Medicinal healing and surgical treatment in ancient China. Gallery of China Features of medicine of Ancient China

China occupies one of the leading places in global medical tourism. Modern clinics, advanced technologies and highly qualified personnel - Chinese medicine is one of the best in the world.

State clinic in Shanghai

The global medical tourism market is estimated at approximately $40 billion per year. China strives to attract as many tourists as possible from all over the world to its clinics. Thanks to its enormous economic power, China has one of the most developed healthcare systems in the world. Clinics equipped with the most modern medical equipment, highly qualified doctors and medical workers, as well as developed infrastructure allow us to provide medical services at the highest level, while maintaining an acceptable pricing policy.

The times when people went to China for the help of traditional Chinese medicine (based on acupuncture and phytotherapeutic procedures) are in the past; now people come to China for treatment of the most serious diseases: cardiology, oncology, surgery, ophthalmology, endocrinology, etc.

Chinese healthcare system

In China, all clinics, both public and private, are under state control. At the state level, all aspects of the work of clinics are regulated: uniform standards of technical equipment, requirements for the level of education and qualifications of doctors and health workers are introduced.

Since 2003, insurance medicine has been introduced in China and therefore there are no significant differences between services in a private and public clinic. Likewise, there is no difference between serving citizens of the country and foreigners. Foreigners have the right to any medical care. If this is provided for by the insurance policy, then the treatment is free of charge; otherwise, medical services are provided on a paid basis.

Pros of medical tourism in China

Chinese medicine has many benefits:

Modern hospitals and clinics

Today there are 35 multidisciplinary clinics in China that have international accreditation. In China, all operating standards of hospitals, both public and private clinics, are regulated at the state level. This guarantees high quality standards of services in any medical institution. China also has advanced research centers, primarily in the fields of immunology, cardiology, oncology, and stem cell research.

Highly qualified doctors and health workers

Chinese doctors are trained to the highest standards. Many specialists were trained in the USA, have international diplomas and speak fluent English.

Competitive cost of treatment

The cost of treatment for a foreigner in China is lower than the cost of treatment in America or Western European countries. The quality of services provided by Chinese clinics meets all Western standards.

Traditional Chinese Medicine

Traditional methods of treatment are also in great demand both among the Chinese themselves and among foreign patients - acupuncture, phototherapy, stone therapy, hypnosis and other alternative methods of treatment and healing.

What is the best treatment in China?

As noted above, China has advanced diagnostic and laboratory testing methods. China has made many discoveries and know-how in the field of medicine. The following are developed at a particularly high level in China:

prosthetic and implantation surgeries
heart surgery
vascular operations
study of the hormonal system
cancer treatment
treatment of diseases of the digestive system
musculoskeletal problems
neurological diseases
dentistry
plastic surgery and cosmetology

With its great economic power, China is investing heavily in the development of medicine, and in the near future it has every chance of becoming a leader in global healthcare.

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Subject: Chinese healthcare system

Introduction

1 General characteristics of healthcare in China

1.1 Dynamics of development

1.2 Transforming the healthcare system - People's Republic of China

1.3 Traditional Chinese medicine and pharmacology

2 Study of health care reform in China

2.1 Reform of the healthcare system in China

2.2 Priority areas for reforming the healthcare system

2.3 Current health issues in China

Conclusion

INTRODUCTION

Everyone is familiar with the incredible richness of the traditions of ancient Chinese medicine. In China, for the first time in the world, a conscious medical concept of health, illness and treatment was formulated, and systematized knowledge about human health was presented in a number of treatises and are the most valuable monuments of ancient thought. It was in China that they began to study diseases and establish their causes by analyzing symptoms.

Since the founding of the People's Republic of China in 1949, considering disease prevention, health protection and the further development of traditional medicine as an important part of the strategy, the Chinese government has paid great attention to the widespread establishment of medical and health care institutions and the training of medical personnel. Hospitals of various levels and medical organizations are available throughout the country, and a comprehensive treatment and preventive network has been formed in cities and rural areas. Health care in the PRC has become the most important state matter. Nowadays, numerous medical personnel work in China, an integral system of educational institutions of medical sciences has been formed, which has given the country a whole galaxy of outstanding specialists in medicine and pharmacology. By the end of 1998, the country had 310 thousand medical organizations (including outpatient clinics), 3.14 million hospital beds (2.91 million in hospitals and sanitary epidemiological stations), 4.42 million medical personnel working in this area ( 1.41 million doctors in hospitals and sanitary and epidemiological stations, 1.07 million nurses), which is 85.6, 36.9 and 8.8 times more, respectively, than in 1949.

1 GENERAL CHARACTERISTICS OF HEALTH CARE IN THE PRC

1.1 Dynamics of development

In accordance with the system of public health care and labor insurance created in the 50s. in China, treatment of workers and employees in case of illness or injury is carried out entirely at the expense of the state. This system has played an active role in protecting the health of workers and employees, stimulating economic development and ensuring social stability. However, as the economy developed and the reform of the country's economic system deepened, its shortcomings became increasingly apparent. Because health care is typically paid for by governments and businesses, health care costs have risen too quickly and have become a burden on government budgets. On the other hand, waste of sanitary and hygienic resources is inevitable. Health care in rural areas, with the exception of a few wealthy regions where it is provided free of charge, still requires payment. The country's general health care system has not yet reached perfection and its coverage is small, so it is imperative to reform the public health care system.

This reform in cities and towns involves creating a mechanism for reimbursing the costs of medical institutions. This means that the health insurance system must be built taking into account local financial and social conditions; Treatment costs must be borne by both the state and enterprises, as well as the patients themselves. In rural areas, a cooperative health care system under the leadership of local governments, which operates at public expense with financial assistance from the government and on the basis of voluntary participation of the population, should be fully developed and improved. It is planned to create insurance funds mainly through contributions from individuals and support from collectives and local authorities in order to provide peasants with basic health care, fulfill the objectives of disease prevention and avoid poverty due to disease. Expanding the coverage of the health insurance system not only promotes complete and timely service from medical institutions, but also meets the requirements for the sustainable development of medical institutions themselves.

The level of medical science is rapidly improving, and control over medicines and sanitary supervision are constantly strengthening. A health insurance system for workers and employees in cities and towns has been established on the basis of public planning and private contributions, and the scope of this system is gradually expanding. Traditional Chinese medicine and pharmacology, as well as a combination of Chinese and Western medicine, are developing together. The incidence of many infectious diseases has noticeably decreased, epidemics have been localized, the work of medicine and healthcare in rural areas is being strengthened, which has significantly improved the health of the population. In terms of the average life expectancy of the population and the reduction in mortality of infants and women in childbirth, China is in the forefront among developing countries; according to some indicators, it has reached the level of developed Western countries.

1.2 Transforming the healthcare system - People's Republic of China

With the founding of the People's Republic of China in 1949, the country's healthcare system was transformed. And earlier, starting from the 19th century, there were a number of missionary hospitals and outpatient clinics in China. Some were just a few beds in a back room, others were more or less full-fledged establishments. The new government decided that well-staffed hospitals should form the core of China's new healthcare system.

healthcare medicine pharmacology Chinese

Chinese Hospital in Xiamen, Fujian Province, China
Source: Wellcome Images

By 1990, the country had a network of modern hospitals. Originally funded by the government, today hospitals in China no longer receive all their funding from the government alone. As a result of reforms introduced after 1979, hospitals now receive two-thirds of their funding from patients directly, or from insurance companies, as is more common in recent years. Ironically, the new economic policies introduced after 1979 created a new market for traditional Chinese medicine. To reduce the growing imbalance between urban and rural health care, hospitals (including traditional Chinese medicine) were built in every region of China. These institutions are intended primarily to provide low-cost medicine to the majority of the country's residents.

The Chinese government continues to improve the healthcare system to make medical care in cities and villages equally high quality and affordable. The efforts of the authorities are supported by millions of rural doctors.

This three-story building is a hospital in the village of Mafu in western Hunan Province, located in central China. Doctor Tian Rui works here. She came to Mafa in 1992, right after graduating from medical school. At first, almost none of the local residents went to the doctor: either there was no money to pay for medical care, or they simply did not believe in medicine. But even under these conditions, Tian Rui was able to cure more than two thousand people over the years. At the very beginning, Tian Rui had to go home to the sick. It took Tian Rui much more time to get to the most remote corners of the village along mountain roads than for the treatment itself.

Tian Rui, physician: “Of course, this is not an easy path. Especially for a woman, and yet I am happy in my own way.”

Few villagers earn more than a few hundred yuan, or $50, a year. Therefore, many simply cannot afford to pay for a doctor's services. Tian Rui says that when a person comes to the clinic, they first treat him, and only then they start talking about money. If they are not there, they ask you to bring payment for treatment later, when the money becomes available. Over 18 years of work, Tian Rui has accumulated several notebooks where she writes down countless debts; she no longer expects to receive the lion's share of them.

Tian Rui says that at first people did not trust doctors, and some were even embarrassed. According to Tian Rui, after free gynecological examinations began in the village, female diseases were found in 90% of the village residents. Now this figure has been reduced by half.

Tian Rui, doctor: “Now they come on their own if they feel unwell. “Before, they were shy, it was difficult to persuade them even for a simple examination.”

Gradually, not only trust in doctors appears, problems with money are also solved. Thanks to the health care reform, more and more villagers are beginning to receive preferential health care. Health insurance has covered almost 90% of the country's population, and starting from this year it is planned to increase the maximum amount of insurance payments for rural residents. It is expected that farmers with health insurance will be able to get back 70% of their medical expenses.

Improving a three-stage treatment and preventive network in rural areas

About 75 percent of China's population lives in rural areas, so rural medicine and healthcare are a constant focus of government attention. Since 1978, since the implementation of the policy of reform and opening up, the country's medical authorities have set themselves the goal of further developing rural sanitation work and providing farmers with medical care, considering this as one of the key points in building a new socialist village with Chinese characteristics. Along with this, on the basis of the comprehensive development of medicine in rural areas, general sanitary and hygienic measures have been put in first place. Currently, in rural areas, a three-stage (district, volost and village) treatment and preventive system has mainly been formed. In 1998, in China there were 2,037 county hospitals, 50.6 thousand volost sanitary and epidemiological stations, and 728.8 hospitals or outpatient clinics were created in almost 90 percent of the 730 thousand villages throughout the country. There are 1.328 million doctors and health workers in rural areas, of which rural doctors account for 74.59 percent. China has laid a good foundation for achieving the World Health Organization's goal of "Achieving health care for all by the year 2000."

Within 50 years after the founding of the People's Republic of China, medical institutions were created in the country, in which the main place is occupied by sanitary and epidemiological stations intended for sanitary surveillance and disease prevention. An all-China sanitary surveillance and epidemic control network has been formed. In 1998, there were 4,018 such institutions in the country, including 1,696 county sanitary and epidemiological stations, 1,889 specialized departments or points of prevention and treatment.

In order to completely eliminate or localize infectious diseases and epidemics, the Chinese government promulgated the “Law on the Prevention and Treatment of Infectious Diseases”, “China’s Action Plan for the Eradication of Poliomyelitis for 1995”, “Theses of the Program for the Elimination of Iodine Deficiency Disease by the Year 2000”. China" and other documents, is actively developing immunization work. Immunological vaccination of children was successfully carried out, which made it possible to significantly reduce the incidence of measles, polio, diphtheria, whooping cough, epidemic encephalitis B and other diseases. Currently, the work on disease prevention and the patriotic movement for sanitation and hygiene are deepening, the health status of the urban and rural population has significantly improved compared to the period preceding 1949. The average life expectancy of the population throughout the country has increased from 35 to 70 years.

The causes of death are mainly malignant tumors, diseases of the blood vessels of the head and cardiovascular diseases. In this respect, the situation in China is similar to developed countries. Research institutions and medical institutions are actively involved in the prevention of cardiovascular and cerebrovascular diseases, cancer and other chronic non-communicable diseases, and monitor outbreaks of infectious diseases both within the country and abroad. Over the past 50 years, China has made remarkable progress in disease prevention and treatment. In 1996, the Disease Control Department of the Ministry of Health of the People's Republic of China received the World Health Organization Award for outstanding achievements in its work.

Protecting the health of women and children. The focus is on protecting the health of women and children. After the founding of the People's Republic of China, the Chinese government began to pay great attention to protecting the health of women and children, declaring it a national strategy. Committees for working with women and children have been established under the State Council of the People's Republic of China and local governments. By the end of 1998, there were already 2,724 medical institutions for women and children throughout the country, including 1,507 county maternal and child health centers, staffed by 73,000 medical specialists.

To ensure the protection of women's health, the PRC laws “On the Protection of the Rights and Interests of Women”, “On the Protection of the Health of Mother and Child”, the regulation “On the Labor Protection of Women Workers” and other legal acts were adopted. China is actively working on the use of safe methods of obstetrics; In cities and rural areas, mandatory medical examinations of pregnant women, care for pregnant women at risk, hospital births, postpartum care and a number of other measures have been introduced to ensure the health of mothers and children. The implementation of these measures yielded positive results: the mortality rate of women in labor decreased from 1,500 cases per 100 thousand people in 1949 to 61.9 cases in 1995.

Since 1978, the Chinese government has begun to pay special attention to protecting the health and monitoring the development of children. Thus, the law “On the Protection of the Rights of Minors” and the “Program to Encourage Children to Breastfeed” were adopted; 5,890 hospitals have been established throughout the country to care for newborns, thanks to which infant mortality has decreased from 200 cases in 1949 to 31 cases per 1 thousand newborns.

Since 1978, China has introduced nationwide routine vaccination. At the state level, measures are being taken to improve the level of physical development of children, and programs are being created to improve their nutrition.

Since the founding of the People's Republic of China, the Chinese government has paid great attention to protecting the health of women and children. Under the National People's People's Congress and the CPPCC, respectively, an institution has been established to ensure legislative support for the rights and interests of women and children and an institution to supervise the implementation of laws. Committees for working with women and children have been established under the State Council of the People's Republic of China and local governments. By the end of 1998, there were 2,724 medical and health care institutions for women and children throughout the country, including 1,507 district points (stations) for maternal and child health care, and 73 thousand medical personnel. A comprehensive network of institutions for the protection of women's and children's health has been formed, covering the entire country.

In order to effectively ensure the protection of women's health, the “Law of the People's Republic of China on the Protection of the Rights and Interests of Women”, the “Law on the Protection of Maternal and Child Health”, “Regulations on the Labor Protection of Women Workers”, “Temporary Regulations on the Protection of the Health of Workers” and other legal acts were adopted. China is actively working on the use of safe methods of obstetrics and measures to protect the health of women during the childbearing period. In cities and rural areas, mandatory medical examinations of pregnant women, registration of premature pregnancies, care for extremely high-risk pregnant women, hospital births, postpartum care and a number of other measures have been introduced to ensure the health of mothers and children. These measures have yielded positive results in protecting maternal and child health in China, for example, the mortality rate of women in childbirth decreased from 1,500 cases per 100 thousand people in 1949 to 61.9 cases in 1995.

Since 1978, the Chinese government has attached special importance to protecting the health and monitoring the development of children. “Theses of a program to improve the welfare of children in China for the 90s” have been developed. and the “Minor Protection Law”, the “Program to Promote Breastfeeding of Children” was promulgated. At the same time, the movement for caring for infants was widely launched, 5,890 hospitals for the care of newborns were created throughout the country, due to which infant mortality decreased from 200 cases per thousand newborns before 1949 to 31 per thousand. Since 1978, a nationwide routine vaccination has been carried out. The level of physical development of children is constantly increasing and their nutritional status is steadily improving.

1.3 Traditional Chinese medicine and pharmacology

Chinese medicine and pharmacology are an important part of the brilliant culture of the Chinese nation. Over several thousand years, they made outstanding contributions to the prosperity and power of China. Chinese traditional medicine, distinguished by its noticeable healing effect, national identity, unique methods of diagnosis and treatment, systematic theoretical principles and rich historical documentation, has its own special place in world medicine and has become the common wealth of the treasury of world medical science. Chinese medicine has a centuries-old history, and it still shows great vitality today. It and modern medicine complement each other, which is the specificity and advantage of traditional Chinese medicine.

Chinese medicine and pharmacology arose during the primitive period. Primitive people, in their struggle with nature, created the rudiments of medicine. While searching for food, they noticed that certain foods could alleviate or cure diseases, which was the beginning of the discovery and use of Chinese medicines. With the advent of fire, people learned that by warming themselves with hot stones or sand, wrapped in skins or tree bark, they could cure some ailments, then, based on repeated practice, the methods of hot medicinal compress and cauterization were discovered. Using stone products as tools of production, people realized that injections and blows to one part of the human body relieved the pain of another part. This is how a method of treatment with stone and bone needles was created, which later turned into acupuncture, and the doctrine of meridians and collaterals was formed.

The main theoretical views of Chinese medicine consist in the original knowledge of dense and hollow visceral organs, meridians and collaterals, “Qi” and blood, body fluids, the causes of disease and pathogenesis. Treatment methods of Chinese medicine are “four methods of examining the patient” and studying the disease: visual (studying the complexion), auditory (listening to the patient’s voice), oral (finding out by asking the patient’s condition) and palpable (feeling his pulse). Study of disease means the process of knowing the cause of disease through analysis, induction, investigation and judgment based on the symptoms of disease and physical symptoms noticed through the “four methods of examining the patient.” In addition to the main method of treatment based on the use of medicine, Chinese medicine also uses acupuncture, massage, qigong breathing exercises and some other original treatment techniques.

More than 2 thousand years ago, the first Chinese medical treatise “Huangdi Neijing” was published, which laid the theoretical foundation of Chinese medicine. After this, many other classical medical works were published, such as “The Canon on Difficult Questions in Medicine”, “Treatise on Exogenous Febrile and Various Diseases”, “Treatise on the Etiology and Symptomatology of Diseases”. “Shennong Bencaojing” (Shennong Pharmacopoeia) is the oldest special work on pharmacology in China. "Tangbencao" is the first pharmacopoeia in China to be published by the government, it is the world's first government pharmacopoeia. During the Ming Dynasty, Li Shizhen compiled the pharmacopoeia “Bencao Gangmu” (“Compendium of Medicinal Substances”), in which he described 1892 types of medicinal herbs and other medicinal raw materials and provided more than 10 thousand recipes based on them.

Since the founding of the People's Republic of China, the government has attached great importance to Chinese medicine and supported its development. In 1986, the State Administration of Traditional Chinese Medicine was established. 2 years later, on its basis, the State Administration for Traditional Chinese Medicine and Pharmacology was created, which develops a development strategy, course, policy and regulations in this area. It provides the combination of Chinese medicine and pharmacology in an organized manner and manages their integration.

Education in the field of traditional medicine is developing rapidly, higher and secondary educational institutions teaching Chinese medicine and pharmacology, correspondence institutes, evening institutes, schools have been opened, and an external education system is being implemented. Thanks to all this, the country has trained a large number of Chinese medicine specialists. A holistic system has been formed in the production of Chinese medicines, characterized by a rich assortment and advanced technologies. In China, traditional medicine doctors learn from each other, trying to find a way to combine Chinese and Western medicine, which is new to China. Currently, a situation has developed in the country in which Chinese, Western and Chinese-Western medicine coexist, adopt each other’s positive qualities, and develop together. The system of theoretical views of Chinese medicine has a deep content. Workers of Chinese-Western medicine, using advanced science and technology and modern methods, have carried out long-term research work on the basic theoretical knowledge of Chinese medicine and its treatment methods. Therefore, they have made progress in scientific commentary on solid and hollow visceral organs, blood stasis and the essence of acupuncture treatment. China is at the forefront in the world in 5 medical fields, including amputated limb replantation, burn treatment, fracture treatment, acute abdominal disease treatment and acupuncture anesthesia. Progress in the last 3 areas has been achieved by combining the methods of traditional Chinese and Western medicine.

In recent years, encouraging successes have been achieved in the treatment of cardiovascular and cerebrovascular diseases, immunological diseases, cancer and fractures using Chinese medicine methods. The discovery and systematization of traditional medicine recipes, the processing and preparation of Chinese medicines, and the modification of finished medicine forms have received new development, which has enhanced the ability of Chinese medicine to prevent and treat diseases and expanded its service scope. Chinese medicine has discovered new methods of non-surgical treatment in the treatment of acute abdominal diseases. Traditional Chinese medicine - acupuncture, acupuncture anesthesia and acupuncture pain relief - is now practiced in 120 countries and regions around the world. In 1987, the World Acupuncture Federation was founded in Beijing, in which more than 50 thousand representatives from 100 countries and regions of the world participate. It is the first international scientific organization headquartered in China, and China is its chairman. In 1989, the International Conference of Qigong Therapy was held in Beijing, in which representatives of 29 countries and regions of the world took part. In 1991, the International Conference on Traditional Medicine and Pharmacology was held in China, at which dozens of countries jointly developed and adopted the Beijing Declaration. To date, China has already established relationships with more than 100 countries and regions in the world in the fields of medical services, scientific research and academic exchange.

In recent years, as homeopathic treatments and non-drug treatments have spread, Chinese medicine has attracted worldwide attention. The framework for international cooperation in the field of medicine is expanding. Japan, the USA and Germany have established cooperative relations with China. The World Health Organization has established 7 cooperative centers for traditional medicine and pharmacology in China. Among all the foreign students and trainees studying natural sciences in China, the largest part are specialists in Chinese medicine. The joint teaching of Chinese medicine by the Beijing Institute of Traditional Chinese Medicine and a public university in England served as a precedent for the opening of a Chinese medicine specialty in other universities in England and Europe. There are schools of Chinese medicine in Japan and the Republic of Korea; in France, the USA, Italy, Australia and other countries - institutes of Chinese medicine and acupuncture institutes; in Germany at the University of Munich - an institute for the study of theoretical knowledge of Chinese medicine.

Today, Chinese medicine and pharmacology are important components of the culture of the Chinese nation and occupy a special place in world medical science. Having a centuries-old history, traditional Chinese medicine still exists today, complementing modern medicine. After the founding of the People's Republic of China, the government began to attach great importance to medicine and support its development. In 1986, the State Administration of Traditional Chinese Medicine was established. 2 years later, on its basis, the State Administration for Traditional Chinese Medicine and Pharmacology was created, which develops a development strategy, course, policy and bills in this area. This management ensures the interaction and integration of Chinese medicine and pharmacology.

However, no matter what the achievements of Chinese medicine were, they remained accessible only to the emperor and a limited number of people close to him. Ordinary citizens had no access to medical care for many centuries, and their average life expectancy was just over 35 years.

The situation changed dramatically with the beginning of the reign of Mao Zedong. It was he who, in the middle of the last century, created an extensive system of primary medical care, modeled on the Soviet one, which became accessible to ordinary people, primarily peasants. Semashko’s healthcare model then turned out to be the only correct way to organize medical care in a country in which millions of people live over a vast territory. And today the question arises again: what should be an effective healthcare system designed for a population exceeding 1/5 of the world's inhabitants?

The emergence of new Chinese medicine. After the founding of the People's Republic of China in 1949, the Chinese government began to pay great attention to the widespread creation of medical and health care institutions and the training of medical personnel. Today, there are hospitals of various levels and medical organizations throughout the country, and an integrated treatment and preventive network has been formed in cities and rural areas. In large cities there are large specialized clinics, including traditional medicine hospitals. There are also comprehensive and specialized hospitals with modern equipment in medium-sized cities in all provinces and autonomous regions. In most rural areas, a three-stage treatment and preventive network has been introduced at the county, volost and village levels; Central district hospitals were created in the districts, volost outpatient clinics were created in the volosts, and first-aid posts were created in the administrative villages.

Healthcare in China has become one of the most important areas of state development. Qualified medical personnel began to work in China, an integrated system of medical educational institutions was formed, which produced a galaxy of outstanding specialists in medicine and pharmacology. If several decades ago in China there were 1.48 doctors and 2.34 hospital beds per 1000 people, then by the end of 1998 the country already had 310 thousand medical organizations, including outpatient clinics; 3.14 million hospital beds; 4.42 million medical personnel, of which 1.41 million are doctors in hospitals and sanitary and epidemiological stations and 1.07 million nurses, which is tens of times higher than similar figures after World War II.

Medical science in China today is actively developing, control over the use of medicines and sanitary supervision are being strengthened. A health insurance system for workers and employees in cities and towns has been established on the basis of public planning and private contributions, and the scope of this system is gradually expanding. The incidence of many infectious diseases has noticeably decreased, and epidemics have been effectively contained. In order to completely eliminate infectious diseases and epidemics, the Chinese government has adopted the Law on the Prevention and Treatment of Infectious Diseases and other documents, and is actively carrying out immunization work. Immunological vaccination of children has been successfully completed, which has significantly reduced the incidence of measles, polio, diphtheria, whooping cough, epidemic encephalitis and other diseases.

At present, the health status of China's urban and rural population has significantly improved compared to the period before 1949. The average life expectancy of the population throughout the country has doubled. With about 75% of China's population living in rural areas, provincial medicine and public health are the focus of the government's ongoing commitment to preventive medicine, which has greatly improved the health status of the population.

2 STUDY OF HEALTH CARE REFORM IN THE PRC

2.1 Rreformatione healthcare systems in China

Healthcare is an integral part of the social sphere of the PRC, the state of which, in many respects, can be considered as a key indicator characterizing the entire social policy of the country’s leadership and the overall level of development of Chinese society.

The current situation in the field of public health in China has every reason to be considered a crisis. This was a natural result of the accelerated economic development of the PRC to the detriment of the balanced development of all spheres of the country’s life.

It is obvious that without such a huge strain of all resources - primarily human - China would not have become one of the regional and world economic giants in such a short time. However, the beginning of the 21st century has shown that the existing health care system is experiencing most of the serious problems that shook the entire Chinese society at that time, including the ever-increasing social stratification, the gap between city and countryside, etc. In 2000, medical expenses per rural resident were 188.6 yuan versus 710.2 yuan for an urban resident, i.e., 3.8 times lower. During 1991-2000, total expenditures on this item increased by almost 50.7 billion yuan, of which only 6.3 billion yuan fell on the villages, i.e. 12.4% of the total increase, and this despite the fact that The rural population was almost twice as large as the urban population. Only 10% of villages retained cooperative medical services by the early 2000s. More than 80% of peasants are forced to receive treatment at their own expense. The share of public health expenditures in total state budget expenditures decreased from 4% in 1980 to 1.71% in 2000, which placed China in one of the last places in the world in terms of this indicator. Africa's poorest countries spend twice as much on healthcare per capita as China.

It cannot be said that Chinese healthcare was in complete decline during the period of the “reform and opening up” policy. For example, the increase in life expectancy in China is quite an impressive achievement these years (see Figure 1).

Thus, the average life expectancy in China in 2006 exceeded the global average by 5 years, and the same indicator in low-income countries by 13-14 years.

Figure 1 - Life expectancy at birth in China (life years)

Quote by: BergerI. » Domestic notes» No. 3, 2008,. Thus, the average life expectancy in China in 2006 exceeded the global average by 5 years, and the same indicator in low-income countries by 13-14 years. However, it should be noted that the pace of economic development of the country clearly exceeded the growth rate of allocations for healthcare and the income of ordinary citizens of the PRC, which led to extremely serious consequences. The main crisis trends in this area are as follows:

- Low level of government funding for the healthcare sector. As for the level of government subsidies for healthcare, as can be seen from Table 1, the share of the state in healthcare expenditures in the PRC was only 38.8% in 2005, while in the world as a whole it reaches 56%. Only 1% of the state budget goes to health care in China, while in total in low-income countries around the world 4.6% of public funds are spent on these purposes, and the global figure in 2005 reached 8.3%.

Table 1 - Health care costs

	Total health expenditure as % of GDP	Government share of total health expenditure (%)	Health care share of total government expenditure (%)


Low income countries
Low-middle income countries
Middle-high income countries
High income countries
The world at large

Quote. By: I. Berger. Chinese healthcare. Reference//» Domestic notes» No. 3, 2008,http://www.strana-oz.ru/?numid=44&article=1682. This ultimately results in China's per capita health care spending being extremely low. Without going into comparison with similar indicators of countries with developed economies, even a comparison of these expenses with the global level of health care spending is more than indicative (see Table 2).

Table 2 - Health care expenditures per capita

	Total costs at average official exchange rate (USD)	Total PPP Costs (International Dollars)	Government spending at average official exchange rate (USD)	Government spending on PPP (international dollars)


High income countries
The world at large

Quote. By: I. Berger. Chinese healthcare. Reference//» Domestic notes» No. 3, 2008,http://www.strana-oz.ru/?numid=44&article=1682. However, changes in this area can still be traced. After the decision was made on the need to reform health care, the growth of health care costs intensified significantly (see Table 3).

Table 3 - Increase in expenditures of the Ministry of Health for the provision of medical services per capita in% compared to last year

- Insufficient level of accessibility of medical services for the population of the People's Republic of China. The low level of government funding for the development of the healthcare system in China is exacerbated by the fact that for the majority of the country's population, obtaining quality medical care is an almost unaffordable luxury. On average in China, spending on these services amounts to about 11.8% of the family budget, second only to spending on food and education. In 2003, a peasant's net annual income averaged 2,622 yuan, and the average cost of his hospital stay reached 2,236 yuan.

Another significant problem is that the increasingly worsening social inequality in the PRC is also projected onto access to medical care. In this regard, the most protected and comfortable group of the Chinese population are government officials and party functionaries. According to some reports, up to 80% of government subsidies for medicine go to serving this group. The least benefits, respectively, are for low-income rural residents and migrant workers who have not received health insurance.

Problem health insurance exacerbates the inability of some population groups to receive basic health services. The fact is that, as with pension insurance, only the working urban population has the most free access to this type of service, provided that these people work in government agencies. After the introduction of a law obliging the employer to enter into an employment contract with all employees, regardless of the type of enterprise, this situation began to improve, since under the contract the employer is obliged to provide employees with health insurance. However, the process is moving extremely slowly, and the practice of oral contract (especially with rural migrant workers) is still very strong.

As for the rural population, only a small percentage was involved in the compulsory health insurance system. And the introduction of a cooperative health insurance system in rural areas is proceeding extremely slowly and with very limited funds.

Closely related to the above problem is also the question of the discrepancy between the quality of medical services in the PRC and the requirements of modern development of the state.

The duality of the problem also lies in the fact that obtaining medical care in China is inaccessible to a fairly large group of the population, not only due to the fact that they do not have enough funds to pay for it, but also because the level and number of medical institutions and medical personnel also do not meet the requirements of society.

Regarding medical personnel , then, 4kStrangely enough, in China in 2006 there were 15 doctors and only 10 paramedical personnel per 10 thousand people (the global figure is 13 and 28, respectively). In general, this level of medical personnel availability (see Table 4) is considered insufficient by international standards. If we compare similar indicators in China and the Republic of Kazakhstan, then in 2006 in Kazakhstan there were 37.6 doctors of all specialties and 125.2 paramedical personnel per 10 thousand people.

Table 4 - Medical personnel in the PRC in 2006-2007. million people



Medical specialists
Of which: doctors and residents

Auxiliary nursing staff
Pharmacists
Medical controllers
Other health workers
Management personnel
Technical staff

Another important indicator characterizing the level of quality of medical care in the country is number of medical facilities and hospital beds . In this regard, it is important to note the following. Firstly, over the period since the start of the “reform and opening up” policy, these indicators have not undergone fundamental changes (see Figure 2).

Secondly, this indicator itself also lags behind similar indicators in other countries. So in Kazakhstan in 2006, the number of hospital beds per 1 thousand people was 7.73, which exceeded the Chinese figure by almost 3 times.

Figure 2 - Dynamics of changes in the number of hospital beds per 1 thousand population in China during the period of the policy of “reform and openness”

In general, over the past two years this indicator has remained relatively stable and no significant qualitative improvements have been observed in this area, and given the continued high rate of natural increase, one can raise the question of a deterioration in the situation. Particularly alarming is the fact that the number of medical institutions in rural areas is decreasing, as well as the number of research preventive institutions, which is especially dangerous, given the frequency of various types of epidemics in China.

The problem is also that bO Most of the government subsidies for the development of healthcare have recently been directed to the development of social health insurance and to increasing the population’s access to medical services, but not to improving the quality of medicine itself.

Table 5 - Number of medical institutions and hospital beds in China in 2006-2007.

	Medical institutions	Hospital beds

Total
Hospitals
Multidisciplinary
Chinese medicine hospitals
Specialized hospitals
District medical care centers
Health centers
Rural health centers
Outpatient clinics
Clinics
Donor centers
Maternal and Child Health Centers
Specialized scientific institutes for disease prevention
Centers for Disease Prevention and Control

In addition, other indicators characterizing the state of not only the quality of medical services in the state, but also the overall socio-economic development of the country are infant mortality rates . In general, in China there is a positive trend in this indicator (see Table 6), however, in comparison with other countries, comparison of some data seems downright scary.

Thus, the infant mortality rate in China in 2006 was 17.2‰, while in Kazakhstan it reached 13.9‰. However, the infant mortality rate under 5 years of age in the same year in Kazakhstan was 1.29‰, and in China - 20.6‰ (and in rural areas 23.6‰)! At the same time, the World Health Organization (WHO), speaking about child mortality rates in China as of August 2008, provides data that the infant mortality rate in China is 23‰, and the child mortality rate under 5 years is 30 ‰.

Table 6 - Regional mortality rates for mothers and children in China for 2006-2007.

This indicates both a low level of pediatrics and a general low standard of living of the population, including the lack of necessary sanitary and hygienic conditions, nutritional levels, vaccination, etc. in most settlements. Thus, according to WHO, in 2006, 81% of the rural and 98% of the urban population had sustainable access to potable water, and only 59% of the rural and 74% of the urban population of China were provided with normal sanitation conditions.

Another problematic trend in the development of the modern Chinese healthcare system is uncertainty in the priorities of its development. Due to the focus on introducing market relations in the healthcare sector and the withdrawal of the state from this area, the situation in this sector has approached critical. This is due to the fact that the role of state support has significantly decreased, but at the same time, conditions have not been created for the full entry of private capital into the field of medicine. In fact, over more than two decades of reforms, conditions for the creation of non-state hospitals have not emerged. Prices for medical services and drugs are still controlled by the state. They are not installed by hospitals, but by relevant government departments.

In addition, the vast majority of hospital beds, equipment and medical personnel are concentrated in public medical institutions. Relying on long-term government support, a few hospitals have concentrated the best resources and achieved a monopoly position with which non-governmental medical institutions cannot compete.

The flip side of the problem is that in public, non-profit health care institutions, employee salaries and bonuses, as well as the operating expenses of the institutions, are mainly financed by their own business activities. This is where doctors strive to prescribe a lot of expensive medications to patients and prescribe expensive examinations and procedures. The state controls the prices of approximately 20% of drugs circulating on the pharmaceutical market and has repeatedly reduced prices in recent years. However, market-regulated drug prices are rising, sometimes manifold. In the vast majority of medical institutions, markups on the price of dispensed drugs reach 30-40%, far exceeding the state standard of 15%.

Thus, the above crisis trends demonstrate the urgent need for large-scale reform of the healthcare system in China. In the middle of this decade, the fourth generation of Chinese leaders began a gradual transition to a policy aimed at improving the quality of life of the population and developing the social sphere of society. This strategy received its final form at the 17th Congress of the CPC in the fall of 2007. Hu Jintao's report at the congress placed more emphasis on the government's responsibility for healthcare reforms. They spoke about the need to strengthen the generally beneficial nature of healthcare and increase the state’s investment activity in this segment.

At the meetings held after the congress, it was decided, on the basis of existing independent developments, to prepare a new consolidated draft of health care reform “with Chinese characteristics” and present it to the public. The project was supposed to provide for the creation by 2020 of a system that would guarantee the provision of basic medical services to all residents of cities and villages.

The Health Development Program in the 11th Five-Year Plan (2006-2010) sets a goal for the formation of a universally accessible basic health care system. Strengthening the leading role of the government, increasing its responsibility, reforming the management of public medical institutions, strengthening their generally beneficial nature, preventing the blind pursuit of profit, and easing the burden borne by the population are highlighted. The parallel development of Chinese and Western medicine and the use of Chinese and Western medicines are proclaimed. Particular importance is attached to healthcare in the countryside and at the communal level in cities. The creation of non-state medical institutions is also encouraged.

The government intends to use the increase in health care spending primarily through subsidies to the population covered by the insurance system, rather than increasing investment in public health care institutions. Thus, a course towards the development of the medical services market was proclaimed.

Problem reforming the health insurance system Also, in recent years, a period of major decisions has passed.

The basic health insurance system today covers mainly urban population of China . In 2007, 223.11 million people participated in the basic health insurance program. urban population, which is 65.79 million more people than in 2006. However, despite this impressive growth rate, this figure represents only 37.6% of China's total urban population in 2007.

An experiment is currently underway to introduce a basic health insurance system for the unemployed urban population. As part of this program, it is expected to allocate at least 40 yuan per year per person.

Regarding health insurance rural population , then this aspect deserves special attention. During the entire period of the “reform and opening up” policy, the rural population (most of whom were more than strapped for money) had practically no equal access to medical services with urban residents.

In order to eliminate this state of affairs, China began an experiment in 2003 to introduce a cooperative health insurance system in rural areas. Under the new system, each peasant pays 10 yuan to the medical care fund. The central and local authorities contribute the same amount for it. When a peasant is forced to seek medical help, part of the cost of treatment is paid from the fund. Since 2008, this system has officially extended to all villages in China.

The number of rural population covered by the basic health insurance system in 2007 was 31.31 million people, which is an increase of 7.64 million people. more than in 2006. This represents only 4.3% of the total rural population. At the same time, by the end of 2007, the cooperative health care system covered 730 million people, or almost 90% of the rural population. However, the system suffers from a lack of funds and is unable to support villagers in cases of serious illness that require hospital treatment. Within the framework of the new five-year plan (2006-2010), it is planned to create a “socialist village” in the PRC. 30 billion yuan ($3.8 billion) will be allocated for rural healthcare needs.

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No matter how great the achievements of traditional Chinese medicine were, for centuries they were available only to the elite. By the beginning of the formation of the People's Republic of China in 1949, the average life expectancy was 35 years, and out of five people born, one died... The situation changed with the beginning of the reign of Mao Zedong. And over the past 60 years, Chinese healthcare has experienced rapid and at the same time extremely interesting development.

Not by days, but by hours

Already in the early 1950s, an extensive system of public medical care, following the Soviet model and with enormous help from the USSR, began to be built at an incredible pace. Semashko’s healthcare model then turned out to be the only correct way to organize healthcare in a country with a huge population and territory.

Hospitals of various levels, the first medical institutes and schools for training nurses and paramedics began to appear in cities. In rural areas, a three-stage network began to be introduced at the county, volost and village levels. Central district hospitals were organized in the districts, volost outpatient clinics were organized in the volosts, and first-aid posts were organized in the villages, as well as at industrial enterprises.

But if the treatment of workers, office workers and military personnel was carried out at the expense of the state, then the leadership of the PRC was forced to leave medical care in rural areas paid for. The paramedic in such health posts was usually from the same village, selected by the authorities for his literacy and completed short-term training courses. You could pay him not only with small coins, but also with a chicken carcass, or... not pay at all if they were the poorest of your fellow villagers. And if the health center was located in the so-called administrative villages, the sanitary and epidemiological station and the “mother and child health care center” were located in the same building.

What fruits could this primitive healthcare created in just 10 years bring, where there was one specialist for thousands of village paramedics and midwives? The fruits, however, were unprecedented in the history of global health, and which in 2010 remain inaccessible not only to the poorest countries in Africa, but even to India, a country as rapidly developing as China.

By the mid-1960s, 80% of China's rural and more than 90% of its urban population had access to a network of medical facilities. Life expectancy has exceeded 50 years, children's life expectancy has dropped from 200 per 1000 births to 30. China became one of the first countries in the world to eradicate a number of infectious diseases, in particular smallpox.

In addition to protecting health, this system ensured economic development and social stability, and turned out to be so strong that it withstood two severe blows, which fell mainly on the qualified medical care sector. In the spring of 1960, the “great friendship” of the USSR and the PRC cracked, thousands of Soviet doctors and medical university teachers left the country. And six years later the tragic decade of the Cultural Revolution began. Thousands of intellectuals, including those in white coats, went to communes for re-education.

Give me capitalist medicine!

In the thirty years that have passed from the beginning of Deng Xiaoping's reforms in 1976 to the Fifth Plenum of the CPC Central Committee, which divided the Chinese "perestroika" into two periods, the health care of this country has gone through an unusually complex and interesting time to study. The new leaders overestimated the role of market relations in the development of healthcare, and it has largely degraded compared to the Mao era. However, in others things have gone forward.

In 2005, the country's health insurance system covered less than 50% of half the urban population and only 10% of the rural population. Budget expenditures on medicine fell from 2.5-3% in different years of Mao's reign to 1.7. As a result, in 2004, the state accounted for only 17% of national spending on medicine, enterprises and social institutions - 29%, and citizens - 54%. The average costs of citizens for treatment increased incomparably faster than their income. During the period not even from 1976, but from 1990 to 2004, they increased more than 10 times!

By the way, even today the high cost of treatment and medicine occupies a prominent place among other social problems in China. Medical expenses eat up about 12% of the family budget, second only to food expenses. The average cost of treating a serious illness is now about $1,000, the average monthly income of a worker is $250, and that of a peasant is three times less.

So, the reformers hoped in vain that the state would be able to ensure the development of this industry by lowering taxes everywhere, at the same time reducing its spending on healthcare and opening the doors to entrepreneurs. Business rushed into the industry of medicines and medical products, and in real healthcare it came up against the effective demand of the population for medical services. In their national volume in 2006, the private sector occupied less than 5%, and even today this figure has grown by only a few percent, with the lion's share of commercial healthcare being institutions and private practitioners of traditional Chinese medicine.

In 2005, sociologist Yang Tuan, an employee of the Chinese Academy of Social Sciences, wrote: “After the distribution of land plots among peasant families, their income increased, but the lack of a social safety net and government allocations for the development of public welfare led peasants to return to an isolated lifestyle. Many government institutions, such as rural schools, medical centers, and nursing homes, are in ruins. China has not invested in the health sector for two decades, relying on people to pay for themselves. Today, the WHO puts China on. "Only Brazil, Burma and Sierra Leone are behind us in a list of 190 countries for equal access to health care," a result the government rightly described as "disgraceful" in one of its official studies."

Address neoliberal biases

And yet, the average life expectancy of the Chinese increased to 70 years by 2005, not only due to the fact that, thanks to the takeoff of the economy, poverty and malnutrition for the vast majority of the population was replaced by poverty, and for some, modest income. The quality of medical services has increased, including in rural areas. Since 2003, a new mechanism for cooperative medical care has been launched for peasants. And the health insurance system for city residents working in state-owned enterprises has advanced compared to the Mao era. And although some businessmen shied away from the obligation to provide their employees with health insurance, a significant portion of those employed in the commercial sector also received it. The formation of national medical science began. The country was already fully self-sufficient in healthcare personnel. A small stratum of the wealthiest citizens received access to high-tech medical care in China.

Launched in 2005, after the Fifth Plenum of the CPC Central Committee, health care reform was designed to preserve the best that had been achieved while at the same time eliminating “neoliberal distortions.”

Die

The Fifth Plenum of the CPC Central Committee, which determined the main guidelines for the Eleventh Five-Year Plan (2006-2010) in terms of economics and social development, was truly a turning point in the implementation of Chinese transformations. The transition from the concept of enrichment put forward by Deng Xiaoping to the slogan of shared prosperity began, that is, the idea of greater social equality began to materialize. The obsession with economic growth rates has given way to the doctrine of sustainable development for the sake of improving the quality of life. The goal was to strengthen social security in order to prevent distortions in economic and social development.

And in the 5 years since that plenum, China has begun to rebuild and improve its healthcare just as decisively and rapidly as in the early 1950s. Budget expenditures on it doubled, exceeding 3% of GDP. The number of newly opened village hospitals and medical posts was measured in the thousands, and the number of county hospitals in the hundreds. Each year, more than 100,000 rural paramedics and nurses attended medical qualification courses.

And many such impressive figures can be cited. We will clarify the main ones. Average life expectancy last year was 72.3 years. Of China's 1.3 billion population in 2009, 63% of city residents and 85% of peasants were provided with health insurance. And in the second decade of the 21st century, China has ambitious plans to create an unprecedented health insurance system on an unprecedented scale.

Breadth is great, but depth?

In October 2008 The Chinese government has submitted for public discussion a draft of a new stage of medical reforms, which was approved by the State Council early last year. Let us clarify the key goals of the project: to ensure medical insurance coverage for 90% of the population by 2011; create a powerful pharmaceutical industry, not only of generics, but also of innovative drugs; improve the infrastructure of primary basic health care. They decided to allocate $125 billion for the implementation of these plans, and so far the investments are going exactly according to schedule.

But by 2020, China plans not only to provide 100% of the population with basic medical care, mainly on the basis of budget funding, but also to introduce a multi-level health insurance system. That is, it is expected that a significant part of the Chinese people (planned figures are not specified) by the beginning of the 2030s will also be provided with insurance that covers qualified treatment of most diseases, in other words, the kind that is common in developed countries.

Let us remind you that there are currently 3 main health insurance programs in China. Two of them, namely the rural cooperative medical insurance scheme (RCMIS) and the basic medical insurance scheme (BMI) guarantee only basic outpatient and inpatient treatment.

But since 2007, the urban resident medical insurance scheme (URMIS) has also been operational, already close to medical “European standards” and providing treatment for most diseases not covered by the BMI policy. In 2007 41 million people were holders of such policies, and by the beginning of 2010. already more than 300 million. If we add to this the wealthy Chinese who do not have insurance, but pay for high-quality treatment from time to time, then we can cautiously assume that a third of the country’s population today already has access, if not to high-tech, but to high-quality specialized medical care.

So, in 10 years will China be able to catch up with developed countries in terms of the state of its healthcare and the level of health of its citizens? The medical sector of China, like the entire Celestial Empire, still remains a country of contrasts, where well-equipped clinics coexist with the house of a village “fershal” from the stories of A.P. Chekhov, entering which the village priest was baptized on a bottle of carbolic acid.... But along with poverty becoming a thing of the past, China's healthcare also has the brilliance of an offensive impulse, precision in the best Western achievements and the ability to weave them with the experience of traditional folk medicine. In short, I want to believe that the Chinese people will be able to implement their plans.

From a historical perspective, Chinese medicine was ahead of Western medicine in some respects. Already more than two thousand years ago, during the reign of the dynasty of the “Spring and Autumn Periods” (770-476 BC) and the “Warring Empires” (475-221 BC), there was a record in China work on medicine, book “Nei Ching”. Works of the Greek physician Hippocrates, who lived in 446-377. BC, who is considered the father of Western medicine, belong to a later time. The Nei Ching can therefore be considered the world's oldest work on medicine. It summarizes the practical medical experience accumulated by previous generations of Chinese doctors, substantiates the theoretical taxonomy of the traditional art of healing in China, and conveys the basics of Chinese medicinal therapy, as well as acupuncture, moxibustion, and acupuncture*.

When comparing the medicine of China and Western countries, some other priorities of Chinese medicine are revealed. These include the use of narcotic drugs to achieve complete anesthesia during abdominal and other types of surgery by the Chinese surgeon and acupuncturist Hua Tuo more than seventeen hundred years ago. Hua Tuo, who lived from 112 to 207 AD, used the famous Ma Fei San tea mixture for anesthesia during his daring operations. The physician Zhang Zhuangqing (150-219 AD) already wrote at that time his work “Consideration of various diseases caused by exposure to cold,” in which issues of special dialectical diagnosis of Chinese medicine are developed, which have retained their significance to this day. This occurred during the lifetime of the Greco-Roman physician Galen (129-199 AD), who laid down a fundamental and extensive teaching in the field of medicine that remained binding on Western doctors until the end of the Middle Ages.

Another significant milestone in the history of Chinese medicine is the publication of the pharmaceutical collection Ben-Jiao Gan-Mu by Li Shizhen in 1578. In total, more than six thousand Chinese books on medicine have reached us, which tell about various methods of treatment and which serve Chinese doctors to this day as reference materials.

In general, Chinese medicine had a great influence on the development of medicine in other countries, using for its part many ideas of foreign medical science. Already during the Qing (221-26 BC) and Han (206 BC - 220 AD) dynasties, there was an exchange of medical knowledge between China, Korea, Vietnam and Japan, which was subsequently extended to the Arab world, Russia and Turkey. The Chinese book on medicinal therapy, Ben-Jiao Gan-Mu, which had normative significance, was translated into many languages, including Latin, Korean, Japanese, Russian, English and French, and became widespread in the Western world.

Under the influence of Western colonial powers, the decline of traditional medicine in China began in the mid-19th century. The country's ruling elite began to give preference to Western medicine; Traditional Chinese medicine was discriminated against as primitive and backward and began to decline. Things came to a real suppression of Chinese medicine under the Kuomintang government (1912-1949). Only after Mao Zedong came to power there was a revival of traditional medicine, which again brought it worldwide recognition. Currently, the PRC recognizes that the future of Chinese medicine lies in the combination of traditional Chinese and modern Western techniques.

Chinese medicine originally consisted of four disciplines. Thus, in the era from the Yin dynasty (1324-1066 BC) to the Zhou dynasty (1066-1221 BC), differences existed between nutrition (Yin-yang-i), medical medicine (Nei -ge), external medicine or surgery (Wai-ga) and veterinary medicine (Shou-i). During the period from the Tang Dynasty (618-907) to the Song Dynasty (960-1279), Chinese medicine received further divisions. 11 different trends emerged:

Health care for adults (Da-feng-mai).
General medicine (Tse-i).
Pediatrics (Hao-feng-mai).
Treatment of paralysis (Feng-ga).
Gynecology (Fu-ge).
Ophthalmology (Yang-ge).
Dentistry (Gou-qi).
Treatment of diseases of the pharynx and larynx (Yan-hou).
Orthopedics (Zhen-gu).
External diseases and surgery (Jin-zhuang).
Acupuncture and moxibustion method, or acupuncture
(Zhen-ju).

Currently, Chinese medicine is divided into nine specialized fields: internal medicine, external medicine, gynecology, pediatrics, ophthalmology, laryngology, orthopedics, massage and acupuncture. Each of these areas covers a large body of knowledge that should be studied specifically as a medical specialty. The only one of these that has become known in the West is acupuncture and moxibustion, “acupuncture.” All of these different specialty areas share a common theoretical basis, which is presented comprehensively for Western physicians for the first time in this book.

Along with the prescription of special medications and the use of acupuncture, Chinese medicine knows the following methods of influence, which are used according to indications in various fields of medicine:

Scraping massage, for example, using a coin (Hua Sha).
Pasting medicines onto the skin (Bo-di).
Banks (Hua-guan).
Injecting medications into the skin by ironing (Yun Fa).
Hydrotherapy (similar to our Kneipp therapy)
(Shui-lao).
Balneotherapy (Yu-fa).
Treatment with medicinal vapors and smokes (Hun-zheng).
Applying beeswax dressings (La-lao).
Dirt (Nee-leo).
Therapeutic gymnastics (Tao-yin).
Massage (Duy-na).
Chinese breathing therapy (Qi gong).
Spinal pinch therapy (mainly in children)
(Nee-zhi).
Skin incisions (Ga-zhi).

Various methods are currently being widely used in medical practice in China and are being improved whenever possible.

When looking for typical features that distinguish Chinese medicine from modern Western medicine, you come across two decisive factors:

Consideration of a person as a single whole (Zhen-di).
Dialectical diagnosis and treatment depending on syndromes (Bin-zheng)*.

Chinese medicine views a person as an organic whole, in which the central place is occupied by storage and hollow organs (Jiang-fu), and internal communications are provided by channels (meridians) and neighboring vessels (Chin-luo). All phenomena of the surrounding world, including humans and nature, are interpreted by Chinese medicine as an interaction between the two principles of yin and yang, representing different aspects of a single reality. The occurrence and development of disease is considered by Chinese medicine as the result of a struggle between the body's defenses (Zheng) and the disease-causing disorder (Ha), as a manifestation of imbalance between yin and yang, or as a result of internal causes existing within the human body. Thus, in the Su-wen part of the book “Nei-ching” it is said: “Where the disease-causing disorder (Ha) penetrates, there is definitely a lack of qi (functional principle, “energy”).”

And in addition to the same part of Su-wen we read: “Where the protective forces (Zheng) are located, the disease-causing disorder (He) does not penetrate.”

When treating diseases, Chinese medicine pays the greatest attention to prevention. In this regard, today, as thousands of years ago, the principle of “treating the patient before the disease occurs” is applied. The basic rule of treatment is “elimination of the cause of the disease (Ben).” Therapeutic rules also include treating the patient with strict consideration of his individual predisposition, geographic location and time of year.

A Holistic Approach to Phenomena Analysis

The holistic approach to the analysis of phenomena characteristic of Chinese medicine is based primarily on two factors:

Consideration of the human body as an organically unified whole.
Recognition of the integrity of the relationship between a person and
nature.

The human body as an organic whole

Chinese medicine proceeds from the fact that various parts of the human body are in close organic relationship with each other. The center of this organic whole is located in the five dense organs, the relationships of which to other parts of the body are established through a system of channels (Chin-luo), which, according to traditional Chinese ideas, includes blood vessels and nerve pathways. The action of the channel system is manifested in the interaction between individual solid and hollow organs and in the exchange between internal organs and other parts of the body.

Preventive medicine in Ancient China

The strength of ancient Chinese medicine was the prevention of disease. Even in the treatise “Nei Jing” it was noted: “The tasks of medicine are to heal the sick and improve the health of the healthy.”

For a long time, important therapeutic and preventive measures in ancient China were massage, therapeutic gymnastics at xing or (translated from Chinese - the game of five animals), based on imitation of a stork, monkey, deer, tiger and bear, breathing exercises, which were used among the people to maintain health and achieve longevity.

Chinese chronicles report the improvement of ancient cities from the middle of the 1st millennium BC. e. (pavements, sewerage, water supply). There is evidence of the widespread introduction of variolation to prevent smallpox. So, according to legend, in the 12th century. BC e. During the smallpox epidemic, Chinese healers tried to prevent the spread of the disease by rubbing crusts of smallpox pustules into the nostrils of healthy children (for girls in the right nostril, and for boys in the left).

Medicinal healing and surgical treatment in Ancient China

Medicinal healing in ancient China reached high perfection. From traditional Chinese medicine they have entered world practice: from plants - ginseng, lemongrass, camphor, tea, rhubarb, resin; from products of animal origin - deer antlers, liver, gelatin; from mineral substances - iron, mercury, sulfur, etc. In 502, the first Chinese pharmacopoeia known in the world was created, in seven books of which 730 species of medicinal plants are described. In ancient China, there were institutions that today are called pharmacies.

Nevertheless, everyone who reached. Our works on medicines were compiled not in ancient (slave-owning) China, but in feudal China, that is, during the Middle Ages - a time of rapid flowering of traditional Chinese culture and medicine.

The first special medical schools also appeared in China only in the Middle Ages (from the 6th century). Until this time, knowledge about traditional healing was passed down by inheritance or in a narrow circle of initiates.

The development of surgical treatment in ancient China (as well as the dissection of human corpses) was constrained. not affected by religious prohibitions that arose in the last centuries BC. e. in connection with the establishment of Confucianism.

Hua Guo is considered the greatest surgeon of ancient China. (141--208), who became famous as a skilled diagnostician and expert in Zhen-Jiu therapy. He successfully treated fractures and performed operations on the skull, chest and abdominal cavities. One of the ancient Chinese books describes a case of recovery of a patient from whom Hua Tuo removed part of the spleen. For pain relief during operations, Hua Tuo used mafusan, mandrake, and also the method of acupuncture, achieving the desired result by introducing one or two needles.