bianweihui [Editorial Board of China Health Yearbook], ed., Zhongguo

weisheng nianjian 1983 [China Health Yearbook 1983] (Beijing: Renmin weisheng chubanshe, 1983), 57.

Percentage of Chinese Medicine Doctors in Commune Clinics (or Union Clinics) of

Selected Counties within Hangzhou Prefecture (Unit: Percentage)

County 1950s 1960s 1970s 1980s

Xiaoshan 59% 29.45% 29% 19.4%

Lin’an 60.6% 47.33% 26.4% 22.7%

Yuhang 71.5% 50.6% 34.9% 17.9%

Seven counties 48.6%

Average 63.7% 30% 20%

Sources: Xiaoshan weishengju, Xiaoshan weishengzhi, 54–56; Lin’anxian weishengzhi bianzhuan

weiyuanhui, Lin’anxian weishengzhi, 116; Yuhangxian weishengju weishengzhi bianzhuanzu, Yuhangxian

weishengzhi, 80; Hangzhoushi weishengju, “1965 nian weisheng shiye zonghe baobiao,” HZA, Vol. 87-3-

262.

Average Number of Barefoot Doctors per Commune Clinic in Selected Counties

within Hangzhou Prefecture during the 1970s (Unit: person)

County Average Maximum (Year) Minimum (Year)

Fuyang 28.9 36.5 (1977) 23.5 (1973)

Chun’an 24.7 33.7 (1976) 16 (1973)

Jiande 23.5 53 (1970) 12 (1975)

Average 25.7 41.6 13.8

Sources: Xu, Fuyangxian weishengzhi, 73; Hangzhoushi weishengju hangzhoushi weishengzhi

bianji weiyuanhui, Hangzhoushi weishengzhi, 87; Chun’anxian jihua weiyuanhui [Chun’an

County Planning Commission], Chun’anxian guomin jingji tongji ziliao, 1949–1978 [Statistical

Data of Chun’an County’s National Economy, 1949–1978] (Chun’an, 1980), 333–46; Yan,

Jiandexian yiyao weishengzhi, 70.

Epidemiologic Transition and Pharmaceuticals in the Villages

Prices for Major Western Medicines in Hangzhou Prefecture, 1953–1984

(Unit: RMB)

Medicines Specification Unit 1953 1957 1965 1969 1984

Penicillin 0.2 million bottle 1.12 0.83 0.31 0.25 0.14

Streptomycin 1 million bottle 2.84 2.15 0.62 0.43 0.28

Antondin 10x2ml box 0.94 0.78 0.80 0.61 0.69

Analgin 100x0.5g bottle 10.66 5.54 2.50 2.30

Tetracycline 100x0.25g bottle 170.13 18.13 6.00 3.50

Terramycin 100x0.25g bottle 177.88 10.25 4.38 2.50

Chloromycetin 100x250mg bottle 74.56 20.72 6.72 5.00

Sulfapyridine 1000x0.5g bottle 73.73 72.87 74.16 34.80 28.0

Sulphaguanidine 1000x0.5g bottle 17.00 16.72 15.00 14.17 13.0

Sources: Hangzhou yiyao shangyezhi bianzhuan weiyuanhui, Hangzhou yiyao shangyezhi, 254; Zhongguo

yiyao gongsi, Zhongguo yiyao shangye shigao, 274.

Vaccines in Four Selected Counties in Hangzhou Prefecture, 1949–1970

Vaccine Year of first inoculation

Smallpox 1950

Typhoid, paratyphoid 1950

Bubonic plague 1952

BCG 1952–1957

Diphtheria toxin 1952–1954

Pertussis 1954

Epidemic Japanese b encephalitis 1957–1958

Anthracnose 1960

Diphtheria, Pertussis, Tetanus

(DPT)

1961

Dysentery bacteriophage 1961

Polio 1962

Para-cholera 1962

Leptospirosis 1961–1966

Measles 1967–1970

Epidemic cerebrospinal

meningitis

1970

Sources: Yan, Jiandexian yiyao weishengzhi, 141–42; Lin’anxian weishengzhi bianzhuan weiyuanhui, Lin’anxian

weishengzhi, 257; Xu, Fuyangxian weishengzhi, 15–16, 173–77; Xiaoshan weishengju, Xiaoshan weishengzhi, 139–79; Qian

Xinzhong, Zhongguo weisheng shiye fazhan yu juece [Health Development and Decision Making in China] (Beijing:

Zhongguo yiyao keji chubanshe, 1992), 850–86; Huang Shuze and Lin Shixiao, eds., Dangdai zhongguo de weisheng shiye

[Health Development in Contemporary China], Vol. 2 (Beijing: Zhongguo shehui kexue chubanshe, 1986), 291–343.

Incidence Rates of Notifiable Infectious Diseases in Hangzhou Prefecture

and Zhejiang Province, 1949–1990 (Unit: 1/100,000)

Sources: Hangzhoushi weisheng fangyizhan, Yiqing ziliao huibian,1950-1979, 12; Zhejiangsheng weisheng fangyizhan [Zhejiang Province Sanitation and Epidemic-Prevention Station], ed., Zhejiangsheng yiqing ziliao huibian, 1950–1979 [Compiled Data of Epidemic Diseases in Zhejiang Province, 1950–1979] (Hangzhou: Zhejiangsheng weisheng fangyizhan, 1982), 1–4; Zhejiangsheng yiqing ziliao huibian, 1980–1989 [Compiled Data of Epidemic Diseases in Zhejiang Province, 1980–1989] (Hangzhou: Zhejiangsheng weisheng fangyizhan, 1994), 7.

0

1000

2000

3000

4000

5000

6000

Hangzhou

Prefecture

Zhejiang

Province

Mortality Rates of Notifiable Infectious Diseases in Hangzhou Prefecture and

Zhejiang Province, 1949–1990 (Unit: 1/100,000)

0

10

20

30

40

50

60

70

80

90

Hangzhou

Prefecture

Zhejiang

Province

Fatality Rates of Notifiable Infectious Diseases in Hangzhou Prefecture and Zhejiang

Province, 1949–1990 (Unit: Percentage)

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

Hangzhou

Prefecture

Zhejiang

Province

Gathering and Planting of Medicinal Herbs in Cooperative Medical Stations in

Hangzhou Prefecture, 1976

County

Production Brigades

Total

number

Brigades with a cooperative medical service

Total

number

Gathering and planting of

medicinal herbs

Area of medicinal herb fields

Total number % mu

Per brigade

Xiaoshan 750 736 165 22.41% 212 1.28

Yuhang 550 550 165 30.00% 473 2.87

Lin’an 636 581 180 30.98% 80 0.44

Tonglu 407 407 163 40.04% 98.9 0.61

Fuyang 589 451 292 64.75% 60.47 0.21

Jiande 515 492 281 57.11% 200 0.71

Chun’an 852 815 463 56.80% 307 0.66

Average 43.16% 0.97

Source: Hangzhoushi weishengju [Hangzhou Prefectural Health Bureau], “Nongcun chijiao yisheng

weishengyuan jieshengyuan qingkuang” [Statistical Data of Rural Barefoot Doctors, Health Workers and

Midwives], 1976, HZA, Vol. 87-3-307.

Healing Styles and Medical Beliefs: Consuming Chinese

and Western Medicine

Expenditures on Different Kinds of Pharmaceuticals in Jiande County, 1961–1983

(Unit: RMB 1000)

Source: Yan, Jiandexian yiyao weishengzhi, 110–11.

Materia Medica Consumption Per Capita

in Jiande County, 1960–1983 (Unit: jin or 500g)

Source: Yan, Jiandexian yiyao weishengzhi, 110–11.

Materia Medica and Chinese Patent Medicine Consumptions

in Three Counties of Zhejiang Province, 1961-1978

Materia Medica and Chinese Patent Medicine Consumptions

in Three Countries of Zhejiang Province, 1970-1987

Top ten medicines consumed per capita in Jiande County throughout the 1970s

Rank Pharmaceuticals

1 tetracycline

2 penicillin

3 Terramycin

4 Gastropin

5 piperazine citrate (for repelling ascarids)

6 anti-pyretics

7 painkiller tablets

8 Anlagin

9 ephedrine tablets

10 syntomycin

Source: Yan, Jiandexian yiyao weishengzhi, 110–11.

Conclusion

Thank you!