The making of Chinese medicine in Hong Kong

Ka Wei Pang (Department of Cultural and Religious Studies, The Chinese University of Hong Kong, Hong Kong)

Social Transformations in Chinese Societies

ISSN: 1871-2673

Publication date: 8 May 2018

Abstract

Purpose

This paper aims to examine the development of Chinese medicine in Hong Kong and argues that Chinese medicine is not a mere healing practice but a discursive practice against its unique institutional context.

Design/methodology/approach

Reviewing the medical history in the colonial and post-colonial era, this paper delineates the dynamics between Chinese medicine and Western medicine, and the discursive shaping of Chinese medicine in Hong Kong.

Findings

While Chinese medicine in post-colonial Hong Kong is modernizing itself from a traditional medicine to the scientific Traditional Chinese medicine (TCM), it partakes in the decolonization and nationalization project and is geared towards the standardized TCM.

Originality/value

This paper proposed a critical cultural perspective in studying the discursive formation of Chinese medicine in Hong Kong.

Keywords

Citation

Pang, K. (2018), "The making of Chinese medicine in Hong Kong", Social Transformations in Chinese Societies, Vol. 14 No. 1, pp. 17-28. https://doi.org/10.1108/STICS-01-2018-0003

Download as .RIS

Publisher

:

Emerald Publishing Limited

Copyright © 2018, Emerald Publishing Limited


Introduction

Chinese medicine seems to be a term and a school of medicine that are homogeneous, simple and straightforward to understand. If medicine refers to the science and healing practice that deal with the maintenance and restoration of health, Chinese medicine then appears to be a Chinese subcategory of medicine. However, many people, including scholars, tend to overlook the nuances between the term “Chinese medicine” and “Traditional Chinese medicine,” which is more commonly known in the Anglo-phone world by its acronym TCM. However, overlooking these nuances would render unsighted undercurrents in the making of Chinese medicine in Hong Kong.

In Hong Kong, Chinese medicine is the second most popular medical practice after Western medicine. Western medicine, a common denotation of the dominant Western allopathic biomedicine, is often thought of as more scientific, professional and reliable among the Hong Kong Chinese. Many may question whether Chinese medicine is a medicine and whether it is an evidence-based medical science, but few question the Chineseness of Chinese medicine. Does the “Chinese” in Chinese medicine point to Chinese as a race or Chinese as a nation-state? Over the past century, it seems to have expanded from the former to the latter. The Chinese-Western medical dynamics began in the early colonial years and persist in the post-colonial era. To understand how Chinese medicine is manipulated and manifested, it is important to look into the medical history of Hong Kong.

The medical history of Hong Kong no doubt reflects the colonial history of Hong Kong. During the British colonial years, Western medicine took over Chinese medicine to be the mainstream medical practice of the city. It was not until in 1997, when Hong Kong has become a Special Administrative Region of the People’s Republic of China (PRC), that Chinese medicine gained its first official endorsement. Yet, it would be reductive to claim that this revival of Chinese medicine is equivalent to decolonization of medicine. The revival of Chinese medicine in Hong Kong, on the one hand, was a dream come true – the long-waited recognition of the professional legitimacy of Chinese medicine was finally granted. On the other hand, the recognition and institutionalization have opened Chinese medicine for further nationalistic and modernization turns of TCM. While many scholars, such as Yip et al. (2016), assume TCM as a blanket term of Chinese medical practices in Hong Kong, this paper contends that Chinese medicine in Hong Kong has always been in the making in its unique institutional context, and the adoption of TCM is part of the nationalizing project.

Chinese medicine is not merely an ancient healing practice but a discursive practice subject to and shaped by institutional context. Here in this paper, the focus is “Chinese medicine”, an umbrella term of various Chinese medical practices including TCM. While the TCM in Hong Kong is a modern term that refers to the institutionalized Chinese medical practices, a location-specific adaptation of the mainland TCM that follows a policy of integration of biomedicine but is restricted from using biomedical techniques and equipment (Wong and Woo, 2005), Chinese medicine in Hong Kong is more diverse and organic. In no position to deny the efficacy of any of the two medical practices, this paper delineates the dynamics between Chinese medicine and Western medicine from the early colonial years to the post-colonial era. Over the century, medicine in Hong Kong was colonized and is being decolonized by similar means: official endorsement of the medical practice, registration of practitioners, institutionalized training, popularization of the medicine and a coincidental outbreak of a communicable disease. Chinese medicine was a traditional medicine in the colonizer’s eyes and is the TCM in the nationalist’s eyes. In post-colonial Hong Kong, promoting Chinese medicine has become a means of decolonizing and nationalizing the city.

From Chinese medicine to traditional Chinese medicine

Medical practices in China have never been homogeneous and unified, but diverse, organic, fluid and flexible. In his book, The Making of Modern Chinese Medicine, 1850-1960, Andrews (2014) illustrates that Chinese medicine encompasses a spectrum of Chinese healing practices, from scholarly practitioners learnt in the family or through apprenticeships, unorthodox practitioners, acupuncturists, healers prescribing temple medicine, street healers, travelling healers, itinerant doctors, drug peddlers and so on. In Hong Kong, the most common Chinese medicine practitioners in colonial Hong Kong were herbalist, bone-setter and acupuncturist. The three common schools of Chinese herbalists have been Shanghan (傷寒派, School of Cold Damage), Wenbing (溫病派, School of Warm Disease) and Tufang (土方派, School of Folk Remedies) (Yam, 1998). In their early encounter with the Europeans, they were on an equal footing with Western medicine. This new import of medical practices from the West in the seventeenth century intrigued and amazed the Chinese medicine practitioners, but they were not threatened by it (Au, 2004). Reciprocally, European doctors were willing to learn or even developed respect to the indigenous Chinese medicines. All these practices of medicine were not seen as problematic until the British colonization.

In the early colonial years, the colonial government of Hong Kong adopted a more non-interference attitude towards the local society. In the eyes of the colonizer, local people were defective. Such racist arrogance could be best illustrated in the Native Exclusion Act of 1791 that:

Both nations [India and China] are to nearly an equal degree tainted with the vices of insincerity, dissembling, treacherous, mendacious, to an excess which surpasses even the unusual measure of uncultivated society. Both are disposed to excessive exaggeration with regard to everything related to themselves. Both are cowardly and unfeeling. Both are to the higher degree conceited of themselves, and full of affected contempt for others. Both are in a physical sense, disgustingly unclean in their persons and houses. (Bala, 2007, pp. 83-84)

Their prejudice against the locals was multiplied by the various infectious diseases due to the inclement weather and tropical storms. Since the early colonial era, Europeans suffered various contagious diseases, such as cholera, malaria, venereal diseases and many others, in the colonies, including India and Hong Kong. These diseases were later known as “tropical diseases”, making direct inference to the colonies, their climates, their people and their cultures. Sir Patrick Manson, the first president of the Royal Society of Tropical Medicine in 1907 who had worked in Formosa (Taiwan), Amoy (Xiamen) and Hong Kong, was the founder of the Hong Kong Medical Society and Hong Kong College of Medicine for Chinese (the forerunner of the University of Hong Kong Faculty of Medicine) (Yu, 2011). They built their own hospitals to protect government officials, the military and their families. By the 1840s, there were the Seamen’s Hospital, the Naval Hospital, the Military Hospital and the Government Civil Hospital in Hong Kong, serving mainly the civil officers, the police and prisoners (Yu, 2011). In the 1870s, an exclusively Chinese hospital, Tung Wah Hospital opened. In view of the colonial government’s minimum intervention and support for the larger Chinese population, Tung Wah Hospital, as a hospital dedicated to Chinese medical services by Chinese doctors (Yang, 2007), became a symbolic Chinese medicine institution in the colony.

Owing to the indifferent attitude of the colonial government on providing healthcare support to the colonies, medical evangelism took the lead in promoting Western medicine in the colony. The nineteenth century was known to be the “great century” of missions. China and other “oriental” regions became hinterland of missionaries of different backgrounds, denomination and base (Fitzgerald, 2001), so missionaries came and laid some groundwork for Western medicine. Following the model and teaching of Jesus, missionary societies came to Asia to heal people’s bodies, as well as their souls. Though many of these medical missionaries had only rudimentary training in medicine and were in tension with the formally trained physicians (Yip et al., 2016), they were able to reach the locals of different classes, and facilitated women’s access to medical services and medical education (Fitzgerald, 2001). The Medical Missionary Society of Canton and Macao built the first missionary hospital in Morrison Hill in 1843. The local Medical Missionary Society was launched in 1881, with most of its committee members of the London Missionary Society. The Society founded the Nethersole Dispensary, which was named after the mother of H.M. Davis, who was Chairman of the Society. Western-educated local urban elites, such as Sir Ho Kai, also conceded the thinking that Western medicine was necessary in transforming the Chinese society (Yang, 2007). Sir Ho Kai contributed to the integration of the Nethersole Dispensary with two other hospitals to become the Alice Ho Miu Ling Nethersole Hospital, which founded the first medical school in Hong Kong – the Hong Kong College of Medicine for Chinese (Lai, 2011). Still, these did not alter the heavy reliance on Chinese medicine at the time.

It was the last decade of the nineteenth century when a plague outbreak in both colonies gave impetus to the Western medicine to gain its hegemony. In 1894, the Bubonic plague broke out in Canton and killed 60,000 people in just a few weeks. The plague quickly spread to Hong Kong. The Sanitary Board took a series of measures, including house searches, compulsory quarantine, hospitalization and disinfection, for the good of “public health”. It is for the first time the “public” in the concept of “public health” that “had expanded beyond the so-called colonizer to the colonized” (MacPherson, 2008). These measures stirred up horror and repugnance among Chinese. There were rumors that the Western doctors were cutting off body parts and organs, stealing fetuses to make drugs; and that all patients sent to the isolation camps would not be discharged alive. Chinese were also strongly against the use of chlorinated lime on the dead bodies in the burial, criticizing it as disrespectful to the deceased (Yang, 2007). All these strong reactions reflected that, on the one hand, the local Chinese were ignorant of Western medicine; and on the other hand, how the Western medical practices offended the Chinese notions of the body – the importance of keeping a complete, intact body, and thus triggered the fear of surgery, dissection and anatomy. Besides, the local Chinese had strong aversion against the house searches and disinfection. To them, these measures had not only invaded the household privacy, but they also risked the chastity and reputation of women, marriage prospects of maidens and safety of pregnant women and infants (Wong, 2006; Yang, 2007). Yet, all these complaints, anger and terror did not overturn the decision of the colonial government, but reinforced their biases that Chinese were ignorant, stubborn, superstitious and backward.

Compulsory segregation and other intrusive intervention by the colonial governments failed to effectively halt the spread of the plague. They had to finally concede and give way to the Tung Wah Hospital in Hong Kong. Being the first and only Chinese medical hospital at the time, Tung Wah Hospital had been buffering the conflicts between the colonial government and the local Chinese during the plague attack. It vented the fury of the locals, fought for patients’ rights and wiped out the rumors against Western medical practices. Yet, in a Commission Report on the Bubonic plague in Hong Kong, the Colonial Secretary even described the operation of Tung Wah Hopsital as “medical and surgical atrocities” (Yang, 2007). Lockhart, the Colonial Secretary of Hong Kong, was also perplexed by the issues of Asian doctors, Chinese hospital and Chinese medicine arisen from Tung Wah Hospital. He wrote a letter to Swettenham, the Colonial Secretary of Strait Settlements in 1895, to seek advice on the management of the Chinese hospital, but was in vain (Yang, 2007). But it is noteworthy that as later analyses revealed, the colonial government had wrongly evaluated Tung Wah Hospital as solely a hospital in the Western sense of the term. It did not take into account that Tung Wah took up also the philanthropic functions of a hospice, a refuge for the poor, and the role of a moderator between the Chinese society and the colonial government. Most patients admitted to the hospital were either terminally ill or dying; their families sent the patients there to avoid post-mortem examination and for a proper Chinese funeral free of charge (Wong, 2006; Yang, 2007; Ting, 2010). Therefore, it was unfair to accuse against Tung Wah Hospital of its incapability based on its relatively high mortality rate.

Against the backdrop of this plague attack, Chinese medicine became further stigmatized and marginalized. The state was convinced that Chinese medicine was synonymous to quaint, irrational, unscientific, superstitious, backward, stagnant, quackery and many other labels of the uncivilized. This indeed paralleled the climatic discourses of tropical medicine (Yu, 2011). This stigmatization and marginalization of Chinese medicine aggravated the biological essentialist view of racism and justified why the colonizer was there to civilize the colonized. The Bubonic Plague strengthened the determination of the state of and accelerated the state’s schedule in replacing Chinese medicine with Western medicine. In the next three decades, the colonial government introduced to Tung Wah Hospital Western medical doctors (who were responsible for public health surveillance and later clinical treatment), expanded Western medical services (in which medical specialists had exclusive rights of many illnesses), shrank its Chinese medical inpatient services and so on (Yang, 2007; Ho, 2009, 2010a, 2010b). Apparently, the Bubonic Plague turned out to be a good excuse and reason to criticize the sanitation and efficiency of Tung Wah Hospital in Hong Kong and eat away at the Hospital’s power, privileges and resources. In the ensuing decades, there were rounds of deliberation in the colonial government on the abolishment of Chinese medicine and struggles within the Hospital on how to preserve the Chinese medical services. In the 1900s, the ratio of Chinese medicine practitioners to Western medical doctors in Tung Wah Hospital was 6:1. The ratio dropped gradually to 6:2 in the 1910s, 7:4 in the 1930s (Ho, 2009), 6:5 in 1940, 2:5 in 1949 and 2:9 in 1955 (Ho, 2010a). And the accusation against the Hospital was, at the same time, pointing also at the inefficacy of Chinese medicine.

Chinese medicine was further undermined because of the registration system for medical practitioners and the local’s exposure to Western medicine. The colonial government set up a registration system to weed out the under-qualified medical doctors and established the legitimacy and hegemony of Western medicine. While this registration system maintained the standards of Western medicine, it also defined Western medicine as the only legitimate form of medical practices. In the 1920s, the compulsory examination by the Western medical doctors in Tung Wah Hospital allowed the local to first experience Western medicine. As mentioned above, the colony had created a pool of local doctors trained in Western medicine by establishing medical schools such as the Hong Kong College of Medicine for Chinese. Missionaries also made special efforts by missionaries in obstetrics and midwifery, and developing maternal and child health services. Some missionary societies set up schools, orphanages and the home for the visually impaired. All these lessened the hostility of the local Chinese towards Western medicine, and even nurtured a clientele base of Western Medicine. As illustrated in the percentage of patients in Tung Wah Hospital inpatient and outpatient services, there were only 15.9 per cent of patients that sought Western inpatient medical treatments in 1898, but soon it raised to around 50 per cent from the 1900s to the 1920s, 61.5 per cent in 1933 and 76.1 per cent in 1940. Even though Chinese medicine was more popular in inpatient services, the percentage of patients seeking Western medicine rose from 0.4 per cent in 1898 to 21.1 per cent in 1940 (Wong, 2006). One of key Chinese figures in negotiating between the two medicines in the early colonial period was Sir Ho Kai. Like Sir Ho Kai, most of the aspirant local elites did not despise Chinese medicine, but hoped to integrate the two. Yet, the asymmetry of state patronage between Western medicine and Chinese medicine had subsequently favored Western medicine, making it more familiar and accessible to the locals.

The British colonization of Hong Kong extended to an era in which Western medicine gained unprecedented influence worldwide. There were huge advances in anatomy, pathology, physiology and many specialties of Western medical science in the twentieth century. The Western medical breakthrough in visual technology and thus the germ theory of disease, as Lei (2014) points out, trumped Chinese medicine in diagnosis, particularly of contagious diseases. Thus, the scientific Western medicine was a symbol of modernity in Republican China (Lei, 2014). The Western medical advancement, the geographical proximity of Hong Kong and China, together with the inauguration of the National Health Service (NHS) of the United Kingdom in 1945 brought positive changes to the development of Western medical services in Hong Kong. At that time, the power of Chinese medicine practitioners had already been undercut a great deal from the Tung Wah Hospital debate; but in the 1950s, there was a large influx of Chinese refugees, among whom many were doctors, to Hong Kong because of the political instability in China. The unregistrable refugee doctors and Chinese medicine practitioners then served as second-class doctors in Hong Kong serving the escalating population (Gould, 2012). In 1957, not long after the civil war in China, the colonial government amended the Medical Registration Ordinance enacted in 1884, and further restricted the scope of treatment and practices of Chinese medicine.

Compared to the thriving Western medicine, Chinese medicine seemed to be its other. In her essay, “Chinese Traditional Aetiology and Methods of Cure in Hong Kong”, Marjorie Topley, a British social anthropologist, employed the terms “modern doctors” and “traditional doctors” to denote Western medical doctors and Chinese medicine practitioners, respectively (Marjorie, 2011). Perceiving the two in this modern/traditional dichotomy is at the same time projecting the former as universalistic (not bound by any ethnic tradition) and the latter indigenous, ethnic-bound and outdated, especially in the eyes of the colonizer. Despite all these unfavorable factors, Western medicine did not enjoy exclusive monopoly, nor did Chinese medicine die out. Chinese medicine in Hong Kong acquired a more ambiguous status outside the state-recognized biomedical realm, waiting to revitalize.

The tradition of Chinese medicine has never died down in Hong Kong in spite of the privileging of Western medicine by the colonial government. In the early 1990s, most Chinese medicine practitioners, including herbalists, bone-setters and acupuncturists, were self-employed or employed by a herbal dispensary (Division of Chinese Medicine, 2007). Also, local Chinese usually opt for different therapies pragmatically. They too perceived Chinese medicine as traditional, but not necessarily in the negative connotation of “backwardness” but the more neutral sense of it as a cultural heritage. It is perceived that Chinese medicine clears the root of the disease with a slower progress, while Western medicine yields faster recovery, but it has side effects and can only cure the symptoms (Lam, 2001). Therapeutic herbal drinks such as five-flower tea, chrysanthemum tea, fruit-and-spike tea and barley drink are popular family folk remedies and leisure beverage at herbal tea houses (Wong, 2005). In face of the thriving Western medicine and its well-established institution, Chinese medicine survived and flourished at the level of folk remedies. Since the 1940s, there had been a few attempts of the diasporic Chinese medicine practitioners settled in Hong Kong to unite their local counterparts (Chan, 2010), but there was no large-scale mobilization for the revival of Chinese medicine until the alarming threats to Chinese medicine practitioners in the late 1980s.

In the last decade of the colonial era, there was a revival of Chinese medicine. The revival was triggered by the deletion of a Chinese medicine-related provision in the first draft of the Basic Law in 1988. Together with the Lung Dam Cho incident, a herbal poisoning case, in 1989, the Working Party for Chinese Medicine was set up in the same year notwithstanding the initial reluctance of the government. In 1995, Preparatory Committee for Chinese Medicine was appointed by the Secretary for Health and Welfare to formulate promotion, development and regulatory plans on Chinese medicine (Chiu et al., 2005; Yip et al., 2016; Chinese Medicine Council of Hong Kong, 2018) . All these are laying groundwork for the change of the city’s sovereignty, and its attendant discursive turn of Chinese medicine.

From traditional Chinese medicine to TCM

In July 1997, the British handed over the sovereignty of Hong Kong to the PRC. As a gesture of decolonization, the Chief Executive Tung Chee-hwa (1997) announced in the first Policy Address of the Hong Kong Special Administrative Region (HKSAR):

For the protection of public health, we aim to introduce a bill in the next legislative session to establish a statutory framework to recognise the professional status of traditional Chinese medicine practitioners; to assess their professional qualifications; to monitor their standards of practice; and, to regulate the use, manufacture and sale of Chinese medicine. The establishment of a sound regulatory system will lay a solid foundation for the future development of traditional Chinese medicine within our overall medical care system. I strongly believe that Hong Kong has the potential to develop over time into an international centre for the manufacture and trading of Chinese medicine, for research, information and training in the use of Chinese medicine, and for the promotion of this approach to medical care.

This was the first time Chinese medicine gained government endorsement in Hong Kong history. Under the Chinese Medicine Ordinance, the Chinese Medicine Council was founded in 1999, two years after the establishment of the HKSAR on the recommendation of Preparatory Committee for Chinese Medicine. The long-stagnant development of Chinese medicine was stimulated by a series of institutionalization of Chinese medicine, or more concisely, TCM: universities began to offer formal training and undergraduate programs, a new registration system confirmed the qualifications of Chinese medicine practitioners, and Chinese medicine became a niche market attractive to business enterprises (Chiu et al., 2005). This timely revival of Chinese medicine coincided with not only the popularization of complementary and alternative medicines in the UK and the USA (Dien, 2006) but also the strong institutional support of TCM by the PRC. This revival of Chinese medicine is more than just a medical issue.

This revival of medicine has triggered the patriotism among local Chinese practitioners. As mentioned above, there are many diasporic Chinese medicine practitioners who took refuge in Hong Kong during the civil war in China. Many of them assumed the loyal keeper of this Chinese cultural legacy and provided Chinese medical therapies to the public outside the government institution. There were various attempts in forming professional associations and unions. Some succeeded and officially registered in Taiwan, but it was not until the late 1980s that there was a larger-scale association formed. Like the rise of Western medicine, the revival of Chinese medicine has also been attributed to the local elites’ patronage. Many of these local elites have been influential figures and political parties in the pro-PRC camp such as Dr Henry Fok and The Hong Kong Federation of Trade Unions (Chan, 2010). Their support of Chinese medicine in one way or another echoes to the PRC directives in promoting TCM as a national heritage. For instance, in an overview of the development of Chinese medicine in Hong Kong, Chan (2010) emphasizes:

Sin-hua Herbalists’ & Herb Dealers’ Promotion Society took up the responsibility of uniting and liaising the patriotic Chinese medicine practitioners in Hong Kong. It is also the first Chinese medicine organization that flies the Five-star red flag [the national flag of PRC] to celebrate the national day of the People’s Republic of China. Since then, the Society has been coordinating the patriotic left-wing [i.e. pro-PRC] Chinese medicine practitioners to take part in the national day celebration, and stressing on patriotic education. […]

Strongly supported by Xinhua News Agency, The Hong Kong Federation of China of Traditional Chinese Medicine was launched in December 16, 1990. The Federation took a clear-cut political stance, endeavoured to organize any patriotic (country-loving, Hong Kong-loving) activities that are good for Chinese medicine, and took the lead in fostering the professionalization of local Chinese medicine, so as to be a role model for Chinese medicine practitioners to love the country and love Hong Kong.

The above excerpts from Chan (2010) not only express the patriotic stance of the two organizations but also testify the loyalty of these diasporic Chinese medicine practitioners who fled to Hong Kong from the Communist China. The above-mentioned patriotic rhetoric used by some Chinese medicine practitioners and societies may sound overstated, but the tendency of resorting to nationalism is common in many texts on Chinese medicine. Even in the official website of the Chinese Medicine Council of Hong Kong (2018), its Chinese version referred the sovereignty handover as “the return to the motherland” (cf. “the return of Hong Kong to China” in its English version). The governmental endorsement of Chinese medicine after 1997 has perked these local Chinese medicine practitioners up. This state-backed revivification of Chinese medicine serves as both a nationalistic and decolonizing project.

Here, it is important to note that the commonly used acronym TCM should not be used as an interchangeable term of Chinese medicine at large. Although introductions of TCM often trace back to the ancient times (The State Council Information Office of the People’s Republic of China, 2016), TCM is in fact a contemporary term coined in the 1950s by PRC (Taylor, 2005). The word “traditional” in its English term TCM is, to Andrews (2014), “a deliberate strategy to reinforce ‘a front of historical continuity’ in order to satisfy Western thirst for an authentically ancient healing wisdom from the Orient”. According to Taylor (2005), TCM is a medical construct alongside the major political reforms at the time. While the National Medicine Movement in Republican China kick-started the self-politicization and “scientization” or modernization of Chinese medicine, the rise of State Medicine in the PRC legitimized Chinese medicine into the national healthcare system by manipulating its value as a “cultural legacy” (Lei, 2014). Chinese medicine was then “scientized” to TCM, and this newly envisioned TCM was rationalized as a transcending example of Chinese science and Chinese modernity against the Western science and capitalist modernity (Lei, 2014). Boli Zhang, President of China Academy of Chinese Medical Sciences, has reiterated that TCM is a form of modernized Chinese medicine, and Chinese medicine is in no way Westernized (Zhang, 2015). This modernized TCM could thus be understood as the full-scale, governmental supported, institutional-bound Chinese medicine distinct to PRC (Taylor, 2005; Lei, 2014). Having been led by state policies, TCM is a standardized Chinese medical practice unlike the organically developed Chinese medicine in Singapore, colonial Hong Kong and Taiwan. Therefore, the revival of Chinese medicine in postcolonial Hong Kong is to a large extent an incorporation of TCM.

The revival of Chinese medicine in Hong Kong as a gesture of decolonization was in no way dissimilar to the promotion of Western medicine as a means of colonization: registration and training. Under the Cap.549 Chinese Medicine Ordinance, there is a Register of Chinese Medicine Practitioners that lists qualified Chinese medicine practitioners who either passed the Licensing Examination or recognized by the Chinese Medicine Practitioners Board under the transitional arrangements. Since 2005, registered Chinese medicine practitioners have to fulfill the Continuing Education in Chinese Medicine requirements if they are to renew their practicing certificates. Only registered Chinese medicine practitioners that hold a practicing certificate could practice Chinese medicine in the city. Besides ensuring the standard of the practicing Chinese medicine practitioners, universities began to offer degree programs in Chinese medicine. In 1998, 1999 and 2002, Hong Kong Baptist University, The Chinese University of Hong Kong and the University of Hong Kong launched their undergraduate programs in Chinese medicine respectively. These programs produce more than 300 graduates every year. The graduates become a sustainable supply of qualified young TCM practitioners on top of the more diverse practicing Chinese medicine practitioners in the city. Notwithstanding the controversy in Mainland China of whether Chinese medicine should be modernized and institutionalized (Guan, 2006), Chinese medicine in Hong Kong is headed towards evidence-based medical science to gain further professional legitimacy.

The first step is to rebuild the faith of Chinese medicine among Hong Kong Chinese. Like Tung (1997) suggested in his Policy Address, Hong Kong aspired to be “an international centre for the manufacture and trading of Chinese medicine, for research, information and training in the use of Chinese medicine, and for the promotion of this approach to medical care.” To combat the skepticism about Chinese medicine, it aligns with the national effort in promoting TCM. Take the School of Chinese Medicine in Hong Kong Baptist University as an example, it “aspires to contribute the best efforts to the modernization, professionalization and internationalization of Chinese medicine”, and one of its core values is “the pursuit of knowledge and the development of expertise through a scientific, modernized approach to Chinese medicine education” (Hong Kong Baptist University, School of Chinese Medicine, 2018). By modernizing, professionalizing and internationalizing Chinese medicine to a medical science, Chinese medicine endeavors to break its “traditional/modern” binary, and transforms from the “indigenous” or “folk” Chinese medicine to the scientific TCM. By means of registration and systematic training, Chinese medicine established its professional legitimacy in Hong Kong, awaiting the next decisive moment.

If the bubonic plague was a turning point for the rise of Western medicine in Hong Kong, the severe acute respiratory syndrome (SARS) let Chinese medicine revamp its image. Despite the Hospital Authority’s accommodation in supporting Chinese medicine clinical research and its services in the public hospitals in 2001 (Chiu et al., 2005), the changes were not apparent in the public arena. In 2003, SARS hit Southern China and subsequently spread to other countries that the World Health Organization had to issue a global alert (World Health Organization, 2018). SARS broke out in Hong Kong and did not yield to Western medicine. In face of the rising death toll, the HKSAR government invited two Chinese medicine experts from the Chinese Medicine Hospital of Guangdong Province to examine the integrated method collaborating Chinese medicine and Western medicine in treating SARS. The Hospital Authority also set up a Chinese Medicine Expert Panel on SARS Exploratory Treatment to formulate research and treatment protocols for tackling the epidemic (Legislative Council, 2003a, 2003b). It was the first time that the public hospitals utilized Chinese medicine in conjunction with Western medicine in treatments. It was also the first time that the Hong Kong public became so conscious of the inefficacy of Western medicine, and sought Chinese medical help. Although it did not bring any systemic change in the medical system, it built and re-built the public confidence in Chinese medicine.

To popularize Chinese medicine in Hong Kong, Chinese medicine needs not medical evangelism but immersing and manifesting itself in this highly capitalist city. Besides commodifying and positioning itself as a complementary health supplement, Chinese medicine relies also on more comprehensive governmental endorsement and recognition to further fortify its professional legitimacy. Before 2006, issuance of medical proofs was only restricted to Western medical doctors, but from 2006, sick leave certificates and other medical proofs issued by registered Chinese medicine practitioners can too be accepted (Labour Department, 2006). Since then, Chinese medicine has become incorporated into the medical benefits by employers, insurance coverage and the Elderly Health Care Voucher Scheme. All these prove to be effective in popularizing Chinese medicine. In 2013/2014, there were more than one million visits to the 17 Chinese Medicine Centres for Training and Research (Chan, 2014). The percentage of citizens consulting Chinese medicine practitioners has risen from 5 per cent in 1996 (Luk, 2001), to 9.7 per cent in 2000, 15.4 per cent in 2007 (Census and Statistics Department, 2007) and 18.1 per cent in 2017 (Census and Statistics Department, 2017). With the concerted effort of the HKSAR government, the universities, the local Chinese medicine practitioners and industry, Chinese medicine revived gradually and steadily.

Conclusion

Chinese medicine is no doubt an important medical heritage that offers an alternative and/or complementary therapy to serve the huge demand of medical service in Hong Kong. Tracing the medical history of Hong Kong, it is clear that the rise of both Western and Chinese medicine in Hong Kong coincided with the advances and international recognition of the medicine per se. The trajectories of their rise too were in a similar vein. During the colonial years, Western medicine took hold because of the bubonic plague, medical evangelism, professional training, registration system and its huge advances in biomedical science. Similarly, Chinese medicine revived in the post-colonial years because of the governmental endorsement, SARS outbreak, the modernization and professionalization of Chinese medicine, institutionalization of Chinese medicine training and registration. The fall and rise of Chinese medicine in many ways are dependent on the institutional context at the time.

Despite the fall and rise, Chinese medicine has never come to a standstill. While the spread of Western medicine can be regarded as a form of colonization of the body psychologically and corporeally (Arnold, 1993), the revival of Chinese medicine should be considered against its socio-cultural-political context as well. Citing Arnold (1993), medicine should be understood as “an influential and authoritative vehicle” that transmits a certain ideology, and at the same time produces and propagates one’s identity. In other words, medicine is not only therapeutic but also discursive and ideological.

In the official documents of the HKSAR government, it adopts the term Chinese medicine (CM) rather than the Traditional Chinese medicine (TCM) used by the Central Government of the PRC. Chinese medicine in the post-colonial Hong Kong is no longer merely an indigenous folk therapy, but an officially endorsed medical practice. Chinese medicine in the post-colonial Hong Kong is more than simply a cultural heritage but a national heritage, a symbol of patriotism. Its Chineseness has become more a standardized national trait than the ethnic or cultural one. In other words, the diverse schools and organic practices of Chinese medicine are slowly homogenizing into the PRC-endorsed modernized TCM. Chinese medicine in the post-colonial Hong Kong is a project that is geared towards decolonizing and nationalizing the city. By establishing as “modern” and “scientific”, institutionalizing its training, commodifying as a niche market, making nationalistic appeals, Chinese medicine in the dominant discourse in Hong Kong walked from the marginalized ethnic-bound traditional Chinese medicine towards the revived modernized national medicine, TCM. Being traditional/Traditional, being Chinese, this medicine is still in the making.

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Further reading

Census and Statistics Department (2000), Thematic Household Survey Report No. 3, available at: www.statistics.gov.hk/pub/B11302032000XXXXB0100.pdf (accessed 27 April 2018).

Corresponding author

Ka Wei Pang can be contacted at: janetpang@link.cuhk.edu.hk